Preliminary results of patient satisfaction with nutrition handouts versus dietetic consultation in oncology outpatients receiving chemotherapy

Aim:  To determine patient satisfaction with nutrition interventions in outpatients receiving chemotherapy identified as at nutritional risk.
Methods:  An observational, cross-sectional study was conducted at an Australian public hospital in 61 oncology outpatients receiving chemotherapy. A simple malnutrition screening tool was used to identify nutritional risk. Patients identified as moderate risk were triaged to receive nutrition handouts on increasing energy and protein intake. Those at high risk received nutrition counselling and support by a dietitian. Patient satisfaction was assessed using a modification of a valid and reliable satisfaction with nutrition services questionnaire.
Results:  Sixty-one patients entered the study and one-third (20/61) were at nutritional risk. Seven patients were at high risk, and received dietetic review while 13 patients were at moderate risk and received nutrition handouts. Patients identified as at nutritional risk (n = 20) were approached to complete the satisfaction with nutrition services questionnaire. Eighteen patients completed the questionnaire (n = 7: dietetic review; and n = 11: nutrition handout). Nutrition information/advice was rated as helpful (n = 15), met patient expectations (n = 16) and overall patient satisfaction was rated highly. Patients who had received a dietitian review recorded a clinically but not statistically higher overall satisfaction with nutrition services than those patients receiving the nutrition handout.
Conclusion:  The high patient satisfaction helps support nutrition intervention at the chemotherapy unit. A prospective trial is required to determine the benefits of this triage and nutrition intervention on nutrition-related outcomes.     

A double-blind, randomized, controlled crossover trial of glutamine supplementation in home parenteral nutrition

OBJECTIVE: Studies suggest clinical benefit of glutamine-supplemented parenteral nutrition. The aim was to determine if the inclusion of 10 g of glutamine as part of the nitrogen source of home parenteral nutrition (HPN) reduces infectious complications. SUBJECTS/METHODS: Thirty-five patients on HPN were recruited and 22 completed the study. Patients were randomized to receive either standard HPN or glutamine-supplemented HPN. Patients were assessed at randomization, 3 and 6 months later then they were crossed over to the alternative HPN and reassessed at 3 and 6 months. Assessments included plasma amino acid concentrations, intestinal permeability and absorption, nutritional status, oral and parenteral intake, quality of life, routine biochemistry and haematology. RESULTS: No difference was seen between the groups at randomization. No difference was detected between the treatment phases for infective complications (55% in the standard treatment phase and 36% in the glutamine-supplemented phase P=0.67). There were no differences in nutritional status, intestinal permeability, plasma glutamine concentrations or quality of life. CONCLUSION: Although limited by the sample size, the study has shown that glutamine as part of the nitrogen source of parenteral nutrition can be given to patients on HPN for 6 months without any adverse effects.     

The impact of enteral feeding protocols on nutritional support in critically ill children

Background:  Studies have shown that feeding protocols may assist in achieving optimal nutritional care in critically ill children. The present study aimed to assess the impact of enteral feeding protocols on nutritional support practices through a continuous auditing process over a defined period.
Materials and methods:  A prospective audit on nutritional practice was initiated in 1994–1995 on all ventilated patients who were admitted for more than a complete 24-h period in the paediatric intensive care unit. The audit was repeated 1997–1998, 2001 and 2005. The collection of data on outcomes included the time taken to initiate nutritional support, the proportion of patients fed via the enteral versus parenteral route, and the proportion of children reaching 50% and 70% of the estimated average requirement (EAR) by day 3. Feeding algorithms and protocols were introduced after each audit with a view to improving practices.
Results:  Over the study period, time taken to initiate nutrition support was reduced from 15 h (1994–1995), 8 h (1997–1998), 5.5 h (2001) to 4.5 h (2005). The proportion of patients on parenteral feeds was reduced from 11% (1994–1995) to 4% (2005). An increase was also documented in the percentage of patients receiving a daily energy provision of 50% and 70% of the EAR by day 3 after the initiation of nutritional support (6% in 1994–1995 to 21% in 2005 for 70% of EAR).
Conclusion:  The present study demonstrates that feeding protocols improve nutritional practices in a paediatric intensive care unit. However, protocol introduction needs to be monitored regularly through audit.     

