Kwashiorkor and an Acrodermatitis Enteropathica-like Eruption after a Distal Gastric Bypass Surgical Procedure

ObjectiveTo describe a case of kwashiorkor and an acrodermatitis enteropathica-like eruption associated with zinc deficiency after a distal gastric bypass surgical procedure.MethodsA case report of a morbidly obese patient who underwent a gastric bypass operation is presented, including clinical, laboratory, and radiologic findings. In addition, the literature on potential nutritional deficiencies after bariatric surgical intervention is reviewed.ResultsA 43-year-old woman with a history of morbid obesity underwent a distal Roux-en-Y gastric bypass procedure at an outside institution. Six months later, she presented to our clinic because of abdominal pain, lower extremity edema, and a patchy maculopapular scaling rash. She had not adhered to a vitamin supplementation regimen prescribed postoperatively. Her symptoms progressively worsened, and she was hospitalized for management of severe malnutrition and dehydration. Laboratory tests revealed low levels of albumin, hemoglobin, vitamin A, vitamin D, copper, and zinc and elevated levels of liver enzymes. Anasarca and bowel wall edema were seen on an abdominal computed tomographic scan, and an upper endoscopy revealed a stomal ulcer and a stricture at the site of the gastrojejunal anastomosis. The patient was diagnosed as having kwashiorkor, zinc deficiency, and an acrodermatitis enteropathica-like eruption. Treatment was begun with total parenteral nutrition, which led to alleviation of her symptoms. Approximately 3 months later, she underwent gastric bypass revision but had numerous postoperative complications.ConclusionKwashiorkor and severe nutritional deficiencies were noted in this patient after a distal gastric bypass surgical procedure. This clinical presentation is uncommon and can be attributed to the increased malabsorption that occurs with distal gastric bypass, the development of mechanical complications, and the inadequacy of nutritional supplementation. After a bariatric operation, careful adherence to follow-up regimens and the involvement of a multidisciplinary team can improve the chances of a successful outcome. (Endocr Pract. 2007;13:277-282)     

Malnutrition and cachexia in patients with head and neck cancer treated with (chemo)radiotherapy

AimTo highlight the problems associated with nutrition that occur in patients with squamous cell carcinoma of the head and neck (SCCHN).BackgroundSCCHN is associated with weight loss before, during and after radiotherapy or concurrent chemoradiotherapy. Because of serious consequences of malnutrition and cachexia on treatment outcome, mortality, morbidity, and quality of life, it is important to identify SCCHN patients with increased risk for the development of malnutrition and cachexia.Materials and methodsCritical review of the literature.ResultsThis review describes pathogenesis, diagnosis and treatment of malnutrition and cancer cachexia. Treatment of malnutrition and cancer cachexia includes nutritional interventions and pharmacological therapy. Advantages and disadvantages of different nutritional interventions and their effect on the nutritional status, quality of life and specific oncological treatment are presented.ConclusionsNutritional management is an essential part of care of these patients, including early screening, assessment of nutritional status and appropriate intervention.     

Bariatric Surgery and the Role of the Clinical Endocrinologist: 2011 Update

ObjectiveTo discuss the emerging roles of bariatric surgery and clinical endocrinology within the context of obesity and diabetes mellitus comprehensive care plans and cost-effective strategies.MethodsRelevant literature is reviewed and clinical cases are presented.ResultsThe global obesity epidemic poses many challenges to clinical endocrinologists and has fomented a coordinated effort among specialists to revolutionize management paradigms. Technologic innovation drives the need for accelerated learning and research efforts in bariatric surgery. The national shortage of physicians with expertise in nutritional medicine compounds the management problems for this expanding patient population. Certain issues merit continued attention and research, such as gastric banding for mild obesity, surgery for treatment of diabetes, sleeve gastrectomy, and nutritional and metabolic consequences.ConclusionClinical endocrinologists should have a central role in the perioperative decision-making for patients undergoing bariatric surgery. (Endocr Pract. 2011;17:788-797)     

