Nutritional assessment in gynecology patients

A nutritional assessment was performed upon 72 patients admitted for major elective gynecologic surgery for nonmalignant diseases. This nutritional assessment included body weight, triceps skinfold, arm muscle circumference, creatinine-height index, serum albumin and transferrin, total lymphocyte count, and dermal antigen testing. We found that 29 patients (42%) had at least one test result indicating a nutritional deficiency. Of the 72 patients, 19 (26%) experienced a postoperative complication. The occurrence of a complication did not correlate with any nutritional parameter other than albumin (p = 0.013), but even then, the positive predictive value of albumin was only 40%. Age also correlated with complication status (p = 0.002).     

普外住院患者营养调查

通过对普外100例住院患者进行身高、体重、三头肌皮褶厚度、血清白蛋白、转铁蛋白、淋巴细胞计数、24h尿肌酐测定。计算理想体重、肌酐、身高指数百分数。对患者营养状况进行客观的综合评价,发现普外住院患者中47％以上存在着不同程度的营养不良。对各项营养状态测定指标进行了评价,并介绍了具体测量方法和营养不良的分型。     

120例冠心病患者的营养调查分析

冠心病发病是多因素的,除遗传因素外,还与环境因素,特别是营养因素有关。本次调查是以住院冠心病人为样本,了解冠心病人的营养状况,追溯冠心病与食源性因素的关系。     

Nutritional assessment in the seriously ill patient.

A consensus definition of malnutrition does not exist. We define “clinically relevant malnutrition” as the state of altered nutritional status that adversely affects clinical outcome. Over four years we have attempted to delineate a clinically applicable and validated nutritional assessment approach. This was accomplished through multiple clinical studies on a large number of surgical patients many of whom were seriously ill. Although an initial prospective study in 64 patients confirmed the relationship between certain nutritional markers and outcome, we found that 97% of patients had at least one abnormality, while 35% had three or more abnormalities, clearly documenting the imprecision in unselected battery testing. In a subsequent retrospective analysis of 161 patients, serum albumin (Alb), serum transferrin (TFN), triceps skinfold (TSF), and skin test reactivity (DH) proved to be the best markers of clinically relevant malnutrition and their relative quantitative importance is embodied in our Prognostic Nutritional Index (PNI), where PNI (% risk) = 158 - 16.6 (Alb) - 0.78 (TSF) - 0.20 (TFN) - 5.8 (DH). In numerous prospective studies of different patient groups, a large percentage of which were critically ill, the PNI has been shown to be a reliable nutritional assessment tool for diagnosing clinically relevant malnutrition. Furthermore, we have shown that seriously malnourished patients classified by the PNI will clinically benefit from preoperative nutritional support. The relevance of baseline and serial nutritional assessment to the nutritional care of the critically ill patient is discussed.     

结肠癌术后辅助化疗病人营养风险的评估

目的:研究结肠癌术后病人辅助化疗对营养风险程度的相关因素,客观评定病人的营养状况。方法:回顾性调查260例结肠癌术后病人的NRS2002营养风险评分,其中137例术后未进行辅助化疗,123例进行术后辅助化疗,并将后者分为不同性别、年龄、肿瘤部位、体质指数(BM I)、TNM分期、肿瘤分化程度和组织学类型等亚组,观察其在营养风险评分的差异。结果:术后辅助化疗组病人营养风险评分高于未辅助化疗组。不同年龄、BM I、TNM分期的病人营养风险评分有显著性差异(P0.05)。不同性别、部位、肿瘤分化程度和组织学类型的病人其营养风险评分无显著性差异(P0.05)。结论:结肠癌术后辅助化疗病人的营养风险较未辅助化疗病人高,而且随着病人年龄、TNM分期的增高,BM I的降低而增加。     

364例医院内感染病人营养风险评估研究

目的:研究医院内感染病人营养不良发生率和营养风险发生率,探讨营养风险与年龄、疾病、感染部位和感染细菌等的关系,为临床进行营养支持提供科学依据.方法:采用NRS2002方法对364例医院内感染病人进行营养风险评估.结果:医院内感染病人营养不良(营养不足)发生率为25.91%,营养风险发生率为60.16%.不同科室医院内感...     

Nutritional assessment of vitamin E in malnourished patients with AIDS

Malnourished patients with acquired immunodeficiency syndrome (AIDS) may have low serum levels and reduced intake of alpha-tocopherol, mainly in the presence of acute-phase response. The aims of this study were to compare intake and serum levels of alpha-tocopherol between malnourished (MN) and non-malnourished (NMN) AIDS patients and to correlate alpha-tocopherol intake and serum levels. Undernutrition was defined as having a body mass index lower than 18. 5 kg/m(2) or a height-creatinine index lower than 70%. A semiquantitative food frequency questionnaire assessed alpha-tocopherol intake. High-performance liquid chromatography determined vitamin serum levels. The patients were divided into MN (n = 14) and NMN (n = 15) groups. There were no statistical differences in relation to clinical findings between MN and NMN, respectively, including moniliasis (7/14 versus 4/15), neurocryptoccocosis and neurotoxoplasmosis (6/14 versus 6/15), pulmonary tuberculosis (4/14 versus 2/15), and fever (1/14 versus 3/15). MN and NMN groups had similar peripheral blood CD(4) levels (111.4+/-87.1 versus 124.4+/-90.9 cells/mm(3)), and both groups had similar and adequate alpha-tocopherol intake (MN = 50.0+/-11.0 versus NMN = 47.2+/-16.5 mg) and serum levels (MN = 17.8+/-7.2 versus NMN = 19.8+/-6.3 micromol/L). Vitamin E intake and serum levels did not show a significant correlation (r = -0.22, P 0.05). Protein-energy nutrition status and acute-phase response were not factors determining vitamin status among AIDS patients.     