肝衰竭病人疾病营养知识、饮食态度及行为调查分析

目的:调查肝衰竭病人疾病相关营养知识、饮食态度、饮食行为(KAP),在了解其疾病营养KAP水平的基础上,对其影响因素进行探讨,为进一步制定针对性的营养教育方案提供科学依据。方法:采用便利抽样法,对2015年10月至2017年2月于郑州市某三级甲等医院就诊的178例肝衰竭病人进行疾病营养知识、态度及饮食行为问卷的现场调查。结果:肝衰竭病人疾病营养KAP的条目均分为(1.56±0.44)分。各维度条目均分中,饮食态度最高为(1.80±0.50)分,营养知识最低为(1.39±0.60)分。KAP各维度得分与病人PG-SGA分级呈显著负相关(P0.01)。文化程度、家庭人均月收入、疾病诊断为肝衰竭病人疾病营养KAP的影响因素。结论:肝衰竭病人疾病营养知识普遍不足,饮食态度较为积极,但饮食行为表现中等。肝衰竭病人疾病营养知识、饮食态度及行为水平的提高,对于病人营养状况改善具有重要意义。应加强对文化程度低、家庭人均月收入低及病程较短病人的关注,促进病人营养知识向正确的饮食行为的转变,从而达成提高病人营养支持效果和生活质量的目的。     

The Malnutrition Screening Tool is a useful tool for identifying malnutrition risk in residential aged care

Background:  The Malnutrition Screening Tool (MST) is a valid nutrition screening tool in the acute hospital setting but has not been assessed in residential aged care facilities. The aim of this secondary analysis was to determine whether the MST could be a useful nutrition screening tool when compared with a full nutrition assessment by Subjective Global Assessment (SGA) in the residential aged care setting.
Methods:  Two hundred and eighty-five residents (29% male; mean age 84 ± 9 years) from eight residential aged care facilities in Australia participated in the study. A secondary analysis of data collected during a nutrition intervention study was conducted. The MST consists of two questions related to recent weight loss and appetite. Although the MST was not specifically applied, weight loss and appetite information was available and an estimated MST score (0–5) was calculated. Nutritional status was assessed by a research assistant trained in using the SGA.
Results:  Malnutrition prevalence was 42.8% (122 malnourished out of 285 residents). Compared to the SGA, the MST was an effective predictor of nutritional risk (sensitivity = 83.6%, specificity = 65.6%, positive predictive value = 0.65, negative predictive value = 0.84).
Conclusions:  The components of the MST have acceptable sensitivity and specificity, suggesting that it can play a valuable role in quickly identifying the risk of malnutrition in the residential aged care setting. Further prospective research using the MST tool against a broader array of objective and subjective nutritional parameters is required to confirm its validity as a screening tool in aged care settings.     

Validation of the General Nutrition Knowledge Questionnaire in an Australian community sample