先天性心脏病患儿术前营养不良的危险因素分析及其对术后临床结局、免疫功能和生存质量的影响

摘要 目的：分析先天性心脏病（CHD）患儿术前营养不良的危险因素,并观察术前营养不良对患儿术后临床结局、免疫功能和生存质量的影响。方法：选取2020年1月-2022年6月期间江苏省人民医院收治的65例CHD患儿,采用世界卫生组织（WHO）推荐的美国国家卫生统计中心制订的相关营养诊断标准评估CHD患儿的营养情况,统计CHD患儿术前营养不良发生率,采用单因素和多因素Logistic回归分析CHD患儿术前营养不良的危险因素,并观察术前营养不良对患儿术后临床结局、免疫功能和生存质量的影响。结果：本次研究入选的患儿中,有31例出现术前营养不良,34例无营养不良。根据患儿的营养状况将患儿分为营养不良组（n=31）和非营养不良组（n=34）。多因素Logistic回归分析结果显示：出生时体质量偏低、母亲有焦虑情况、母亲有抑郁情况是CHD患儿术前营养不良的危险因素,母亲主动获取疾病知识则是其保护因素（P<0.05）。两组并发症发生率组间对比无统计学差异（P>0.05）,营养不良组的住院时间长于非营养不良组,住院费高于非营养不良组（P<0.05）。两组术后3个月CD3⁺、CD4⁺、CD4⁺/CD8⁺升高,CD8⁺下降,且非营养不良组的改善效果优于营养不良组（P<0.05）。两组术后3个月术前沟通问题、心脏问题和症状、治疗焦虑、感知身体外貌、认知心理问题评分均升高,且非营养不良组的改善效果均优于营养不良组（P<0.05）。结论：出生时体质量偏低、母亲有焦虑情况、母亲有抑郁情况是CHD患儿术前营养不良的危险因素,而母亲主动获取疾病知识是CHD患儿术前营养不良的保护因素。术前营养不良会导致CHD患儿术后免疫功能下降,生存质量降低,临床结局相对偏差。     

老年心力衰竭患者营养不良的影响因素分析及早期肠内营养对营养不良患者心功能、营养状况和肠道黏膜屏障功能的影响

摘要 目的：探讨老年心力衰竭（HF）患者营养不良的影响因素及早期肠内营养对营养不良患者心功能、营养状况和肠道黏膜屏障功能的影响。方法：选取2021年2月~2022年4月期间在我院接受治疗的180例老年HF患者作为研究对象。入院后采用微型营养评价简表（MNA-SF）评估患者的营养状况。根据MNA-SF评分结果分为营养不良组（n=83）和营养正常组（n=97）。应用单因素及多因素Logistic回归分析老年HF患者营养不良的危险因素。对老年HF营养不良患者给予早期肠内营养干预,观察其治疗前、治疗一周后心功能、营养状况和肠道黏膜屏障功能的变化情况。结果：老年HF患者营养不良与性别、居住地、饮酒史、病因、职业类别、谷丙转氨酶、血肌酐、收缩压（SBP）、舒张压（DBP）无关（P>0.05）,而与年龄、医保类型、病程、婚姻状况、美国纽约心脏病学会（NYHA）分级、文化程度、C反应蛋白（CRP）、家庭人均月收入、B型脑钠肽（BNP）、吸烟史、左心室射血分数（LVEF）有关（P<0.05）。Logistic回归分析结果显示：病程偏长、CRP偏高、BNP偏高、NYHA分级为IV级、年龄偏大、吸烟史是老年HF患者发生营养不良的危险因素（P<0.05）。治疗1周后,营养不良组老年HF患者的LVEF升高,BNP下降（P<0.05）。治疗1周后,营养不良组老年HF患者的前白蛋白（PA）、转铁蛋白（TRF）升高（P<0.05）。治疗1周后,营养不良组老年HF患者的D-乳酸（D-Lac）、二胺氧化酶（DAO）、肠脂肪酸结合蛋白（IFABP）下降（P<0.05）。结论：老年HF患者营养不良受到病程、CRP、BNP、NYHA分级、年龄、吸烟史等多种因素的影响,针对老年HF患者营养不良给予早期肠内营养,有助于改善患者心功能、营养状况和肠道黏膜屏障功能。     

