上海市134例老年肺结核患者营养状况评价

Evaluation on nutritional status of 134 elderly patients with pulmonary tuberculosis in Shanghai

目的了解上海市老年肺结核患者的营养状况,分析其膳食营养素摄入量和膳食结构。方法选取2018年3—8月收治于上海市肺科医院结核科符合肺结核诊断标准的134例老年肺结核患者。采用微型营养评定法(MNA)评估患者营养状况;采用24 h膳食调查法和连续3天食物频率法了解膳食营养素摄入情况和膳食结构;同时对上述患者进行体格检查及实验室检查。结果上海市134例老年肺结核患者MNA评估结果显示营养状况良好、存在营养不良的危险和营养不良的比例分别为37.3%、30.6%和32.1%。除维生素E、铁和锌的摄入量接近中国居民膳食营养素参考摄入量(DRIs)外,每日能量、蛋白质、脂肪、碳水化合物、维生素A、D、C、B_1、B_2和B_6、钙、磷、碘和硒摄入量,均低于DRIs。营养不良组及存在营养不良的危险组的体重、体质指数、上臂肌围、腓肠肌围、血红蛋白、总蛋白、前白蛋白、白蛋白及转铁蛋白等指标均明显低于营养状况良好组(均P<0.05)。每日谷类和豆类及制品摄入量基本符合中国居民膳食指南要求,蔬菜、水果、蛋类和奶类及谷类制品摄入量偏低,肉禽水产类偏高。结论上海市134例老年肺结核患者营养不良与营养不良的危险发生率较高,该群体大部分存在多种膳食营养素摄入不足及膳食结构欠合理,临床医护人员及营养部门应有针对性地改善其营养状况。

[Objective]To understand the nutritional status of elderly tuberculosis patients in Shanghai,analyze their dietary nutrients intakes and dietary pattern.[Methods]134 elderly pulmonary tuberculosis patients were selected from Department of Tuberculosis in Shanghai Pulmonary Hospital from March to August in 2018.The nutritional status of the patients was assessed using the Mini Nutritional Assessment(MNA).The dietary nutrients intakes and dietary pattern were assessed using a 24-hour dietary survey and a three-day food frequency method.Meanwhile,the physical and laboratory tests were performed on these patients.[Results]The MNA assessment of elderly tuberculosis patients showed that the patients with good nutritional status,potential malnutrition and malnutrition accounted for 37.3%,30.6%and 32.1%,respectively.The daily intakes of energy,protein,fat,carbohydrates,vitamins A,D,C,B1,B2,B6,calcium,phosphorus,iodine and selenium were all lower than Chinese dietary nutrient reference intake(DRIs),while the intakes of vitamin E,iron and zinc approached DRIs.The body weight,body mass index,upper arm muscle circumference,gastrocnemius circumference,hemoglobin,total protein,prealbumin,albumin and transferrin in potential malnutrition group and malnutrition group were significantly lower than those in good nutrition group.The daily intakes of cereals and beans and products basically met the dietary guidelines of Chinese residents.However,these patients had lower intakes of vegetables,fruits,eggs and dairy products and cereals,and higher intakes of aquatic products,meat and poultry.[Conclusion]There is a high incidence of malnutrition and its risk in 134 elderly tuberculosis patients in Shanghai.Most of patients have insufficient intakes of various dietary nutrients and unreasonable diet pattern.The clinical staff and nutrition departments should improve their nutritional status by taking targeted measures.