Aim:  To validate the General Nutrition Knowledge Questionnaire developed by Parmenter and Wardle (1999) in an Australian community sample. This questionnaire differs from previous assessments of knowledge because it incorporates a broad range of nutrition concepts, including knowledge of dietary recommendations, healthy food choices, nutrient sources and some diet–disease relationships.
Methods:  The original questionnaire was developed in the UK, and thus modified to suit the current Dietary Guidelines for Australians and current public health nutrition recommendations. A total of 156 people, of which 116 were community members, completed the questionnaire (113 items). As an indication of concurrent validity, a subsample of nutrition and dietetic students were included (n = 40). As a measure of test–retest reliability, a subsample (n = 57), including students and community members, answered the questionnaire on two occasions, two weeks apart.
Results:  Both overall internal reliability of the questionnaire items (Cronbach's alpha = 0.92) and test–retest reliability (r = 0.87) were high. The nutrition and dietetic students, hypothesised to have higher knowledge levels, scored consistently higher than the general community sample, indicating good concurrent validity.
Conclusion:  A test of a modified version of the General Nutrition Knowledge Questionnaire found it to be a valid and reliable measure of nutrition knowledge, appropriate for use in a section of the Australian community. The validated tool may be used in the future for the comprehensive assessment of general nutrition knowledge; however, further testing in differing sections of Australian society may be warranted.     

Approaches to intestinal failure in Crohn's disease

Crohn's disease is one of the leading causes of intestinal failure. The term 'type 2' intestinal failure is used to describe the relatively rare type of intestinal failure that occurs in association with septic, metabolic and complex nutritional complications, typically following surgical resection and/or laparostomy for intra-abdominal sepsis. A multidisciplinary approach to the management of patients with type 2 intestinal failure is crucial, and it is helpful to approach patient care in a structured manner using the 'sepsis-nutrition-anatomy-plan' algorithm: resolution of sepsis is required before adequate nutritional repletion can be achieved, and it is crucial to optimise nutritional status, and define intestinal anatomy before delineating a definitive medical or surgical plan. A structured approach to the management of patients with inflammatory bowel disease, who have developed type 2 intestinal failure, should reduce the likelihood of these patients developing 'type 3' intestinal failure, which is characterised by the need for long-term parenteral nutrition. However, Crohn's disease is still the commonest indication for home parenteral nutrition in the UK.     

Special commentary: a call for intensive metabolic support

PURPOSE OF REVIEW: This special commentary addresses recent clinical reviews regarding appropriate nutrition and metabolic support in the critical care setting. RECENT FINDINGS: There are divergent approaches between North America and Europe for the use of early nutrition support and combined enteral nutrition and parenteral nutrition support possibly due to the commercial availability of specific parenteral nutrients. The advent of intensive insulin therapy has changed the landscape of metabolic support in the intensive care unit, and previous notions about infective risk of parenteral nutrition will need to be re-addressed. Patients with brain failure may benefit from an intensive insulin therapy with a blood glucose target that is higher than that used in patients without brain failure. Patients with heart failure may benefit from the addition of nutritional pharmacology that targets proximate oxidative pathophysiological pathways. Intradialytic parenteral nutrition may be viewed as another form of supplemental parenteral nutrition when enteral nutrition is insufficient in patients on hemodialysis in the intensive care unit. SUMMARY: It is proposed that intensive metabolic support be routinely implemented in the intensive care unit based on the following steps: intensive insulin therapy with an appropriate blood glucose target, nutrition risk assessment, early and if needed combined enteral nutrition and parenteral nutrition to target 20-25 kcal/kg/day and 1.2-1.5 g protein/kg/day, and nutritional and metabolic monitoring.     

Eating disorder management in hospital patients: Current practice among dietitians in Australia

Aim:  To examine dietetic practice during the management of eating disorders in inpatient and daypatient settings.
Methods:  A survey was sent to dietitians working in the clinical management of eating disorders within Australia. Thirty-six qualified dietitians including all dietitians working at the specialist units in Australia participated in the study.
Results:  Most dietitians aim to meet patients' nutritional requirements by food alone without artificial feeding. High-energy supplements are the preferred method of increasing energy intake to eating disorder patients. Nasogastric feeding was a standard feeding practice for anorexia nervosa reported by one-third of dietitians. Total parenteral nutrition was not considered an option for nutritional rehabilitation. In the treatment of anorexia nervosa, variable energy intakes for individual patients were prescribed aiming for weight gain of up to 1.0 kg/week in inpatients and 0.5 kg/week in outpatients.
Conclusion:  In Australia, there is no standard nutritional management for anorexia and bulimia nervosa. This survey establishes a baseline for nutritional management and practice of dietitians working with patients with eating disorders. Further research is needed regarding use of nasogastric feeding, and weight gain targets in anorexia nervosa.     