维持性腹膜透析患者认知功能障碍与营养状况的关系研究

摘要 目的：探究维持性腹膜透析患者认知功能障碍与营养状况的关系。方法：前瞻性纳入2019年1月至2020年6月在济宁医学院附属医院就诊的172例维持性腹膜透析患者，收集患者一般资料。采用蒙特利尔认知评估量表（MoCA）评估患者的认知功能，根据MoCA评分分为认知功能正常组及认知功能障碍组。采用微型营养评估量表（MNA）评估患者营养状态，以MNA评分分为营养正常组、潜在营养不良组、营养不良组，比较认知功能正常组及认知功能障碍组营养状况占比情况，分析维持性腹膜透析患者认知功能与营养状况的相关性及影响认知功能的相关因素。结果：与认知功能正常组比较，认知功能障碍组患者透析时间明显延长，MNA总分、MoCA总分明显降低（P<0.05）。与认知功能正常组比较，认知功能障碍组患者营养正常者比例明显降低，营养不良者比例明显升高（P<0.05），潜在营养不良者比例有所升高但差异无统计学意义（P>0.05）。经Pearson相关性检验分析显示，维持性腹膜透析患者MoCA总分与MNA总分呈明显正相关（P<0.05）。经Logistic回归分析显示，透析时间（延长）、营养不良均为维持性腹膜透析患者认知功能障碍的危险因素（P<0.05）。结论：维持性腹膜透析认知功能障碍患者营养不良发生率明显升高，且患者认知功能障碍与营养状况具有明显相关性，加强患者的营养状况有助于降低认知功能障碍的发生风险。     

Nutritional and Protein Deficiencies in the Short Term following Both Gastric Bypass and Gastric Banding

Background

The number of morbidly obese patients undergoing bariatric surgery (BS) has increased dramatically in recent years. Therefore, monitoring food intake and its consequences in terms of nutritional status is necessary to prevent nutritional deficiencies. The aim of this study was to analyze the effect of food restriction on nutritional parameters in the short-term (≤3 months) period after BS in morbid obesity.

Method

In a prospective study, we followed 22 obese women who underwent Roux-en-Y gastric bypass (GBP) or adjustable gastric banding (AGB) at baseline (T0) and 1 (T1) and 3 (T3) months after surgery. We evaluated food intake, nutrient adequacy and serum concentrations of vitamins and minerals known to be at risk for deficiency following BS.

Results

Before surgery, we observed suboptimal food intakes, leading to a risk of micronutrient deficiencies. Serum analysis confirmed nutritional deficiencies for iron and thiamine for 27 and 23% of the patients, respectively. The drastic energy and food reduction seen in the short term led to very low probabilities of adequacy for nutrients equivalent across both surgeries. Serum analysis demonstrated a continuous decrease in prealbumin during the follow-up, indicating mild protein depletion in 21 and 57% of GBP patients and 50 and 63% of AGB patients, respectively, at T1 and T3. Regarding vitamins and minerals, systematic supplementation after GBP prevented most nutritional deficiencies. By contrast, AGB patients, for whom there is no systematic supplementation, developed such deficiencies.

Conclusions

Our results suggest that cautious monitoring of protein intake after BS is mandatory. Furthermore, AGB patients might also benefit from systematic multivitamin and mineral supplementation at least in the short term.     

Metabolic surgery for type 2 diabetes mellitus

Background: Metabolic surgery for morbid obesity induces significant weight loss and resolution of many obesity-related comorbidities, the most notable of which is remission of type 2 diabetes mellitus (DM). Such changes seem to precede significant weight loss in this population shortly after undergoing diversionary procedures.Objective: This article explores the evidence for salutary metabolic benefits of bariatric surgery, with special emphasis on glycemic control and remission of type 2 DM.Methods: We conducted a query of the PubMed database for articles published in English within the past 15 years using the search terms bariatric surgery, obesity, type 2 diabetes, gastric bypass, gastric banding, incretins, enteroinsular axis, GLP-1 (glucagon-like peptide-1), and GIP (glucose-dependent insulinotropic polypeptide). We targeted review articles as well as those discussing the effects of bariatric surgery on the enteroinsular axis and the respective effects on glyce-mic control.Results: Most of the clinical reports indicated a high remission rate (≥85%) for type 2 DM, and relatively higher rates in patients who underwent diversionary procedures. Studies with small cohorts and laboratory data suggested a role for gastrointestinal hormones in the regulation of glucose homeostasis after bariatric surgery.Conclusions: Gastrointestinal surgery for severe obesity, through restrictive and/or neurohormonal effects, is an effective treatment for type 2 DM. Surgically induced weight loss was found to be sustainable, durable, and associated with remission of type 2 DM, a reduction in mortality, and improvement in quality of life.     