老年鼻饲患者营养状况的评价

目的评价老年鼻饲患者营养状况.方法采用膳食调查、人体测量、实验室检查方法,对31例78～99岁的老年鼻饲患者进行营养状况评价.结果调查的患者普遍存在营养不良.产生原因①热能摄入不足,平均每日1339±283kcal;②营养素摄入不均衡,蛋白质摄入基本符合要求,平均每日59.1±13.3g,碳水化物摄入偏低,占总热能的52.5%±8.90%,脂肪摄入偏高,占总热能的30.0%±8.96%;③老年人消化、吸收功能减退,自身合成代谢减少,分解代谢增加;④老年人往往同时患有多种慢性疾病,使鼻饲内容及用量受到限制.结论临床医生和营养人员应根据患者的具体情况进行科学计算,确定每日热能和营养素供给量以及各类食物的合理搭配,并在治疗过程中予以调整.     

Nutritional assessment and treatment of patients with liver cirrhosis

Prevalence of chronic liver diseases, including liver cirrhosis, is increasing worldwide. The nutritional state assessment in these patients is complicated, and besides anthropometry is based on several other tools in order to be more accurate. Specific dietary recommendations are needed in patients with chronic liver diseases in order to help prevent and treat liver decompensation because malnutrition is an independent predictor of mortality. This review focuses on essential aspects in the nutritional assessment of cirrhotic patients and some general recommendations for their treatment.     

Nutritional and immunological assessment of patients with anorexia nervosa

The nutritional and immunological status of patients with anorexia nervosa was assessed. Anthropometric measurements were found to be lowered as were the serum levels of zinc (p<0.01), copper (p<0.01) and ceruloplasmin (p<0.05) in comparison with the control group. However the serum levels of albumin, pre-albumin, transferrin and retinol binding protein, vitamins A and D and leucocyte vitamin C were generally found to be within normal limits. Lymphocyte transformation was measured in response to stimulation with the mitogens Con A, PHA and PWM. Responses were normal in all patients with the exception of one who showed a depressed response to Con A. Natural killer cell activity was measured against the target cell line K562 and was not found to differ significantly from controls. It is suggested that the relatively normal protein and vitamin status is responsible for maintaining the apparently normal cellular immune function in patients with anorexia nervosa.     

Nutritional assessment in surgical planning

In a retrospective study 72 patients with gastro-intestinal carcinoma underwent a major surgical resection. Preoperative anthropometrical and biochemical data were examined. A computer-based stepwise discriminant analysis was used to identify the most important variables for predicting mortality. It was possible to compute a linear predictive model of seven parameters which we have called the ‘Nutritional Index’, relating the preoperative nutritional status to operative outcome.In two prospective controlled studies, the predictive value of the Nutritional Index was confirmed by nutritional assessment of 605 surgical patients undergoing major surgery. The discriminant function enabled us to identify surgical patients with high, moderate and normal operative risk. The ‘Nutritional Index’ may be a decisive guide in the planning of alternative surgical procedures; the more extensive the planned surgical procedure the higher the predictive value of the Nutritional Index.     

Nutritional and pulmonary function assessment in patients with chronic obstructive lung disease

This investigation was undertaken to determine the prevalence and degree of malnutrition among patients with chronic obstructive pulmonary disease and to determine if a relationship exists between nutritional assessment parameters and pulmonary function. Thirty-seven patients admitted for the treatment of chronic obstructive pulmonary disease to a respiratory care unit of a Veterans Administration facility were studied. Nutritional status was evaluated using anthropometric measurements, laboratory data and immunologic assay. Deficits in anthropometric measurements were frequent and severe in this group of patients. Furthermore, our data demonstrated that patients with a forced vital capacity <30% of predicted value had significantly reduced lean body mass as measured by the mid-arm muscle circumference (p<0.05). Investigation of the nutritional status of patients with chronic obstructive pulmonary disease using controlled nutrition intervention trials may elucidate the relationship of nutritional state to pulmonary function in this group of patients.     

Nutritional assessment using a microcomputer. 2. Programme evaluation

Nutritional assessment ideally should be used to determine the nutritional requirements of a patient taking into account his nutritional and metabolic status. It should also be used to monitor a patient's progress and any alteration in requirements. In addition, nutritional assessment should be able to identify groups of patients at risk from the effects of malnutrition. Finally, the parameters used for assessment should be simple, yet effective and readily available to any hospital. A computer program designed by the Nutrition Support Service, Riyadh Armed Forces Hospital, Saudi Arabia and in use for the past 2 years has been evaluated and found to fulfil these criteria.     

Nutritional assessment using a microcomputer. 1. Programme design

Nutritional assessment is used to determine the nutritional status, metabolic status and nutritional requirements of patients receiving nutritional support. It is also used to identify patients at risk from the effects of malnutrition. Nutritional assessment uses anthropometric and laboratory data and involves reference to standard tables and equations and is therefore time consuming and tedious. When a large battery of tests is used, consistent interpretation of the results is difficult. This paper describes the design of a computer program which computes nutritional and metabolic status of patients and prescribes the nitrogen and calorie requirements.     

Nutritional assessment in the critically ill

Essentially, there have not been any outstanding recent developments in nutritional assessment techniques. However, it would appear that the acceptance that there is no absolute gold standard for nutritional assessment has led to the development of disease specific and clinically relevant subjective global type-assessments, which are user-friendly and effective tools. The further development of dual frequency bioelectrical impedance models may allow for greater accuracy in the differentiation of alterations in body composition.