欧洲营养不良风险调查方法在中国住院患者的临床可行性研究

目的检验营养不良风险调查(NRS)判定住院患者营养不良及是否需要营养支持的方法在国内的可行性。方法153例新住院患者参加本研究。入院后首先评估是否符合NRS评定条件,符合者第2天早晨进行评定;对不符合入组条件者检查血清白蛋白(sALB),按中国人正常值sALB<35g/L判定为营养不良。体质指数(BMI)采用中国标准,<18.5kg/m2判定为营养不良。NRS方法(欧洲肠内肠外营养学会2002年发布)由体质指数、近期体重变化、膳食摄入、疾病严重程度等4方面构成,其总评分≥3分判定为需要营养支持。结果139例新住院患者可用NRS评定,营养不良BMI<18.5kg/m2者占15.5%。全部对象的总评分≥3分者33.8%。不宜用NRS评定者14例,因无法站立者9例,胸、腹水者5例。此14例均测sALB,营养不良sALB<35g/L者5例(35.7%)。结论结合中国BMI正常值应用NRS来评定营养不良及判断是否需要营养支持是可行的。对因无法站立等原因而无法准确用NRS者,建议参考sALB<35g/L来判定有无营养不良。更大范围的临床实践有待进一步进行。     

浙江省住院患者营养风险筛查及营养支持状况分析

<正>营养不良是指因能量、蛋白质及其他营养素缺乏或应用过度,导致患者机体功能乃至临床结局发生不良影响[1]。但通常营养不良是指营养不足即蛋白质-能量营养不良(PEM)。住院患者发生营养不良会导致多种不良临床结局。国内有许多     

Socioeconomic Risk Factors of Poor Nutritional Status in Polish Elderly Population: The Results of PolSenior2 Study

Poor nutritional status (PNS) threatens successful aging. Identifying potentially modifiable predictors of PNS is essential for elaborating a preventive strategy for the population at risk. To assess the prevalence of PNS in the Polish elderly population and analyze its socioeconomic correlates based on the data from the nationwide PolSenior2 project. Special emphasis was put on potentially modifiable factors among the identified PNS predictors. Nutritional status was assessed in 5698 community-dwelling older adults with the Mini Nutritional Assessment–Short Form. We evaluated the effect of age, sex, level of education, marital status, place of residence, subjective loneliness, and self-reported poverty on the nutritional status of the studied subjects. PNS was found in 25.3% of studied subjects (27.7% women and 21.9% men; p < 0.001). Female sex, older age, unmarried status (in men), subjective loneliness, and self-reported poverty were independent correlates of PNS. The two last above-mentioned predictors were identified as potentially modifiable. Based on our results, we recommend preventive interventions (e.g., performing regular screening), particularly in unmarried (men), poorly educated individuals, self-reporting poverty, complaining of loneliness, and the oldest old. PNS preventive strategies should include social support (both emotional and instrumental) to reduce the effect of poverty and subjective loneliness.     

Nutritional Status in Sick Children and Adolescents Is Not Accurately Reflected by BMI-SDS

Objective: Nutritional status provides helpful information of disease severity and treatment effectiveness. Body mass index standard deviation scores (BMI-SDS) provide an approximation of body composition and thus are frequently used to classify nutritional status of sick children and adolescents. However, the accuracy of estimating body composition in this population using BMI-SDS has not been assessed. Thus, this study aims to evaluate the accuracy of nutritional status classification in sick infants and adolescents using BMI-SDS, upon comparison to classification using percentage body fat (%BF) reference charts.

Design: BMI-SDS was calculated from anthropometric measurements and %BF was measured using dual-energy x-ray absorptiometry (DXA) for 393 sick children and adolescents (5 months–18 years). Subjects were classified by nutritional status (underweight, normal weight, overweight, and obese), using 2 methods: (1) BMI-SDS, based on age- and gender-specific percentiles, and (2) %BF reference charts (standard). Linear regression and a correlation analysis were conducted to compare agreement between both methods of nutritional status classification. %BF reference value comparisons were also made between 3 independent sources based on German, Canadian, and American study populations.

Results: Correlation between nutritional status classification by BMI-SDS and %BF agreed moderately (r ² = 0.75, 0.76 in boys and girls, respectively). The misclassification of nutritional status in sick children and adolescents using BMI-SDS was 27% when using German %BF references. Similar rates observed when using Canadian and American %BF references (24% and 23%, respectively).