Influencia de la enfermedad psiquiátrica previa en la evolución de los pacientes sometidos a cirugía bariátrica

IntroductionPresurgical evaluation of patients undergoing bariatric surgery includes, among others, a psychological/psychiatric evaluation. Psychiatric disorders that did not contraindicate surgery may persist and influence on weight loss and postoperative clinical course, hindering the success of the procedure. The aim of our study was to analyze the postoperative evolution of our series of patients with and without psychiatric symptoms before surgery.Patients and methodsRetrospective analysis of 109 patients undergoing bariatric surgery with duodenal switch from 2003 to 2008 (follow up > 6 months). We studied weight changes, immediate and delayed complications of surgery and nutritional deficiencies in post-surgical follow-up in patients with previous psychiatric disorders (group 1, n = 17) compared with patients without psychiatric disorders (group 2, n = 92).ResultsPatients in group 1 showed a greater tendency for weight gain. They regained a 9,4% of the initial excess weight lost between 18 months after surgery and 36 months after surgery, while patients in group 2 regained only 0.2% in the same period (p < 0.05). There was no difference in immediate surgical complications (5/17 vs 25/92 patients). The mean incidence of late surgical complications was 0.71 per patient in group 1 and 0.22 complications per patient in group 2 (p = 0.02). 52.9% of patients in group 1 had at least one late complication compared to 19,6% of patients in group 2 (p = 0.003). The three most common complications in patients with previous psychiatric disorders were chronic diarrhea, vomits and malnutrition. The presence of nutritional deficiencies were common in both groups, mainly soluble vitamins, iron and zinc. During postoperative follow-up, we found 3.1 ± 1.6 nutritional deficiencies per patient in group 1 and 2.5 ± 1.7 in group 2 (p = 0.04). More than three nutritional deficiencies were found in 8 patients in group 1 (52.9%) compared to 23 patients in group 2 (25%) (p = 0.03).ConclusionsThe presence of previous psychiatric disorders may be a predictor of a less positive outcome in morbidly obese patients who undergo bariatric surgery.     

基于控制营养状况评分的2型糖尿病住院患者营养状况评价及其危险因素的多因素Logistic回归分析

摘要 目的：应用控制营养状况（CONUT）评分评价2型糖尿病（T2DM）住院患者营养状况并通过多因素Logistic回归分析营养不良的危险因素。方法：选取2021年1月～2022年1月在我院住院的454例T2DM患者,根据CONUT评分分为营养不良组68例和营养正常组386例。收集患者基线资料,采用多因素Logistic回归分析T2DM住院患者营养不良的危险因素。结果：454例T2DM住院患者营养不良发生率为14.98％（68/454）。单因素分析显示,两组患者糖化血红蛋白A1c（HbA1c）、年龄、高密度脂蛋白胆固醇（HDL-C）、体质指数（BMI）、C反应蛋白（CRP）、病程、淋巴细胞计数、吸烟、血红蛋白、白蛋白、餐后2 h血糖比较,差异有统计学意义（P＜0.05）。多因素Logistic回归分析显示,白蛋白降低、年龄≥60岁、血红蛋白降低、BMI降低、HDL-C降低、病程延长、吸烟、CRP升高为T2DM住院患者营养不良的独立危险因素（P＜0.05）。结论：T2DM住院患者营养不良发生率较高,年龄、BMI、病程、吸烟、白蛋白、血红蛋白、HDL-C、CRP为T2DM住院患者营养不良的独立影响因素,CONUT评分能快速筛查T2DM住院患者营养状况,有助于指导临床及时采取干预措施。     

Validez de la valoración subjetiva global como método de despistaje de desnutrición hospitalaria. Prevalencia de desnutrición en un hospital terciario

