营养风险筛查NRS2002的临床应用观察

采用营养风险筛查2002(NRS2002),选取2012年1月至2012年12月在上海市第十人民医院呼吸内科、肝胆内科、神经内科、普通外科、脊柱外科的新入院住院患者进行营养风险筛查,并调查住院期间的营养支持状况及营养指标的变化。结果显示,共有750例患者入选,呼吸内科和神经内科营养风险最高均为42%,但存在营养风险的患者营养支持率分别为23.8%和31.7%,肝胆内科存在营养风险的患者营养支持率最高,但也仅为47.6%;营养风险≥3分的患者中体质指数(BMI)、血清前白蛋白(PA)、血红蛋白(HB)3个指标均低于营养风险<3分的患者,且存在统计学意义(p<0.05)。结果表明,NRS2002适用于住院患者营养风险筛查,存在营养风险的患者营养支持率普遍较低,相关营养指标可辅助判断营养状况。     

Serum insulin-like growth factor levels do not predict functional recovery after hospitalization in nonagenarian patients

AIM: To analyze the insulin-like growth factor 1 (IGF-1) serum levels in nonagenarian patients and to investigate the predictive capacity of this measure to assess the functional recovery of this population following hospitalization. METHODS: We performed a prospective study in 60 consecutive nonagenarian patients admitted for medical or surgical diseases. We assessed IGF-1 serum levels and nutritional status. The functional status was assessed using the Barthel index. Thirty-four patients were reinvestigated 3 months after discharge from hospital. RESULTS: The mean levels of IGF-1 were lower in nonagenarians than in younger patients. No relationship was found between IGF-1 levels and nutritional status. The decline in Barthel index values 3 months after discharge from hospital did not correlate with serum levels of IGF-1 on admission. CONCLUSION: IGF-1 serum levels in nonagenarian patients do not predict functional recovery after hospitalization.     

不同营养评价方法对住院患者营养状况评价的比较及意义

目的:分析比较身高标准体重法、体质指数法(BMI法)、体质指数校正法与生物电阻抗测量方法在住院患者营养评价中的意义。方法:随机抽取我院内科176名患者作为观察对象,用以上4种方法分别进行营养状况评价,测量结果采用单因素卡方分析法和Ridit分析比较。结果:用4种方法评价同一群体住院病人的营养状况时,其结果的差异有显著意义。结论:评判体脂和肥胖时应该首选能反映身体脂肪量及比例和身体内脂肪分布的腰臀比指标。标准体重法、BMI法和BMI校正法三种方法,在评价住院患者的营养状况时,最好能将腰臀比指标与其他指标共同使用。     

Efficacy of liraglutide, a glucagon-like peptide-1 (GLP-1) analogue, on body weight, eating behavior, and glycemic control, in Japanese obese type 2 diabetes

ABSTRACT: BACKGROUND: We recently reported that short-term treatment with liraglutide (20.0 +/- 6.4 days) reduced body weight and improved some scales of eating behavior in Japanese type 2 diabetes inpatients. However, it remained uncertain whether such liraglutide-induced improvement is maintained after discharge from the hospital. The aim of the present study was to determine the long-term effects of liraglutide on body weight, glycemic control, and eating behavior in Japanese obese type 2 diabetics. METHODS: Patients with obesity (body mass index (BMI) >25 kg/m2) and type 2 diabetes were hospitalized at Osaka University Hospital between November 2010 and December 2011. BMI and glycated hemoglobin (HbA1c) were examined on admission, at discharge and at 1, 3, and 6 months after discharge. For the liraglutide group (BMI; 31.3 +/- 5.3 kg/m2, n = 29), patients were introduced to liraglutide after correction of hyperglycemic by insulin or oral glucose-lowering drugs and maintained on liraglutide after discharge. Eating behavior was assessed in patients treated with liraglutide using The Guideline For Obesity questionnaire issued by the Japan Society for the Study of Obesity, at admission, discharge, 3 and 6 months after discharge. For the insulin group (BMI; 29.1 +/- 3.0 kg/m2, n = 28), each patient was treated with insulin during hospitalization and glycemic control maintained by insulin after discharge. RESULTS: Liraglutide induced significant and persistent weight loss from admission up to 6 months after discharge, while no change in body weight after discharge was noted in the insulin group. Liraglutide produced significant improvements in all major scores of eating behavior questionnaire items and such effect was maintained at 6 months after discharge. Weight loss correlated significantly with the decrease in scores for recognition of weight and constitution, sense of hunger, and eating style. CONCLUSION: Liraglutide produced meaningful long-term weight loss and significantly improved eating behavior in obese Japanese patients with type 2 diabetes.     