Conclusions: Using BMI-SDS to determine nutritional status in a sick population is not considered an appropriate clinical tool for identifying individual underweight or overweight children or adolescents. However, BMI-SDS may be appropriate for longitudinal measurements or for screening purposes in large field studies. When accurate nutritional status classification of a sick patient is needed for clinical purposes, nutritional status will be assessed more accurately using methods that accurately measure %BF, such as DXA.     

Survival and Nutritional Status of Male and Female Heart Transplant Patients Based on the Nutritional Risk Index

Malnutrition among heart-transplant patients may affect survival. The aim was to investigate the survival and nutrition status among male and female heart transplant patients who underwent transplantation, before and 1 year after surgery based on the nutritional risk index (NRI). The medical records of ninety heart-transplant patients (2009–2014) from the King Faisal Specialist Hospital, Riyadh, were reviewed. The assessment included demographic data, anthropometric measurements, and NRI calculation. Moreover, postoperative data included the length of stay and survival. Paired t-test and survival analysis by Kaplan–Meier (KM) curves were used. A total of 90 patients (males 77.78%) were included. The prevalence of malnutrition in the preoperative phase by NRI was 60% (7.78% as severe; 40% as moderate, and 12.22% mild NRI scores). After 1 year, body mass index (BMI) and NRI increased significantly (p < 0.001). Furthermore, NRI was significantly different between men and women (p < 0.01), while KM survival curves were insignificantly different (p = 0.67). Recipients with postoperative moderate or severe nutritional risk (NRI < 97.5) had significantly shorter survival in the first-year post-transplantation (HR = 0.82; 95% CI, 0.75–0.89; p < 0.001). Our findings indicate that the NRI after 1 year of transplant correlated significantly with mortality. Besides, there was no significant gender difference regarding survival; however, malnutrition and low survival were more prominent among women.     

学龄前儿童营养状况及影响因素调查

十几年来，随着我国社会经济状况的好转，严重营养不良的患病率已明显下降，但还未达到“最佳”状态。本研究旨在了解本地区学龄前儿童营养不良的危险因素，为进一步防治营养不良提供理论依据。     

应用人体成分分析仪评价COPD住院患者营养状况

营养不良是多数慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者预后不良的危险因素,且随病情发展程度会逐渐加重,导致治疗时间延长,病死率增加.因此,评价COPD患者营养状况尤为重要.生物电阻抗法(bioelectrical impedance analysis,BIA)是目前应用前景较好的营养状况检查方法,本研究用该Inbody-S20人体成分分析仪测量本院61例COPD住院患者的体质成分并进行营养状况评价.     

Multilevel Analysis of the Nutritional and Health Status among Children and Adolescents in Eastern China

We aimed to identify multiple nutritional health problems and the relevant factors among children and adolescents aged 7–17 years. This study was part of the China Nutrition and Health Surveillance of Children and Lactating Mothers in 2016–2017, conducted in Jiangsu Province in eastern China. After sampling, 3025 school-age children and adolescents were enrolled into this study. Demographic information collections and anthropometric measurements were conducted by trained local Center for Disease Control and Prevention (CDC) staff. Venous blood in the amount of 6 mL was drawn from each participant in the morning and used for testing biochemical and nutritional indicators. Multivariate logistic regression analysis and Poisson regression analysis were used for overnutrition- and undernutrition-related disorders to test relevant personal, parental, and household factors. The prevalence of wasting, overweight, and obesity was 5.5%, 14.8%, and 12.7%, respectively. Metabolic syndrome (MetS) was prevalent among 5.1% of participants. Among the study participants, 29.5% had hyperuricemia. The overall prevalence of high low-density lipoprotein (LDL) and high total cholesterol (TC) of all participants was 4.8% and 7.4%, respectively. 0.9% of the participants had vitamin A deficiency (VAD) and 14.6% had marginal vitamin A deficiency; 25.1% had vitamin D deficiency (VDD) and 54.5% had inadequate vitamin D levels. Anemia was present in 4.0% of all participants. The prevalence of zinc deficiency was 4.8%. Demographic characteristics, behavioral characteristics, parents’ characteristics, and family characteristics were associated with these multiple malnutrition disorders. The double burdens of malnutrition, which includes overnutrition- and undernutrition-related diseases, were prevalent among the school-age children and adolescents in Jiangsu Province in eastern China. There were various factors related to different nutritional problems. Thus, health education focusing on behavior intervention and nutrition education are necessary in containing nutritional problems among children.     