IntroductionHospital malnutrition is a highly prevalent problem that affects patient morbidity and mortality resulting in longer hospital stays and increased healthcare costs. Although there is no single nutritional screening method, subjective global assessment (SGA) may be a useful, inexpensive, and easily reproducible tool.MethodsA cross-sectional, observational, randomized study was conducted in 197 patients in a tertiary hospital. SGA, anthropometric data, and biochemical parameters were used to assess the nutritional status of study patients.ResultsFifty percent of subjects were malnourished according to SGA. A higher prevalence of malnutrition was found in medical (53%) as compared to surgical departments (47%). Half the subjects (50%) had malnutrition by SGA, but only 37.8% received nutritional treatment during their hospital stay. Mean hospital stay was longer for patients malnourished (13.5 days) or at risk of malnutrition (12.1 days) as compared to well nourished subjects (6.97 days). SGA significantly correlated (P < .012) with anthropometric and biochemical malnutrition parameters.ConclusionsPrevalence of hospital malnutrition is very high in both medical and surgical departments and is inadequately treated. SGA is a useful tool for screening hospital malnutrition because of its high degree of correlation with anthropometric and biochemical parameters.     

Decreased Inpatient Mortality in Obese Patients With Abdominal Nets

ObjectiveNeuroendocrine tumors (NETs) of the abdomen are rare tumors with an incidence of 3.56 per 100,000 in the general population. Obesity is a growing public health problem with varying effects on the severities of other diseases. We investigated the association between obesity and inpatient morbidity/mortality in patients with abdominal NETs utilizing the Nationwide Inpatient Sample (NIS).MethodsWe analyzed data from the NIS database to investigate the association between obesity and abdominal NETs using patient information from 22,096 patient discharges from January 1, 2009 to December 31, 2010.ResultsWe demonstrate that obesity is strongly associated with decreased rates of inpatient mortality in patients with NET (odds ratio [OR] = 0.6, multivariate P = .02) and that malnutrition is associated with a nearly 5-fold higher risk of inpatient mortality (multivariate P < .0005). We did not find a statistical interaction between obesity and malnutrition; however, patients who were both malnourished and obese had a lower mortality risk than purely malnourished patients.ConclusionsOur data suggests that nutritional status may be an important factor in inpatient mortality in patients with NETs, with obesity being protective. (Endocr Pract. 2014;20:1309-1314)     

老年慢性阻塞性肺疾病患者营养状况及血清甲状腺素和瘦素表达变化及其相关性分析

目的:探讨老年慢性阻塞性肺疾病(COPD)患者的营养状况以及血清甲状腺素、瘦素水平变化,并分析其相关性。方法:选择我院2015年6月至2017年12月收治的64例老年COPD患者作为研究对象,按照营养状态分为营养不良组(34例)和非营养不良组(30例)两组,并选择同期来院检查的32例健康人作为对照组,比较三组患者的营养状况以及血清甲状腺素、瘦素水平,并分析血清瘦素水平与营养状况以及血清甲状腺素的相关性。结果:营养不良组患者的体重、体质量(BMI)、血清清蛋白(ALB)、血红蛋白(Hb)、肩胛下皮褶厚度(SSF)、三头肌皮褶厚度(TSF)、上臂周径(MAC)、上臂肌围长(MAMC)、理想体质量百分比(IBW%)营养状态指标以及血清瘦素、三碘甲状腺原氨酸(T3)、四碘甲状腺原氨酸(T4)、促甲状腺素(TSH)水平明显低于对照组和非营养不良组,差异具有统计学意义(P0.05),而非营养不良组和对照组两组患者的各项营养状态指标差异无统计学意义(P0.05)。老年COPD患者血清瘦素与BMI、TSF、MAC、IBW%营养指标以及血清TSH水平呈正相关(P0.05)。结论:营养不良的老年COPD患者的血清瘦素以及甲状腺素水平明显降低,瘦素与COPD患者相关营养状态指标以及TSH呈正相关,与甲状腺素通过下丘脑-垂体-甲状腺轴,共同参与机体能量代谢、体质量以及饮食的调节。     