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.     

Weight Loss and Decrease of Body Mass Index during Allogeneic Stem Cell Transplantation Are Common Events with Limited Clinical Impact

Purpose

Weight loss in cancer patients has been attributed with significant morbidity and mortality. During allogeneic stem cell transplantation (SCT), oral nutrition is often hampered and hence total parenteral nutrition (TPN) is necessary. We therefore investigated the course of weight during stem cell transplantation and the clinical consequences of weight change.

Methods

180 consecutive patients who received allogeneic SCT between January 2010 and December 2011 at our center were analyzed for weight loss, laboratory and clinical parameters.

Results

During SCT, a median decrease of 6.6% of body mass index (BMI) was observed for the whole population (from 25.3 at admission to 23.6 at discharge), and a 1.6fold increase of malnutrition despite use of TPN (28.3% to 45.0%). 55.6% of patients experienced a significant weight loss of ≥5% with a median decrease of 9.2% in BMI. Serum levels of albumin, total protein and cholesterol rapidly decreased during conditioning therapy. After a median of 2.4 years, the median BMI was still only 23.4 (not different from discharge). However, we did not observe a meaningful difference in side effects and survival between patients that did or did not lose weight.

Conclusion

Weight loss is commonly observed during allogeneic SCT despite TPN, but the clinical consequences thereof seem limited: we observed no significant impact on patients with a decrease ≥ 5% in BMI on transplant outcome, side effects or survival.     

Risk Factors for Hospital Readmission after Radical Gastrectomy for Gastric Cancer: A Prospective Study

Background

Hospital readmission is gathering increasing attention as a measure of health care quality and a potential cost-saving target. The purpose of this prospective study was to determine risk factors for readmission within 30 days of discharge after gastrectomy for patients with gastric cancer.

Methods

We conducted a prospective study of patients undergoing radical gastrectomy for gastric cancer from October 2013 to November 2014 in our institution. The incidence, cause and risk factors for 30-day readmission were determined.

Results

A total of 376 patients were included in our analysis without loss in follow-up. The 30-day readmission rate after radical gastrectomy for gastric cancer was 7.2% (27of 376). The most common cause for readmission included gastrointestinal complications and postoperative infections. On the basis of multivariate logistic regression analysis, preoperative nutritional risk screening 2002 score ≥ 3 was an independent risk factor for 30-day readmission. Factors not associated with a higher readmission rate included a history of a major postoperative complication during the index hospitalization, prolonged primary length of hospital stay after surgery, a history of previous abdominal surgery, advanced age, body mass index, pre-existing cardiopulmonary comorbidities, American Society of Anesthesiology grade, type of resection, extent of node dissection and discharge disposition.

Conclusions

Readmission within 30 days of discharge after radical gastrectomy for gastric cancer is common. Patients with nutritional risk preoperatively are at high risk for 30-day readmission. Preoperative optimization of nutritional status of patients at nutritional risk may effectively decrease readmission rates.     