Effects of Two Different Levels of Dietary Protein on Body Composition and Protein Nutritional Status of Growing Rats

This study aimed to investigate the effect of a high-protein diet on growth, body composition, and protein nutritional status of young rats. Newly-weaned Wistar rats, weighing 45–50 g, were distributed in two experimental groups, according to their diets, which contained 12% (G12) or 26% protein (G26), over a period of 3 weeks. The animals were euthanized at the end of this period and the following analyses were performed: chemical composition of the carcass, proteoglycan synthesis, IGF-I concentration (serum, muscle and cartilage), total tissue RNA, protein concentration (muscle and cartilage) and protein synthesis (muscle and cartilage). The high-protein diet was found to result in a higher fat-free mass and lower fat mass in the carcass, with no difference in growth or protein nutritional status.     

Differentiation of the Nutritional Risk of Polish Elderly People According to Selected Demographic Characteristics and Declared Socioeconomic Status

Nutritional risk screening in older people can help to not only identify health risks but also to treat them effectively. The aim of this work was to assess the relationship between the demographic characteristics (age, gender and place of residence) and socioeconomic status of older people in the community and nutritional risk. The Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN-14) questionnaire was used to evaluate the nutritional risk. The study was conducted in 417 people (312 women and 105 men) between 60 and 95 years old (70.8 ± 6.73 years). Multivariate correspondence analysis (MCA) was used to determine the relationships between the categories of variables describing the level of nutritional risk, demographic characteristics and the value of the socioeconomic status (SES) index. To assess the relationship between identified nutritional risks, demographics and SES index variables, we used logistic regression analysis. Based on these studies, nutritional risk factors for older people in Poland were identified. It has been shown that larger cities and low socioeconomic status are closely linked to higher nutritional risk. At the same time, age and gender were not significant factors influencing nutritional risk. Identifying the factors that increase the nutritional risk of older people can help to improve their quality of life.     

DeltaF508 CFTR Hetero- and Homozygous Paediatric Patients with Cystic Fibrosis Do Not Differ with Regard to Nutritional Status

The purpose of this study was to compare the nutritional status between deltaF508 CFTR hetero- and homozygous paediatric patients with cystic fibrosis. We assessed the percentage profiles of fatty acids measured in erythrocyte membranes and the serum levels of vitamins A, D3, E and K1 in the studied groups. We also measured the weights and heights and calculated the body mass indexes (BMIs). The studied groups consisted of 34 heterozygous and 30 homozygous patients. No statistically significant differences were found in the serum vitamins or erythrocyte membrane fatty acid profiles between the hetero- and homozygous patient groups, except for heptadecanoic acid (p = 0.038). The mean percentiles of height, weight and BMI did not differ significantly between the two groups. The homozygous and heterozygous paediatric patients with cystic fibrosis were similar in terms of their nutritional statuses.     

头颈胸部恶性肿瘤92例营养状况分析

目的 横断面调查头颈胸部肿瘤患者的营养状况,为临床营养治疗提供依据.方法 采用主观全面评价法(SGA)对92例头颈胸部恶性肿瘤患者进行营养调查,并测定生化指标、人体测量指标及人体成分指标.结果 92例头颈胸部恶性肿瘤患者SGA评定营养不良的发生率为29.4％,不同肿瘤类型及临床分期营养不良的发生率也不同,分别为22.7％ ～ 37.5％和11.1％ ～38.5％;SGA与多数传统营养指标之间有相关性(r=0.212 ～0.422,P＜0.05);生化、人体测量及人体成分指标比较,除淋巴细胞总数及细胞外水无差异外,营养不良组水肿指数高于营养正常组(P＜0.05),其他指标均低于营养正常组(P＜0.05).结论 恶性肿瘤患者存在一定程度的营养不良,应结合多种指标早期持续地监测恶性肿瘤患者的营养状况,从而制定相应的营养治疗方案.     

