再论营养不良的三级诊断

Rethinking for three-level diagnosis of malnutrition

准确的营养诊断是合理营养治疗的前提。2015年,中国抗癌协会肿瘤营养与支持治疗专业委员会提出营养不良的三级诊断后,得到了社会各界的高度认同,被广泛引用与讨论,认为三级诊断是一个创新,通过了解营养不良的后果,从而更好地指导临床治疗。本文小结几年来的工作体会,综合社会各界的意见与建议,结合国际营养诊断的最新进展,对营养不良的三级诊断提出再一次讨论。本次讨论对第二、三级诊断的营养评估、综合评价重新进行了界定,将膳食调查、人体学测量和能量需求估算重新归位于营养评估,增加国际领导人营养不良倡议、格拉斯哥预后评分等内容,将第二级诊断——营养评估局限在直接的“营养”上,使其回归营养评估本身,将营养评估的目标锁定于发现有无营养不良并判断其严重程度,从而将与营养直接或间接相关的、超出营养评估定义的内容纳入第三级诊断——综合评价。将第三级诊断的名称由综合测定修改为综合评价。通过本次讨论,使营养不良三级诊断更加明晰、更加流畅。

A precise nutrition diagnosis is the prerequisite of proper nutrition therapy provision.Since its proposal by the Chinese Society for Oncology Nutrition and Supportive Care in 2015,the three-level diagnosis system for nutrition has been in the center of focus and discussion.The three-level system is considered as an innovative method to present the consequences of malnutrition so that a better treatment could be provided.In the current review,the concept of the three-level system is updated and outlined by combining the clinical experiences,suggestions from various sectors,and recent advances in nutrition diagnosis.This discussion revises the second and the third level in the system,namely,nutritional assessment and comprehensive investigation.Dietary assessment,anthropometry,and energy requirement estimation are now parts of nutritional assessment.The new system also includes criteria such as global leadership initiative on malnutrition(GLIM)and Glasgow prognostic score(GPS).Such modifications allow for focusing on nutrition-related parameters during the nutritional assessment to identify the presence of malnutrition or the severity of malnutrition.In this discussion,comprehensive measurement is now represented by the comprehensive investigation.It comprises evaluations on variables that are directly or indirectly related to nutrition,as well as contents beyond the definition of a nutritional assessment.The updated three-level diagnosis system for nutrition provides a clearer and more practical guidance in a clinical setting.