Safety and Dosing Study of Glucagon‐Like Peptide 2 in Children With Intestinal Failure

Background and Aims: A glucagon‐like peptide 2 (GLP‐2) analogue is approved for adults with intestinal failure, but no studies of GLP‐2 have included children. This study examined the pharmacokinetics, safety, and nutritional effects of GLP‐2 in children with intestinal failure. Methods: Native human GLP‐2(1‐33) was synthesized following good manufacturing practices. In an open‐label trial, with parental consent, 7 parenteral nutrition–dependent pediatric patients were treated with subcutaneous GLP‐2 (20 µg/kg/d) for 3 days (phase 1) and, if tolerated, continued for 42 days (phase 2). Nutritional treatment was directed by the primary caregivers. Patients were followed to 1 year. Results: Seven patients were enrolled (age: 4.0 ± 0.8 years; bowel length, mean ± SEM: 24% ± 4% of predicted). All were parenteral nutrition dependent since birth, receiving 44% ± 5% of calories by parenteral nutrition. GLP‐2 treatment had no effect on vital signs (blood pressure, heart rate, and temperature) and caused no significant adverse events. Peak GLP‐2 levels were 380 pM (day 3) and 295 pM (day 42), with no change in half‐life or endogenous GLP‐2 levels. Nutritional indices showed a numeric improvement in z scores and citrulline levels; the z score was maintained while citrulline levels returned to baseline once GLP‐2 was discontinued. Conclusions: GLP‐2 was well tolerated in children, with a pharmacokinetic profile similar to that of adults. There were no changes in endogenous GLP‐2 release or metabolism. These results suggest that GLP‐2 ligands may be safely used in pediatric patients; larger trials are suggested to investigate nutritional effects.     

The role of diet in the management of gout: a comparison of knowledge and attitudes to current evidence

Background:  Evidence supports dietary modifications in the management of gout. Despite this, the degree of implementation of this evidence by nutrition professionals and rheumatologists and those affected by gout is unknown. The present study aimed to compare usual dietary practices of patients with gout to evidence for dietary management of gout and to investigate whether the knowledge and attitudes of nutrition professionals and rheumatologists reflects current evidence.
Methods:  A food frequency questionnaire was used to determine usual dietary intake of patients with gout, a separate questionnaire examined gout-related dietary modifications ( n  = 29). Online questionnaires to examine attitudes towards dietary management of gout were completed by nutrition professionals and rheumatologists.
Results:  Proportions of participants whose reported intakes were inconsistent with current evidence for the dietary management of gout were: alcohol, n  = 14 (48%); beer, n  = 18 (62%); seafood, n  = 29 (100%); meat, n  = 7 (24%); beef/pork/lamb, n  = 24 (83%); dairy products, n  = 12 (41%); vitamin C supplementation, n  = 29 (100%). Of the 61 rheumatologists and 231 nutrition professionals who completed the online survey, the majority considered that weight loss and decreased alcohol intake were important or very important outcomes. Proportions were lower for decreased purine intake. Thirty-four (56%) rheumatologists do not refer patients with gout to dietetic services and, of those who do, the majority refer less than half.
Conclusions:  Overall, patients with gout in the present study were not implementing evidence for dietary management of their condition and complex dietary issues were evident.     