血液肿瘤住院患儿营养风险筛查及高度营养风险的危险因素分析

摘要 目的：筛查血液肿瘤住院患儿营养风险,并对其营养不良风险的危险因素进行分析。方法：选取2019年1月-2019年12月我院收治的的血液肿瘤住院患儿290例,采用自制问卷调查表,调查患儿的一般资料情况,采用欧洲肠外肠内营养协会推荐使用的儿科营养风险筛查工具（STAMP）评价患儿营养风险状况,采用单因素及多因素Logistic回归分析高度营养风险的危险因素。结果：依据STAMP评分标准,对研究对象290例患儿进行评价,高度营养风险的患儿247例,占比85.17%。中度营养风险的患儿43例,占比14.83%。低度营养风险患儿0例,占比0.00%。单因素分析结果显示,血液肿瘤住院患儿营养不良风险与年龄、化疗次数、肿瘤分期、总蛋白缺乏、血红蛋白缺乏有关（P<0.05）,而与居住地、性别、肿瘤类型、家庭人均月收入、患儿监护人文化程度无关（P>0.05）。Logistic回归分析发现,年龄为1~3岁、化疗次数＞5次、肿瘤分期为晚期、存在血红蛋白缺乏是血液肿瘤住院患儿高度营养风险的危险因素（P＜0.05）。结论：血液肿瘤住院患儿存在较高比例的营养不良风险,且受年龄、化疗次数、肿瘤分期、血红蛋白缺乏等多种因素影响,临床可考虑针对此类群体进行营养筛查,并给予及时的干预,以改善血液肿瘤住院患儿的营养状况。     

老年住院患者营养不良状况分析

目的:利用简易营养评价精法(short-form mini-nutritional assessment,MNA-SF)评价住院老年患者营养状况,并探讨老年患者营养状况与躯体功能的关系。方法:选取我院老年病及内科收治的年龄≥65岁的住院患者共104例,使用MNA-SF评价患者的营养状况,根据患者年龄、性别、慢性病等情况入组营养不良患者36例,营养良好患者68例,比较两组患者的饮食习惯、躯体功能,并对营养评分与握力、步速进行相关性分析。结果:与营养良好组相比,营养不良组进食肉食次数较少(16%vs 48%, P=0.012),握力[(11.67±9.89)kg vs (20.46±9.89)kg, P0.001]及步速(0.46±0.641m/s vs 1.16±0.65m/s,P0.001)均显著降低。老年住院患者MNA-SF得分与握力及步速呈显著正相关(r=0.562, P0.001)和(r=0.600,P0.001)。结论:住院老年患者的营养状况与进食肉食次数、握力和步速相关。     

A comparison of risk factors for cryptosporidiosis and non-cryptosporidiosis diarrhoea: A case-case-control study in Ethiopian children

BackgroundCryptosporidiosis is a major cause of diarrhoea in young children in low-and-middle-income countries. New interventions should be informed by evidence pertaining to risk factors and their relative importance. Inconsistencies in the literature may to some extent be explained by choice of methodology, furthermore, most previous risk factor studies compared cryptosporidiosis cases to diarrhoea cases of other aetiologies rather than with controls without diarrhoea.Methodology/Principal findingsWe investigated a broad set of factors in under-2-year-olds presenting with diarrhoea to a hospital and a health center in southwestern Ethiopia. We applied quantitative cut-offs to distinguish between cryptosporidiosis and incidental Cryptosporidium infection or carriage, a hierarchical causal framework to minimize confounding and overadjustment, and a case-case-control design, to describe risk factors for both cryptosporidiosis and non-cryptosporidiosis diarrhoea. Moderate and severe acute malnutrition were strongly associated with both cryptosporidiosis and non-cryptosporidiosis diarrhoea. Previous healthcare attendance and low maternal education were only associated with cryptosporidiosis, whereas unsafe child stool disposal, prematurity and early cessation of exclusive breastfeeding were significantly associated with non-cryptosporidiosis diarrhoea only. By estimation of population attributable fractions, socioeconomic factors—specifically low maternal education—and public tap water use, were apparently more important risk factors for cryptosporidiosis than for non-cryptosporidiosis diarrhoea.Conclusions/SignificanceNutritional management of moderate acute malnutrition may be an effective intervention against cryptosporidiosis, particularly if combined with targeted therapy for cryptosporidiosis which, again, may mitigate nutritional insult. Focused caregiver education in healthcare settings and follow-up of children with acute malnutrition may prevent or improve outcomes of future episodes of cryptosporidiosis.     

