肿瘤内科住院患者膳食认知行为横断面多中心研究

A multi-center survey on dietary knowledge and behavior among Chinese inpatients in oncology department

目的调查肿瘤内科住院患者膳食认知现状、膳食摄入量、营养状况,分析肿瘤患者膳食营养知识水平、行为习惯及营养不良可能的发生原因,为医护人员对患者进行营养宣教及营养治疗提供依据。方法以全国分布的18家医院,选择肿瘤内科住院患者进行横断面调查研究。患者以面对面调查形式自行填写膳食知识及行为问卷调查,主诊医生查房询问患者膳食摄入情况及进行食欲评分;营养师进行营养风险筛查、膳食史回顾调查,按ESPEN及中国肿瘤营养指南推荐的拇指法则计算患者的能量及蛋白质每日目标需要量。比较患者实际营养摄入量与目标摄入量是否有差别。结果共完成535例有效问卷调查:95.2%的患者认为科学的膳食非常重要,70%的患者对如何科学的膳食存在疑问,82.0%的患者会遇到膳食知识矛盾的困惑,当获取的膳食信息有矛盾时,64.2%的患者会听取主诊医师的意见;主诊医师、网络、电视是患者了解如何科学膳食的最主要的3条途径,分别占所有途径的26.0%、18.5%以及16.1%;99.6%的患者存在膳食知识误区,认为患病后不可食用某类或全部富含蛋白质的食物;90.0%以上的患者服用灵芝孢子粉、海参、人参、冬虫夏草以及其他类保健食品;93.0%的患者未接受过规范的营养教育。通过营养风险筛查、膳食调查及评价发现:15.6%的患者存在营养风险(NRS 2002≥3分),实际每日摄入能量为1169.20±465.97kcal,显著性低于目标需求量1797.95±375.27kcal(P<0.01),仅达目标需要量的65.3%;实际每日蛋白质摄入量为46.55±21.40g,显著性低于目标需求量(P<0.01),仅达目标需要量的74.4%。主诊医师查房询问患者膳食情况表明:69.0%的患者认为饮食还行、挺好的、很好或者非常好。通过膳食回顾调查发现,其中有34.0%的患者能量摄入不足目标量60.0%。可见如果仅通过查房医生简单的询问,不足以正确的反应患者的实际膳食摄入情况。结论肿瘤内科住院患者对科学的膳食营养认知差,接受规范的营养教育率低。患者普遍存在膳食摄入量低,NRS 2002评分或查房医生的询问不足以反映肿瘤患者的实际摄入情况。因此,加强临床医生与营养师的密切合作,有针对性的进行营养宣教将对改善患者的膳食知识及行为起到重要作用。

Objective To investigate the current associated factors of dietary knowledge,intake and nutritional status in malignancy inpatients,and the malnutrition causes involved in dietary nutrition knowledge level,behavior,providing recommendations to patients for nutrition education and intervention.Methods535participants,from18hospitals were investigated by a self-made questionnaire composed of dietary knowledge and behavior.Physicians asked and recorded the level of dietary intake and appetite scoring of the participants.Nutritional risk screened with NRS2002and dietary survey by24h dietary recalls were completed by adietitian.Besides,the target energy intake and the target protein intake was calculated by“rule of thumb”recommended by ESPENguideline,comparing the difference between the actual intake and target intake.Results According to the questionnaire,95.2%ofparticipants thought it was important to have a good dietetic habit,and nearly half of them searched for guides on how to diet;70%of the patients had no clear idea of what was a scientific dietary;82%of patients had contradictary dietary knowledge contradiction;64.2%of patients would listen to the opinion of the attending physician when contradiction happened.The three main ways tolearn about diet are attending physician,network,and TV,respectively26.0%,18.5%and16.1%.Importantly,99.6%of the patientmistakes on dietary knowledge,for example,crab,chicken,lamb,fish and prawns should not be eaten by cancer patients.In addition,more than90%of participants taking ganoderma lucidum spore powder,sea cucumber,ginseng,cordyceps sinensis and so on.93%of the patients never received a qualified nutrition education.Besides,15.6%of the participants had nutritional risk(NRS2002≥3scores).The actual daily energy intake was1169.20±465.97kcal,which was significantly less than target energy intake(P<0.01),amounting to65.3%of the target requirements.Actual daily protein intake was46.55±21.40g,which was significantly less than targetenergy intake(P<0.01),amounting to74.4%of target requirements.On the other hand,69%of the participants were“Not too bad,Ok,Good or Very good”according to the records of physicians,while34%of them did not reach60%of the target requirementsthrough dietary recall.So the results of physicians’inquiries did not reflect the actual dietary intake for cancer patients.Conclusions The survey indicated that cancer patients had poor understanding of the scientific dietary nutrition and were in low level of normative nutritional education among Chinese malignancy inpatients.Dietary intake of most cancer patients decreased,and the actual intake cannot be responded by NRS2002scoring or the physicians’inquiring.It is necessary to enhance the cooperation between dietitians and physicians,and hold targeted nutrition education,in order to improve the level of dietary knowledge.