胃癌术后早期经鼻空肠营养管肠内营养患者的强化护理的临床效应

目的:探讨强化护理措施对胃癌患者术后营养状态的改善作用,为减少术后营养相关并发症的发生提供可借鉴的方法。方法:选择2012年1月-2013年12月在我科实施胃癌手术患者的临床资料进行分析,根据术后营养支持方式的不同,将患者分为早期肠内营养支持组和常规肠内营养组。观察并比较两组患者的生命体征变化、术后肛门排气时间及并发症的发生情况等。结果:强化护理组23例胃癌患者给予术后早期肠内营养治疗后,恢复肛门排气时间为53±7.4 h,经过5±2.1 d的肠内营养后,术后体重增加1.2±0.4 kg,无肠内营养相关并发症发生,肠外营养支持时间明显缩短。结论:本研究显示强化早期肠内营养护理具有迅速改善胃癌病人营养不良状态,减少营养不良相关并发症发生,减轻病人经济负担等优点。     

营养干预对局部晚期鼻咽癌患者放化疗期体质量及营养状态的影响

目的:探讨营养干预对局部晚期鼻咽癌患者在放化疗期间的营养状态及体质量的影响。方法:选取我院2015年1月-2019年12月收治的112例鼻咽癌晚期患者,按随机数表法分成营养干预组和对照组各56例,均采用同一放化疗治疗方案,观察组在此基础上给予营养干预。对比两组患者在放化疗治疗期间的生活质量(QOL)评分、营养状态、黏膜损害程度、体质量变化和近期疗效。结果:放射剂量达40Gy时,营养干预组QOL评分≥41分的比例显著高于对照组(P0.05);放疗结束后营养干预组发生Ⅲ级以上的口腔黏膜损害的患者比例显著低于对照组(P0.05);放化疗第4周营养干预组的体质量显著高于对照组(P0.05);放化疗治疗结束后两组原发灶残余比例和淋巴结转移比例比较均无统计学差异(P0.05);放化疗第4、7周营养干预组的血红蛋白(Hb)、总蛋白(TP)和白蛋白(Alb)显著高于对照组(P0.05)。结论:鼻咽癌患者在放化疗期间,营养状况下降明显,营养干预治疗能够有效改善患者的体质量和营养状况,对于患者的后续治疗具有重要意义,应在晚期鼻咽癌的临床治疗中推广营养干预。     

Nutritional Status of Maintenance Dialysis Patients: Low Lean Body Mass Index and Obesity Are Common,Protein-Energy Wasting Is Uncommon

Background and Aims

Maintenance dialysis patients are at increased risk of abnormal nutritional status due to numerous causative factors, both nutritional and non-nutritional. The present study assessed the current prevalence of protein-energy wasting, low lean body mass index and obesity in maintenance dialysis patients, and compared different methods of nutritional assessment.

Methods

In a cross-sectional study conducted in 2014 at Roskilde Hospital, Denmark, we performed anthropometry (body weight, skinfolds, mid-arm, waist, and hip circumferences), and determined plasma albumin and normalized protein catabolic rate in order to assess the prevalence of protein-energy wasting, low lean body mass index and obesity in these patients.

Results

Seventy-nine eligible maintenance dialysis patients participated. The prevalence of protein-energy wasted patients was 4% (95% CI: 2–12) as assessed by the coexistence of low lean body mass index and low fat mass index. Low lean body mass index was seen in 32% (95% CI: 22–44). Obesity prevalence as assessed from fat mass index was 43% (95% CI: 32–55). Coexistence of low lean body mass index and obesity was seen in 10% (95% CI: 5–19). The prevalence of protein-energy wasting and obesity varied considerably, depending on nutritional assessment methodology.

Conclusions

Our data indicate that protein-energy wasting is uncommon, whereas low lean body mass index and obesity are frequent conditions among patients in maintenance dialysis. A focus on how to increase and preserve lean body mass in dialysis patients is suggested in the future. In order to clearly distinguish between shortage, sufficiency and abundance of protein and/or fat deposits in maintenance dialysis patients, we suggest the simple measurements of lean body mass index and fat mass index.     