Sarcopenia,Obesity, Sarcopenic Obesity and Risk of Poor Nutritional Status in Polish Community-Dwelling Older People Aged 60 Years and Over

Poor nutritional status (PNS) is a modifiable factor determining abnormalities in body composition-sarcopenia, obesity, and sarcopenic obesity (SO). We aimed to assess the prevalence of these conditions and their association with PNS in 211 community-dwelling older adults. Sarcopenia was diagnosed based on the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) recommendations. Obesity was diagnosed with the Percent Body Fat (>42% in women and >30% in men). Subjects fulfilling the criteria for obesity and concomitantly with reduced lower and/or upper limbs muscle strength and muscle mass (ALM/BMI < 0.512 in women and <0.789 in men) were classified as SO phenotype. Participants without obesity and sarcopenia were categorized as ‘normal’ phenotype. Nutritional status was estimated with the Mini Nutritional Assessment, and a score of <24 indicated PNS. In total, 49.8% participants had abnormal body composition (60.7% men and 42.5% women; p = 0.001). Sarcopenia, obesity, and SO were diagnosed in 10%, 32.7%, and 7.1% of subjects. PNS was found in 31.3% of the study sample. Its prevalence differed between phenotypes: 81% in sarcopenia, 60% in SO, 14.5% in obesity, and 28.3% in the ‘normal’ phenotype group (p = 0.000). Based on the results, abnormal body composition is prevalent in elderly subjects. Sarcopenia and SO are often associated with PNS.     

Associations of Overall Survival with Geriatric Nutritional Risk Index in Patients with Advanced Pancreatic Cancer

Nutritional assessment is critical in cancer care to maintain quality of life and improve survival. The Geriatric Nutritional Risk Index (GNRI) may be a practical tool to assess nutritional status and predict survival. This study aimed to examine survival using GNRI in advanced-stage pancreatic cancer (PC). The retrospective analysis used data of patients with stage III or IV PC. Inclusion criteria: age > 18 and hospital admission for at least three days at or following diagnosis between 2014 and 2017. Data collected: demographics, albumin levels, BMI and weight. Days between the first and last admission, median survival and GNRI scores calculated. Patients categorized into groups: any nutritional risk (GNRI ≤ 98) and no nutritional risk (GNRI > 98). 102 patients had a median survival of 87.5 days and mean GNRI of 98.7. Patients surviving longer than 90 days showed higher mean weight (p = 0.0128), albumin (p = 0.0002) and BMI (p = 0.0717) at the first admission. Mean survival days for patients at any nutritional risk were 110 days compared to 310 days for no nutritional risk (p = 0.0002). GNRI score at first admission after diagnosis is associated with survival. It is vital to monitor nutritional status using weight and albumin to promote increased survival from diagnosis.     

Serum Biomarkers Associated with Malnutrition and Nutritional Risk in Elderly Primary Care Patients: A Cross-sectional Study from Bosnia and Herzegovina

BackgroundThe aim of the study was to determine the ability of ferritin, haemoglobin, albumin and total cholesterol to identify nutritional risk and malnutrition among elderly primary care patients.MethodsThe cross-sectional study included 446 elderly adults over 65 years of age from four areas of Bosnia and Herzegovina. In addition to anthropometric, functional, cognitive and biochemical indicators, nutritional status was evaluated using 24-hour recall of meals, the Mini Nutritional Assessment (MNA), and Seniors in the Community: Risk Evaluation for Eating and Nutrition, Version II (SCREEN II).ResultsMalnourished/at-risk study respondents had lower mean levels of haemoglobin (P=0.001) and total cholesterol (P<0.001), compared to those with normal nutritional status. Albumin levels significantly differed regarding nutritional status (P=0.004), but not nutritional risk level (P=0.521). Significant differences in serum ferritin levels were not found between malnourished and normally nourished study respondents (P=0.779) Determinants of albumin level were eating more than three meals a day (P<0.001), fewer than two portions of fruit and vegetables a day (P=0.024), drinking one glass of wine (P<0.001) and reporting functional independence (P=0.011). The AUC curves for serum ferritin, albumin and total cholesterol levels in men and women, as well as for haemoglobin levels in women, were poor to fair (AUC<0.800).ConclusionAlthough ferritin, haemoglobin, albumin and total cholesterol may be useful biomarkers of nutritional status, their accuracy in diagnosing malnutrition and nutritional risk among elderly primary health care patients is limited.     