Good food in family day care: Improving nutrition and food safety in family day care

Aim:  To determine the effectiveness of a nutrition and food safety intervention in family day care schemes.
Methods:  Staff and carers from seven Sydney family day care schemes completed a nutrition and food safety knowledge questionnaire and diet history about food and drinks offered to children in care before and after attending workshops and receiving advice and resources. Participating schemes' nutrition and food safety policies were assessed before and after intervention. At baseline, 18 staff members and 104 carers were interviewed. Diet histories were collected for 20 infants and 103 one-to-five-year olds. Post intervention, 21 staff and 102 carers were interviewed and diet histories collected for 22 infants and 102 one-to-five-year olds. Baseline and post-intervention data were compared using the χ²-test for categorical data (or the Fisher's exact test when expected values were below five), and t -tests for independent samples for normally distributed means.
Results:  Nutrition and food safety knowledge and the number (from one to seven) and quality of appropriate policies improved post intervention. Changes in mean per cent nutrition scores for infants (78.2% to 83.4%) and for one-to-five-year olds (68.8% to 75.2%; P  < 0.01) indicated improvements in nutritional quality of food and drinks offered during care.
Conclusion:  Health promotion strategies can improve food and drinks offered in family day care and make a sustainable contribution to children's access to safe and nutritious food.     

Satisfaction and Adherence in Patients with Iron Overload Receiving Iron Chelation Therapy as Assessed by a Newly Developed Patient Instrument

Objectives:  This study assesses satisfaction with iron chelation therapy (ICT) based on a reliable and valid instrument, and explores the relationship between satisfaction and adherence to ICT.
Methods:  Patients in the USA and UK completed a new "Satisfaction with ICT" (SICT) instrument consisting of 28 items, three pertaining to adherence. Simple and multivariate regression analyses assessed the relationship between satisfaction with different aspects of ICT and adherence.
Results:  First assessments of the SICT instrument indicate its validity and reliability. Recommended thresholds for internal consistency, convergent validity, discriminant validity, and floor and ceiling effects were met. A number of variables were identified in the simple linear regression analyses as significant predictors of "never thinking about stopping ICT," a proxy for adherence. These significant variables were entered into the multivariate model to assess the combined factor effects, explaining 42% of the total variance of "never thinking about stopping ICT." A significant and positive relationship was demonstrated between "never thinking about stopping ICT" and age ( P  = 0.04), Perceived Effectiveness of ICT ( P  = 0.003), low Burden of ICT ( P  = 0.002), and low Side Effects of ICT ( P  = 0.01).
Conclusions:  The SICT is a reliable and valid instrument which will be useful in ICT clinical trials. Furthermore, the administration of ICT by slow subcutaneous infusion negatively impacts on satisfaction with ICT which was shown to be a determinant of adherence. This points to the need for new more convenient and less burdensome oral iron chelators to increase adherence, and ultimately to improve patient outcomes.     

Inflammatory bowel disease: nutritional implications and treatment

It is clear that the nutritional state of patients with inflammatory bowel disease is often impaired and that the provision of nutritional support results in an improvement in nutritional state of these patients. Improvement in nutritional status can be achieved as effectively with enteral as with parenteral nutrition. The nutritional support appears to have no primary therapeutic effect in patients with ulcerative colitis. With regard to nutritional support in Crohn's disease, parenteral nutrition should be restricted to use as supportive rather than primary therapy. Available information now seems to suggest that most of the benefits of parenteral nutrition in Crohn's disease are related to improvement in nutritional state rather than as primary therapy, and its use should be restricted to treatments of specific complications of Crohn's disease, such as intestinal obstruction, related to stricture formation or short bowel syndrome following repeated resection. The present available evidence indicates that defined elemental diets may have a primary therapeutic role in the management of first acute attacks of Crohn's disease when there is a need to improve the nutritional status of patients with inflammatory bowel disease as an adjunct to primary drug therapy. Enteral nutrition is as efficacious as parenteral nutrition; moreover, it is safer to administer and more cost-effective.     