肠内营养对活动期溃疡性结肠炎伴营养不良患者营养状况、肠黏膜屏障功能和肠道菌群的影响

摘要 目的：观察肠内营养对活动期溃疡性结肠炎（UC）伴营养不良患者营养状况、肠黏膜屏障功能和肠道菌群的影响。方法：选取2019年8月~2021年9月期间上海长征医院收治的120例活动期UC伴营养不良患者,根据随机数字表法分为对照组（60例,接受全肠外营养治疗）和研究组（60例,接受肠内营养治疗）。观察两组治疗3周后的临床总有效率,对比两组治疗前、治疗3周后的营养状况、肠黏膜屏障功能指标和肠道菌群数量,记录两组治疗期间不良反应发生率。结果：研究组（90.00%）临床总有效率高于对照组（68.33%）（P<0.05）。研究组治疗3周后D-乳酸（D-LA）、二胺氧化酶（DAO）、内毒素（ET）水平低于对照组同期（P<0.05）。研究组治疗3周后血清白蛋白、血红蛋白水平高于对照组同期（P<0.05）。研究组治疗3周后乳酸杆菌、双歧杆菌数量高于对照组同期,大肠杆菌数量则低于对照组同期（P<0.05）。两组不良反应发生率对比无差异（P>0.05）。结论：活动期UC伴营养不良患者选用肠内营养进行治疗,可促进营养状况和肠黏膜屏障功能改善,调节肠道菌群结构,安全有效。     

Resultados de la aplicación de un protocolo de valoración nutricional en un centro sociosanitario

The aim of this study was to determine nutritional status in 83 residents of a nursing home and to evaluate outcomes after the application of a nutritional assessment protocol designed by the Department of Social Welfare of the autonomous community of Valencia (Spain).The sample was classified according to body mass index (BMI), hypoalbuminemia and application of the geriatric nutritional risk index. Nutritional interventions consisted of applying general recommendations and follow-up in residents without malnutrition, providing adequate powdered diets in residents with chewing and swallowing disorders and risk of bronchoaspiration, adjusting total enteral nutrition in residents with nasogastric feeding tubes and initiating vitamin supplementation in residents with severe malnutrition.After 3 months, the mean BMI showed a nonsignificant increase (P=.168), reducing the number of residents with malnutrition from 29% to 23%. The number of residents who received nutritional supplements without indication also decreased, resulting in an estimated saving of 965 euros. Active participation of the multidisciplinary team in the coordinated and continuous follow-up of nutritional status in residents contributed to achieving adequate nutritional status and improved the rational use of artificial nutrition in the nursing home.     

帕金森病患者营养不良的影响因素分析及与衰弱、认知功能和跌倒风险的关系研究

摘要 目的：分析帕金森病（PD）患者营养不良的影响因素,并观察营养不良对衰弱、认知功能和跌倒风险的影响。方法：选取江苏省人民医院2019年3月至2022年3月期间收治的100例PD患者。采用简易营养评价量表（MNA）对研究对象进行营养状态评估,将100例患者分为营养不良组（n=52）和无营养不良组（n=48）。获取所有患者的一般资料,经Logistic回归分析PD患者营养不良的影响因素。同时对比无营养不良组、营养不良组的衰弱、认知功能和跌倒风险情况。结果：PD患者营养不良与年龄、体质量指数、Hoehn-Yahr分级、居住地、婚姻状况、血红蛋白、白蛋白、前白蛋白、每日左旋多巴等效剂量（LEDDs）、睡眠状况、焦虑状况、抑郁状况、味觉障碍、吞咽障碍、食欲下降有关（P<0.05）。Logistic回归分析,结果显示：年龄偏大、Hoehn-Yahr分级为III~V级、睡眠状况偏差、焦虑/抑郁状况严重、味觉障碍、吞咽障碍、食欲下降、LEDDs偏高是PD患者出现营养不良的危险因素（P<0.05）。营养不良组的衰弱发生率高于无营养不良组,衰弱前期、无衰弱发生率低于无营养不良组（P<0.05）。营养不良组的简易精神状态检查量表（MMSE）、蒙特利尔认知评估量表（MOCA）评分低于无营养不良组（P<0.05）。营养不良组的起立-行走计时测验（TUGT）时间、站起测验（CRT）时间长于无营养不良组,走直线步态测验（TGT）正确步数少于无营养不良组（P<0.05）。结论：PD患者营养不良发生风险较高,且受到年龄、睡眠状况、焦虑状况、抑郁状况、Hoehn-Yahr分级、味觉障碍、吞咽障碍、食欲下降、LEDDs的影响,且营养不良可加重衰弱、降低认知功能和增加跌倒风险。