两县早产/低出生体重儿与足月儿营养情况比较

目的 比较中国西部两县早产/低出生体重儿与正常足月儿的营养不良发生情况,分析营养不良影响因素。方法 从中国西部陕西省和重庆市符合研究条件的农业县中随机抽取到两个样本县,于2010年9-11月对两县6~36月龄472例早产/低出生体重儿和461例正常足月儿的喂养和生长发育情况进行调查。用SPSS 19.0统计软件对相关数据进行常规统计分析,此外应用MlwiN 2.25软件进行多水平Logistic模型分析。结果 本研究中早产/低出生体重儿组(简称早产组)与正常足月儿组(简称足月组)营养不良患病率分别为22.0%和10.0%(P<0.01),其中生长迟缓患病率两组分别为18.4%和8.9%(P<0.01),低体重患病率两组分别为4.9%和3.0%(P>0.05),消瘦患病率两组分别为2.8%和1.1%(P>0.05)。多水平Logistic回归结果显示,小儿出生类别为早产/低出生体重儿、小儿年龄大、喂养指数不合格、偏食和贫血是小儿营养不良发生的危险因素,OR值分别为1.612、1.027、3.089、2.077及2.001。 结论 中国西部早产/低出生体重儿营养不良患病率高于正常足月儿,主要表现在身长增长不良;抚养人的不正确喂养实践是营养不良的主要影响因素。     

营养不良儿童99例的三种不同干预效果分析

目的 观察综合性干预措施与常规4∶2∶1保健指导对营养不良儿童的干预效果。方法 选取99名低体重营养不良儿童为干预对象,根据家长知情自愿参与原则分干预A组、干预B组、对照组,分别进行一年的西医综合干预措施、中西医结合综合干预措施或单一措施(常规4∶2∶1保健指导)的干预效果评价。结果 儿童营养状况好转率干预A组为62.5%、B组为71.9%,对照组为37.1%,A、B两组均明显高于对照组,且B组效果优于A组(χ²=17.00,P=0.03)。采用儿童饮食行为干预问卷(Identification & Management of Feeding Difficulty,IMFeD)对干预组儿童进行干预后,A组、B组胃口差分别减少25%及47%,挑食偏食分别减少50%及53%,不良饮食习惯分别减少46.9%及56.2%,两组间差异均有统计学意义(P＜0.01)。 结论 采取健康讲座、膳食分析、饮食行为干预及中医治疗等合理的综合干预措施可有效降低营养不良患病率,是改善儿童营养状况的有效手段。     

地震灾区宁强县6~24月龄婴幼儿营养干预效果研究

【目的】 评价发放辅食营养包和开展健康教育对地震灾区宁强县婴幼儿营养状况的改善效果。 【方法】 对宁强县所有6~24月龄婴幼儿添加辅食营养包、对婴幼儿看护人开展婴幼儿喂养健康教育,在干预措施实施18个月前后,分别抽取327名和300名6~24月龄婴幼儿进行调查,对比干预前后婴幼儿的身高、体重、血红蛋白、WAZ(Weight-for-age Z-score)、HAZ (Height-for-age Z-score)、WHZ (Weight-for -Height Z-score)、低体重率、生长迟缓率、消瘦率以及贫血检出率的差异。 【结果】 6~24月龄婴幼儿干预后平均体重较干预前增加0.90 kg(t=-9.94,P<0.01),平均身长增加3.40 cm(t=-7.74,P<0.01),差异有统计学意义;干预后的WAZ(-0.48 vs 0.09,t=-6.95,P<0.01)、HAZ (-0.73 vs -0.25,t=-4.63,P<0.01))、WHZ(-0.15 vs 0.30,t=-4.90,P<0.01)均有显著提高;干预后婴幼儿血红蛋白平均浓度由10.94 g/dL提高到11.70 g/dL(t=-7.97,P<0.01),贫血检出率由49.5%降至23.9%( χ²=43.72,P<0.01)。 【结论】 通过18个月的营养干预可以显著改善宁强县6~24月龄婴幼儿营养状况。     

Malnutrition in Pediatric Chronic Cholestatic Disease: An Up-to-Date Overview

Despite recent advances, the causes of and effective therapies for pediatric chronic cholestatic diseases remain elusive, and many patients progress to liver failure and need liver transplantation. Malnutrition is a common complication in these patients and is a well-recognized, tremendous challenge for the clinician. We undertook a narrative review of both recent and relevant older literature, published during the last 20 years, for studies linking nutrition to pediatric chronic cholestasis. The collected data confirm that malnutrition and failure to thrive are associated with increased risks of morbidity and mortality, and they also affect the outcomes of liver transplantation, including long-term survival. Malnutrition in children with chronic liver disease is multifactorial and with multiple potential nutritional deficiencies. To improve life expectancy and the quality of life, patients require careful assessments and appropriate management of their nutritional statuses by multidisciplinary teams, which can identify and/or prevent specific deficiencies and initiate appropriate interventions. Solutions available for the clinical management of these children in general, as well as those directed to specific etiologies, are summarized. We particularly focus on fat-soluble vitamin deficiency and malnutrition due to fat malabsorption. Supplemental feeding, including medium-chain triglycerides, essential fatty acids, branched-chain amino acids, and the extra calories needed to overcome the consequences of anorexia and high energy requirements, is reviewed. Future studies should address the need for further improving commercially available and nutritionally complete infant milk formulae for the dietary management of this fragile category of patients. The aid of a specialist dietitian, educational training regarding nutritional guidelines for stakeholders, and improving family nutritional health literacy appear essential.     