Coenzyme Q10 concentration in plasma and blood cells of juvenile patients hospitalized for anorexia nervosa

The antioxidant status of coenzyme Q10 (CoQ10) was investigated in plasma, erythrocytes, and platelets of juvenile patients with anorexia nervosa. Blood for analysis of the CoQ10 status was taken from 16 juvenile patients suffering from anorexia nervosa (restricting form) at the time point of admission to the hospital and at discharge after about 12 weeks. Plasma and blood cells isolated by a density gradient were stored at -84 °C until analysis. CoQ10 concentration and redox status were measured by high pressure liquid chromatography with electrochemical detection and internal standardization. The improvement of physical health during the hospital refeeding process was followed up by the body mass index (BMI). The antioxidant status of plasma CoQ10 in juvenile patients suffering from anorexia nervosa indicated no abnormalities in comparison to healthy controls. However, the decreased concentration of CoQ10 observed in platelets at the time point of hospital admission may represent mitochondrial CoQ10 depletion. This initial deficit improved during the hospital refeeding process. The platelet CoQ10 concentration showed a positive correlation to the BMI of the patients.     

93例糖尿病住院患者的营养状况评价

对糖尿病住院患者入院时进行营养评价,分别对93例30～60岁糖尿病患者入院时做人体测量和生化检查,与正常人群作对照.结果显示,观察组患者的体质量、体质指数、总蛋白、白蛋白、低密度酯蛋白以及三酰甘油的平均值均高于正常组、而高密度脂蛋白低于正常组,差异有显著性意义(p＜0.05).结果表明,采用多项综合指标评价糖尿病患者的...     

Relationship between Affective Symptoms and Malnutrition Severity in Severe Anorexia Nervosa

Background

Very few studies have investigated the relationship between malnutrition and psychological symptoms in Anorexia Nervosa (AN). They have used only body weight or body mass index (BMI) for the nutritional assessment and did not always report on medication, or if they did, it was not included in the analysis of results, and they did not include confounding factors such as duration of illness, AN subtype or age. The present study investigates this relationship using indicators other than BMI/weight, among which body composition and biological markers, also considering potential confounders related to depression and anxiety.

Methods

155 AN patients, (DSM-IV) were included consecutively upon admission to inpatient treatment. Depression, anxiety, obsessive behaviours and social functioning were measured using various scales. Nutritional status was measured using BMI, severity of weight loss, body composition, and albumin and prealbumin levels.

Results

No correlation was found between BMI at inclusion, fat-free mass index, fat mass index, and severity of weight loss and any of the psychometric scores. Age and medication are the only factors that affect the psychological scores. None of the psychological scores were explained by the nutritional indicators with the exception of albumin levels which was negatively linked to the LSAS fear score (p = 0.024; beta = −0.225). Only the use of antidepressants explained the variability in BDI scores (p = 0.029; beta = 0.228) and anxiolytic use explained the variability in HADs depression scores (p = 0.037; beta = 0.216).

Conclusion

The present study is a pioneer investigation of various nutritional markers in relation to psychological symptoms in severely malnourished AN patients. The clinical hypothesis that malnutrition partly causes depression and anxiety symptoms in AN in acute phase is not confirmed, and future studies are needed to back up our results.     

Childhood malnutrition and growth in a rural area of Western Kenya

An anthropometric survey was carried out on 1,383 school students aged 5-17 years in Suba district (a rural area of western Kenya). Body size and proportion were computed from height, weight, sitting height, arm circumference, and skinfolds. The aim of the study was to evaluate patterns of growth and nutritional status of the Luo population by assessment of the prevalence and trends of malnutrition among children and adolescents. Very few age-groups show significant sex differences for height, body weight, and arm muscle area. However, there are several differences in skinfold thicknesses and arm circumference, always with higher mean values in girls. Analysis of the nutritional status (weight-for-age, height-for-age, and BMI-for-age) shows significant differences among the age-groups in both sexes. Boys present lower Z-scores than girls and there are higher percentages of malnourished subjects (stunted and underweight) among the males. The Luo data were compared with those of other African populations. Their body dimensions, nutritional status, and growth are similar to those of the other sub-Saharan samples. In conclusion, the Luo children are generally undernourished at the older ages: adolescents (11-16 years of age) show the most severe undernutrition and the highest percentages of undernourished subjects. In addition to the higher risk of undernutrition in teenagers, an emerging problem of over-nutrition is evident among the younger age-groups, with a higher prevalence in females. These findings are discussed in light of sexual dimorphism in sensitivity to adverse environmental conditions.     