Diet quality of persons living with HIV/AIDS on highly active antiretroviral therapy

Background  This study sought to assess the diet quality of individuals living with HIV/AIDS who were receiving antiretroviral therapy in São Paulo, Brazil.
Methods  This cross-sectional study involved 56 HIV-infected adults. Demographic and anthropometric data were collected, and diet quality was measured using the Healthy Eating Index (HEI), modified for Brazilians, which included ten components: adequacy of intake of six different food groups, total fat, cholesterol, dietary fibre and dietary variety.
Results  Among the individuals assessed, 64.3% of the participants had a diet needing improvement, while 8.7% had a poor diet. The overall HEI score was 68.3 points (SD = 14.9). Mean scores were low for fruits, vegetables, dairy products and dietary fibre; and high for meats and eggs, total fat and cholesterol. The overall HEI score was higher among individuals who were not overweight ( P  = 0.003), who were also more likely to achieve dietary goals for dairy products ( P  = 0.039) and grains ( P  = 0.005).
Conclusion  Most of these adults living with HIV/AIDS had diets that required improvement, and being overweight was associated with poorer diet quality. Nutritional interventions aimed at maintaining healthy body weight and diet should be taken into account in caring for HIV-infected people.     

Long-term efficacy of 'ready-to-drink' protein substitute in phenylketonuria

Background:  In phenylketonuria (PKU), protein substitute is an essential part of dietary treatment. Short-term studies have demonstrated that liquid protein substitutes (LPS) are efficacious, and improve compliance in teenagers and adults with PKU, although there are no data available to demonstrate that their effectiveness is sustained over time. The present retrospective study aimed to evaluate the long-term efficacy of ready-to-drink protein substitute in a group of people with PKU.
Methods:  Thirty-four patients (17 females and 17 males, median age 14.9 years, range 7.2–53.8 years) with PKU on dietary management were recruited from Birmingham Children's Hospital. All patients who were taking a LPS for a median of 2.4 years (range 6 months to 4.1 years), had their plasma phenylalanine concentrations, anthropometric and nutritional biochemical markers reviewed, both before and when taking the LPS.
Results:  There was a significant improvement in median plasma phenylalanine ( P  < 0.05), vitamin B₁₂ ( P  < 0.01), calcium ( P  < 0.05) and albumin ( P  < 0.05) concentrations in subjects ( n  = 13) aged >18 years when taking the LPS. In the children aged 7–18 years ( n  = 21), median plasma phenylalanine concentrations were maintained on LPS. Their plasma selenium concentrations ( P  < 0.05) deteriorated, but calcium ( P  < 0.05), albumin ( P  < 0.01), haemoglobin ( P  < 0.01) and haematocrit ( P  < 0.01) significantly improved.
Conclusions:  This retrospective review suggested that, in adult patients, the long-term use of LPS is associated with better compliance by lowering blood phenylalanine and improving nutritional biochemical markers.     

肠内营养在维护门静脉高压症术后患者肠道黏膜屏障功能中的作用

目的了解肠内营养在维护门静脉高压症术后患者肠道黏膜屏障功能中的作用和地位。方法40例门静脉高压症手术患者随机进入肠内(EN)或肠外营养(PN)组,术后分别接受肠内外营养,观察两种营养方式对患者内脏蛋白合成能力、肝功能及其储备、胃肠功能、内毒素水平、肠道细菌移位和乳果糖/甘露醇比值等方面的影响。结果两种营养方式均能改善患者的营养状况。EN术后并发症少,在刺激肠道蠕动,减轻内毒素水平,防止肠道菌群移位,维护肠黏膜屏障方面优于PN,且差异显著(P<0.05)。结论EN是维护此部分患者肠道黏膜免疫屏障功能稳定的有效方式。     

Implementation of an electromagnetic imaging system to facilitate nasogastric and post-pyloric feeding tube placement in patients with and without critical illness