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.     

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.     

nutritionDay: An Australian hospital's participation in international benchmarking on malnutrition

Aim: Malnutrition is a significant issue for hospitals worldwide. This project examined malnutrition prevalence and associated factors including meal consumption in an Australian hospital. Methods: The cross‐sectional study was undertaken at a private hospital in Brisbane, Australia, for ‘nutritionDay in Europe’ 2009. Nutritional status (subjective global assessment), demographic, medical condition and intake data were collected from 147 inpatients across five medical specialties. Results: The present study found 19.7% (29) of patients were malnourished (17.7% mild to moderately malnourished, 2% severely malnourished). Unintentional weight loss was reported by 39.5% of patients (58) and 49% of patients (72) reported eating less than normal. There were 41.5% of patients (61) who reported not having their usual appetite, with 46.3% (68) eating half or less of a hospital meal. The likelihood of being malnourished increased 4.0 times (CI 1.4–11.6, P= 0.01) for patients who ate less than normal during the previous week and 15 times (CI 4.2–53.5, P < 0.001) for those patients who reported eating less than one quarter to nearly nothing. The likelihood of being malnourished increased 2.9 (CI 1.1–7.6, P= 0.026) and 4.8 (CI 1.6–14.3, P= 0.005) times for patients consuming less than half of breakfast and dinner respectively. Binary logistic regression modelling found a malnutrition screening tool score of ≥2 and average meal consumption of 50% or less were predictors of malnutrition. Conclusions: The present study provides evidence of the increased likelihood of malnutrition in relation to decreased meal consumption and provides insights for future interventions in the acute care setting.     

The aetiology and impact of malnutrition in paediatric inflammatory bowel disease

Disease‐associated undernutrition of all types is very common in paediatric inflammatory bowel disease (IBD). Recent weight loss remains one of the triad of clinical manifestations and a cornerstone for the diagnosis of Crohn’s disease (CD), although significantly fewer patients now present as being underweight. Recent evidence suggests that the introduction of medical treatment will quickly restore body weight, although this does not reflect concomitant changes in body composition. CD children present with features of nutritional cachexia with normal fat stores but depleted lean mass. Poor bone health, delayed puberty and growth failure are additional features that further complicate clinical management. Suboptimal nutritional intake is a main determinant of undernutrition, although activation of the immune system and secretion of pro‐inflammatory cytokines exert additional independent effects. Biochemically low concentrations of plasma micronutrients are commonly reported in IBD patients, although their interpretation is difficult in the presence of an acute phase response and other indices of body stores adequacy are needed. Anaemia is a common extraintestinal manifestation of the IBD child. Iron‐deficient anaemia is the predominant type, with anaemia of chronic disease second. Decreased dietary intake, as a result of decreased appetite and food aversion, is the major cause of undernutrition in paediatric IBD. Altered energy and nutrient requirements, malabsorption and increased gastrointestinal losses are additional factors, although their contribution to undernutrition in paediatric CD needs to be studied further.     

Prediction of Malnutrition Using Modified Subjective Global Assessment-dialysis Malnutrition Score in Patients on Hemodialysis

Malnutrition is widely prevalent among patients on hemodialysis. Malnutrition can be estimated using a fully quantitative scoring system Subjective Global Assessment-Dialysis Malnutrition Score which is simple, reliable and dynamic. The primary objective of the study was to assess the severity of malnutrition in patients with end stage renal disease and undergoing hemodialysis in a tertiary care teaching hospital in Chennai, using Subjective Global Asses sment-Dialysis Malnutrition Score and correlate it with standard indicators of malnutrition like anthropometric and biochemical parameters of the study population by Pearson's correlation. Anthropometric assessment included height, body weight, triceps skin fold thickness, mid arm circumference, mid arm muscle circumference % and biochemical parameters included serum albumin, transferrin, ferritin, total protein, total cholesterol, blood urea nitrogen and creatinine. Based on the scores, of the 66 patients, 91% were moderately malnourished. There was a significant negative correlation between modified Subjective Global Assessment-Dialysis Malnutrition Score and anthropometric measures such as triceps skin fold thickness, mid arm circumference, mid arm muscle circumference; biochemical markers such as albumin, transferrin and ferritin. The data obtained from this study confirm that a high degree of malnutrition was prevalent in patients on hemodialysis, as shown by anthropometric assessment, biochemical markers of malnutrition and Subjective Global Assessment-Dialysis Malnutrition Score. Nutritional status as determined by Subjective Global Assessment-Dialysis Malnutrition Score is a useful and reliable index for identifying patients at risk for malnutrition and it correlates well with anthropometric and biochemical assessment. may be integrated in regular assessment of malnutrition in patients on maintenance hemodialysis.