Nutritional Status of Children Hospitalized for Parapneumonic Effusion

Background & Aims

Among children hospitalized for pneumonia, those with parapneumonic effusion (PPE) are at particular risk for nutritional deterioration. This study aimed to 1) investigate the evolution of the nutritional status during hospitalization and at outpatient follow-up; 2) determine clinical risk factors for weight loss during hospitalization; 3) describe the nutritional interventions for these children.

Methods

Retrospective chart review (January ‘07 - September ‘12) of 56 children with pneumonia, complicated by PPE in two Belgian hospitals for data on body weight and height at admission (t₀) and discharge (t₁), and two weeks (t₂) and one month (t₃) after discharge. Length of hospitalization (LoS), length of stay in paediatric intensive care (LoS_PICU) and maximal in-hospital weight loss (t_max) were calculated and nutritional interventions were recorded.

Results

The median (range) age was 3.5 (1.0–14.8) years. Weight or height was lacking in five (8.9%) children at t₀ and in 28 (50%) at t₁; 21.4% was weighed only once during hospitalization. At t_max, respectively 17/44 and 5/44 children lost ≥5% and ≥10% of their weight. Median (range) LoS and LoS_PICU were 18.0 (10–41) and 4.0 (0–23) days. One-fourth received a nutritional intervention. Weight for height at admission (WFH(t₀)) significantly predicted maximal weight loss (β (95% CI) = −0.34 (−2.0–−0.1); p = 0.03). At t₂ and t₃, 13/32 and 5/22 of the children with available follow-up data did not reach WFH(t₀), whilst in 4/35 and 5/26 body weight remained ≥5% under the weight(t₀).

Conclusions

One-third of children with pneumonia complicated by PPE and monitored for weight and height, lost ≥5% of their body weight during hospitalization. One-fourth did not reach initial WFH one month after discharge. Those with a higher WFH at admission were at higher risk of weight loss. More attention for monitoring of weight loss and the nutritional policy during and after hospitalization is warranted.     

Malnutrition and the heart.

Earlier concepts that the heart is spared in malnutrition have been shown to be incorrect. Inadequate intake of protein and energy results in proportional loss of skeletal and myocardial muscle. As myocardial mass decreases, so does the ability to generate cardiac output; however, various compensatory factors come into play. Nutritional supplementation for malnourished patients reverses the compensatory factors and may increase the short-term potential for heart failure. Severe cardiac debility results in poor nutrition, which may in turn produce unsuspected but clinically significant myocardial atrophy. Nutritional support may play a role in improving cardiac function in selected patients with cardiac cachexia who are being prepared for cardiac surgery and in patients with rapid weight loss who are at risk for sudden death due to arrhythmias. Malnutrition is common in hospitalized patients, and many patients in hospital now receive nutritional supplementation; both facts have important cardiac implications.     

Seasonal variation of body weight loss after bariatric surgery

Seasonal variations have been described in humans in several variables such as sleep, mood, appetite, food preferences, or body weight. We hypothesized that these variations could also influence the decrease in body weight rate in patients submitted to body weight loss interventions. Thus, here we tested the variations of weight loss according to the time of the year the surgery took place in a group patients (n = 1322) submitted to bariatric surgery in the Hospital Universitari de la Vall d’Hebron in Barcelona (geographical coordinates: 41°25?41″N 2°8?32″E). For the analysis, the percentage of total body weight loss (%TWL), excess body weight loss (%EWL) and percentage of body mass index loss (%BMIL) were calculated at 3 (n = 1255), 6 (n = 1172), 9 (n = 1002), and 12 months (n = 1076) after surgery. For %EWL and %BMIL a statistically significant seasonal variation was detected when the variables were calculated at 3 months, but not at the other times, with more weight loss in summer-fall. However, seasonal variations were not detected for %TWL (p = 0.09). The mean amplitude of the seasonal rhythm for %EWL was of 1.8%, while for the rhythm of %BMIL was 0.7%. Moreover, a second peak was detected in January–February modulating the seasonal rhythm of the two variables. Results confirm seasonal variations in humans and indicate that short term responses to weight loss can be modulated by the time of year.     