Background:  Artificial nutrition support is required to optimise nutritional status in many patients. Traditional methods of placing feeding tubes may incur clinical risk and financial costs. A technique facilitating placement of nasogastric and post-pyloric tubes via electromagnetic visual guidance may reduce the need for X-ray exposure, endoscopy time and the use of parenteral nutrition. The present study aimed to audit use of such a system at initial implementation in patients within an acute NHS Trust.
Methods:  A retrospective review was undertaken of dietetic and medical records for the first 14 months of using the Cortrak® system. Data were collected on referral origin, preparation of the patient prior to insertion, placement success rates and need for X-ray. Cost analysis was also performed.
Results:  Referrals were received from primary consultants or consultant intensivists, often on the advice of the dietitian. Fifty-nine percent of patients received prokinetic therapy at the time of placement. Thirty-nine tube placements were attempted. Sixty-nine percent of referrals for post-pyloric tube placement resulted in successful placement. X-ray films were requested for 22% of all attempted post-pyloric placements. Less than half of nasogastric tubes were successfully passed, although none of these required X-ray confirmation. The mean cost per tube insertion attempt was £111.
Conclusions:  This system confers advantages, particularly in terms of post-pyloric tube placement, even at this early stage of implementation. A reduction in clinical risk and cost avoidance related to X-ray exposure, the need for endoscopic tube placement and parenteral nutrition have been achieved. The implementation of this system should be considered in other centres.     

A quality improvement nutrition screening and intervention program available to Home and Community Care eligible clients

Objective:  To develop and implement a nutrition screening and dietetic referral system for Home and Community Care (HACC) eligible clients.
Design:  Quality improvement project utilising a prospective, observational design.
Setting:  Sixteen Australian organisations caring for HACC eligible clients.
Subjects:  One thousand one hundred and forty-five HACC eligible clients (mean age 76.5 ± 7.2 years) were screened for nutritional risk during 2003–2005.
Interventions:  Nutrition screening was conducted by trained project officers, allied health staff, community care coordinators and nursing staff using a modified version of the malnutrition screening tool (MST). Dietitians performed a nutrition assessment using the scored Patient Generated-Subjective Global Assessment (PG-SGA) and provided individualised nutrition counselling for those identified to be at risk of malnutrition and agreeing to treatment.
Results:  According to the MST, 170 clients (15%) were identified as being at risk of malnutrition. Of these, 75 (44%) agreed to the dietetic referral and PG-SGA assessment, and 57 were subsequently assessed as malnourished (PG-SGA category B or C), suggesting a malnutrition prevalence between 5% and 11%. Of the 34 malnourished clients receiving multiple dietetic reviews (mean 4.1 ± 2.0 per client), 28 improved, with 17 achieving a well-nourished PG-SGA A rating.
Conclusion:  The development and implementation of a nutrition screening and referral system can identify HACC eligible clients who would benefit from services provided by a dietitian. Further research should identify the reasons why some HACC eligible clients are reluctant to be referred to a dietitian.     

早期肠内营养和肠外营养支持重型颅脑损伤的效果观察

目的探讨早期营养支持对重型颅脑损伤患者营养状况的效果影响。方法回顾性分析我院2004年1月～2008年10月间收治的重型颅脑损伤患者38例,随机分为肠内营养加肠外营养支持组(观察组)19例和全肠外营养支持组(对照组)19例。观察组早期肠内营养(enteral nutrition,EN)和肠外营养(parenteral nutrition,PN)结合,10天后转为全肠道营养,对照组10天内行全肠外营养支持,观察血糖、血浆白蛋白、淋巴细胞计数,并发症发生率及预后。结果观察组能获得充足的能量和蛋白质合成物,1周时的血糖控制程度、血浆白蛋白及外周血淋巴细胞总数优于对照组(P<0.05),观察组并发症少于对照组。观察组10天后病死率为(15.79%)明显低于对照组(31.58%)。结论重型颅脑损伤行早期肠内营养和肠外营养结合符合病人的病理、生理要求,能使该类病人营养状况和生存率提高。