Assessment of Intramuscular Fat and Correlation with Body Composition in Patients with Rheumatoid Arthritis and Spondyloarthritis: A Pilot Study

Rheumatoid arthritis (RA) and spondyloarthritis (SpA) are associated with changes in body composition. Ectopic intramuscular fat (IMAT) may alter muscle function and contribute to cardiometabolic disorders. In a pilot study, we analyzed IMAT in the calf with peripheral quantitative computed tomography (pQCT) and examined correlations between IMAT quantity and body composition parameters. In 20 patients with active RA and 23 with active SpA, IMAT was correlated with visceral fat (VAT; r = 0.5143 and 0.6314, respectively; p < 0.05) and total lean mass (r = 0.5414 and 0.8132, respectively; p < 0.05), but not with whole body fat mass. Total lean mass mediated 16% and 33% of the effects of VAT on IMAT in RA and SpA, respectively. In both RA and SpA, calf muscle area was correlated with total lean mass (r = 0.5940 and r = 0.8597, respectively; p < 0.05) and fat area was correlated with total body fat (r = 0.6767 and 0.5089, respectively; p < 0.05) and subcutaneous fat (r = 0.6526 and 0.5524, respectively; p < 0.05). Fat area was inversely correlated with handgrip and walking tests, and it was associated with disease activity and disability. We showed that ectopic IMAT, measured with pQCT, was correlated with VAT, but not with total body fat, in RA and SpA. This result suggests that metabolically active fat was specifically associated with IMAT.     

The Nutritional Status of Individuals Adopted Internationally as Children: A Systematic Review

Since 1955, international adoption has been a way of finding homes for children who have been orphaned or abandoned. We aimed to describe the nutritional status of individuals adopted internationally and their long-term nutritional and health outcomes. We searched four databases for articles published from January 1995 to June 2020, which included information on anthropometric or micronutrient status of children adopted internationally (CAI). Mean Z-scores on arrival to adoptive country ranged from −2.04 to −0.31 for weight for age; −0.94 to 0.39 for weight for height; −0.7 to 0 for body mass index; −1.89 to −0.03 for height for age; −1.43 to 0.80 for head circumference for age. Older children, those adopted from institutionalized care or with underlying disability, were more likely to be malnourished. Though long-term data was scarce, mean Z-scores post-adoption ranged from −0.59 to 0.53 for weight for age; −0.31 to 1.04 for weight for height; 0.39 to 1.04 for body mass index; −1.09 to 0.58 for height for age; −0.06 to 1.23 for head circumference for age. We conclude that though CAI are at high risk of malnutrition at baseline, marked catch-up growth is possible, including for those older than two years of age on arrival. This has implications not only for CAI but for the wider population of malnourished children worldwide. Research on how to optimize catch-up growth is a priority.     

Lower Geriatric Nutritional Risk Index (GNRI) Is Associated with Higher Risk of Fractures in Patients Undergoing Hemodialysis

Background: Although malnutrition and bone fracture are both major complications in patients undergoing hemodialysis, their association has not been clarified. The aim of our study was to clarify the association between the geriatric nutritional risk index (GNRI), an indicator of nutritional status, and the incidence of bone fractures in patients undergoing hemodialysis. Methods: We included 1342 registered patients undergoing hemodialysis and performed a post hoc analysis. We divided patients into the high GNRI group (≥92), considered to have a low risk of malnutrition, and the low GNRI group (<92), considered to have a high risk of malnutrition. Fracture-free survival in the low and high GNRI groups was evaluated by the Kaplan–Meier method. Cox proportional hazards models were used to identify the risk factors for fractures requiring hospitalization. All results were stratified by sex. Results: New bone fractures developed in 108 (8.0%) patients in 5 years of follow-up. Bone fractures occurred more frequently in the low GNRI group compared with the high GNRI group (HR: 3.51, 95% CI: 1.91–6.42, p < 0.01 in males; HR: 2.47, 95% CI: 1.52–4.03, p < 0.01 in females). A low GNRI was significantly associated with an increased incidence of bone fractures, even after adjustment for covariates. However, the serum levels of calcium, phosphate, parathyroid hormone, and alkaline phosphatase were not associated with the incidence of bone fractures. Conclusions: A low GNRI is an independent risk factor for bone fractures in patients undergoing hemodialysis. Early intervention for the low GNRI group may be important in preventing the occurrence of fractures.     

济宁医学院学生营养状况的综合评价

对该院７００名大学生且面营养状况调查分析表明，热量、铁、硫胺素、尼克酸、抗坏血酸等营养素达到或超过供给量；蛋白质数量基本满足需要，但质较差，脂肪摄入偏低，维生素Ａ、胡萝卜素、维生素Ｂ２有不同程度的缺乏。体检发现部分学生暗适应时间延长，身高、体重等生长发育指标与我国北方标准基本符合。维生素负荷试验显示维生素Ｂ２缺乏。血红蛋白测定发现有３５％的学生患轻度贫血，以女生多见。