Obese patients in medical intensive care unit: influence of counseling on weight loss and cardiovascular parameters

A case series of 12 obese patients admitted to medical intensive care unit (ICU) due to life-threatening diseases and the influence of weight loss on cardiovascular parameters is presented. We assessed body weight, body mass index (BMI), blood pressure, pulse, and laboratory values on admission. At discharge from ICU patients were counseled on how to lose weight. They were examined one and six months later. Statistically significant (p < 0.05) decrease of body weight (median at the beginning of a treatment 134 kg, after six months 127.5 kg), BMI (median 41.5 kg/m2 at the beginning of a treatment; 38.9 kg/m2 after six months), systolic blood pressure (medians 145 mmHg and 130 mmHg), diastolic blood pressure (medians 95 mmHg and 85 mmHg) and pulse (medians 104 beats per minute, 78 beats per minute) was found. The reduction of the waist circumference was not significant. One patient died due to severe acute pancreatitis. Patients reported feeling much better after losing weight.     

Nutritionele screening bij de oncogeriatrische patiënt

Geriatric patients are not defined by their age but by their general profile. Ageing is characterized by loss of organ function together with a reduced capability for adapting to changes in the environment (loss of homeostatic mechanisms) leading to frailty. In the older patient with cancer, there can be problems of dietary intake next to the effects of ageing per se. On top of this situation, the deleterious effects of the inflammatory processes induced by the tumour are superimposed. When these changes are translated into nutritional concepts, it is clear that, in the older cancer patient, there is a strong overlap of starvation, sarcopenia, and cachexia. Nutritional assessment should be part of the routine preliminary evaluation of the older oncology patient. Difference should be made between assessment of risk and actual nutritional status, which should be assessed with specific malnutrition indices. Body weight assessment with specific attention to unintended weight loss is essential in this evaluation. One should recognise the fact that body mass index (BMI) should be interpreted with caution, but that a low value for BMI still heralds an increased malnutrition risk. This increased alertness for nutritional problems has a lot to offer in the willingness for early intervention. The nutritional assessment, however, must be framed in a larger comprehensive geriatric assessment addressing several functional domains.     

胃肠外科术后ERAS及大承气冲剂对患者手术应激影响

摘要 目的：探讨胃肠外科术后加速康复外科(enhanced recovery after surgery,ERAS)及大承气冲剂对患者手术应激影响。方法：选取我院近3年所收治的80例胃肠外科手术患者,将其随机分为研究组和对照组,每组患者40例,两组患者围手术期分别采取ERAS及大承气冲剂、传统处理方法及常规西医治疗结合安慰剂,对比围手术期不同处理方式对患者手术应激影响。结果：两组患者手术前心理（汉密尔顿焦虑量表(Hamilton Anxiety Scale,HAMA)）、生理（C反应蛋白(CRP)、肾上腺素、皮质醇）应激指标对比无统计学差异（P＞0.05）,手术后7 d,研究组患者各项应激指标均明显低于对照组（P＜0.05）;研究组患者术后首次排气时间、术后首次排便时间、术后首次下床活动时间、平均住院时间均明显短于对照组（P＜0.05）;两组患者手术前各营养状态对比均无统计学差异（P＞0.05）,对比指标发现,各营养指标均应激降低后,逐渐恢复,研究组患者术后3 d降低程度明显低于对照组（P＜0.05）,在手术后7 d逐渐恢复术前水平。结论：胃肠外科术后ERAS及大承气冲剂更有利于患者术后胃肠功能恢复,术后应激反应更轻,促使患者机体营养状态稳定,可缩短患者的住院时间,促使患者术后康复,值得临床上推广应用。