Nutritional assessment with different tools in leukemia patients after hematopoietic stem cell transplantation

Objective： Correct nutritional assessment is essential for leukemia patients after hematopoietic stem cell transplantation （HSCT）. This study aimed to investigate the best nutritional assessment method for leukemia patients after HSCT, and find the possible nutritional risk of the patients during the transplantation process in order to intervene in the patients with nutritional risks and undernourished patients timely, so that the entire transplantation process could be successfully completed. Methods： A prospective study was performed in 108 leukemia patients after HSCT, and different nutritional assessment methods, including nutritional risk screening 2002 （NRS2002）, mini nutritional assessment （MNA）, subjective globe assessment （SGA） and malnutritional universal screening tools （MUST）, were used. The associations between nutritional status of these patients and nutritional assessment methods were analyzed. Results： A total of 108 patients completed SGA, and 99 patients completed NRS2002, MNA and MUST. During the treatment process, 85.2% of the patients lost weight, wherein, 50% lost weight greater than 5%, and 42.6% had significantly reduced food intake. For nutritional risk assessment, the positive rates of NRS2002, MNA and MUST were 100%, 74.7% and 63.6%, respectively. There was a significant difference （P〈0.05） among the positive rates of NRS2002, MNA and MUST. In undernutrition assessment, the positive rate of SGA （83.3%） was significantly higher than that of MNA （17.2%） （P〈0.05）, and the incidence rate of nutritional risk among leukemia patients _〈30 years old was greater than that of patients 〉30 years old （P〈0.05）. Conclusions： Patients with leukemia were in poor nutritional status during and after HSCT. The leukemia patients 〈30 years old had a greater incidence rate of nutritional risk. As nutritional risk screening tool, the specificity of NRS2002 is not high, but it can be used for evaluating nutritional deficiencies. MNA is a good nutritional risk screening tool, but not an adequate tool for nutritional assessment. If assessment of undernutrition is necessary, the combination of all these screening tools and clinical laboratory indicators should he applied to improve accuracy.

Assessment of the Nutritional Status of 202 Elderly People Living at Home in Sidi-Bel-Abbès (Western Algeria)

Background: Malnutrition is common for elderly representing a major public health problem with many consequences for the health. Objectives: To assess the nutritional status of a population of elderly living at home. Subjects and Methods: The assessment was conducted from a population of elderly living at home who saw their doctor in the office of a public health centre. For each subject, the anthropometric parameters (weight, height, body mass index (BMI)), biochemical (serum albumin) and Mini Nutritional Assessment (MNA) tools have been measured and calculated. Results: 202 mostly female (56.44%) subjects aged 73.59 ± 5.87 years were included in this study. 78% were suffering from chronic diseases, the most frequent of which was diabetes (32%). 7.43% of the diseased population have BMI < 21, 5.94% experienced undernutrition (MNA < 17) and 68.81% are at risk of malnutrition (MNA: 17 - 23.50). According to serum albumin, 8.91% of the sample is considered to be malnourished. Conclusion: The MNA has proven to be a screening tool more sensitive than other tools (BMI and albumin) in the evaluation of nutritional risk.

Assessment of Risk of Malnutrition in Elderly Hypertensive Patients with or without Associated Cardiovascular Risk Factors Living at Home (West Algeria) Sidi-Bel-Abbès

Undernutrition is frequently underestimated in the elderly, because clinical manifestations are non-specific. For the francophone Club geriatrics and nutrition, poly medication is one of the warning signs to be the possibility of malnutrition in an elderly person. To do this, it is particularly interesting to verify what the profiles of hypertensive patients who are at risk of malnutrition are. This component remains very little explored and studies are lacking. The authors conducted a descriptive cross-sectional study whose objective is to evaluate the prevalence of undernutrition in hypertensive patients with or without associated cardiovascular risk factors, in a population of consultants of liberal medical offices, determine the profiles of hypertensive patients who are at risk of undernutrition and describe their eating habits and their anthropometric parameters as well as the link between the number of supported antihypertensives and risk of undernutrition. 1144 patients with an average age of 65 years old have been collected during the period of recruitment. The data collection was done using a questionnaire: the MNA. Sensitive and specific, it is validated method which has international sacle. The percentage of the risk of malnutrition was estimated at 36.7%. Thus the number of associated cardiovascular risk factors becomes larger, and the risk of malnutrition is increased. The risk of malnutrition was three times higher in patients who take more than three medications per day compared with those who consumed less (75.8% vs. 24.2%). As a monotherapy, an increased risk of malnutrition is associated with diuretics. For these older hypertensives, the risk of malnutrition was linked to the type of used dual. The percentage of hypertension risk of malnutrition treated with free dual was significantly higher compared to hypertensive treated dual handset. Some associations have proved to be more favorable than others in terms of nutritional risk. Finally, a third of hypertension patients who were treated with quadruple therapy were at risk of malnutrition. This work was also designed to present an argument to a doctor to detect the risk of undernutrition in elderly hypertensives. The use of the MNA is a simple, effective and quick way for pressure balance rhymes with nutritional balance.

Nutritional Status of Elderly People Living at Home in Sidi-Bel-Abbes (West Algeria)

The aim of the study was to assess the nutritional status of a cohort of elderly people living independently at home. 314 elderly individuals were selected during general medicine examinations. The collection of nutritional data concerned the measurement of some anthropometric parameters (body weight, height, and BMI), the Mini Nutritional Assessment (MNA) and serum albumin. The average age was 72.92 ± 6.26 years with a feminine predominance (59.55%). The BMI was 25.63 ± 4.43 Kg·m-2 and serum albumin 36.45 ± 5.77 g·L-1. 61% of the investigated population were affected by chronic diseases such as: diabetes (39%). Using the MNA as a mean of screening;46.18% of individuals presented a risk of malnutrition and 4.78% were undernourished. However, when the BMI and serum albumin were used;14.01% and 42.35% have been considered as undernourished respectively. The MNA seems to be a more sensitive tool rather than the other screening parameters (BMI and serum albumin) in the assessment of nutritional risk in the elderly.

Associations of social participation, demographic, socioeconomic and disease factors with nutritional risk in a group of older Hong Kong adults

Aims: To identify the impact of social participation, socio-demographic, socio-economic and disease factors on nutritional risk among older persons in Hong Kong. Background: Few published work has investigated the relative risks of social participation, demographic, socioeconomic and disease factors with malnutrition in community-living older people, this study is to investigate the associations of these risk factors on the nutritional status in better nutrition support for the old age group. Design: A crosssectional study. Methods: It was a secondary analysis of a database in a mobile community centre between January 2008 and December 2009. One thousand seven hundred and thirty one participants aged between 54 and 103 were collected. With 319 full Mini Nutritional Assessment (MNA) completed, the participants’ demographic, socio-economic data, diseases, and nutritional status were analyzed with relative risk and 95% confidence interval level to identify the factors that make them vulnerable to nutritional risk. Results: The prevalence of malnutrition in the community-dwelling old was 3.95% and 83.7% of the sample was at risk of malnutrition. Living on allowances, young old who was socially engaged and good relationship with family members were at less risk to malnutrition. Conclusions: Special attention should be taken to these groups as they are prone to develop malnutrition.

Elderly Persons Aged 80 Years and Older and Their Nutritional Status

A challenge for health care providers is that there will be a distinct rise globally in the number of elderly people aged 80 years and over. Malnutrition is a well-known problem among elderly people;few studies have focused on the nutritional status of those aged over 80, irrespective of whether they live in nursing homes (NHs) or in ordinary housing. The aim of the study was to examine the nutritional status of elderly people aged 80 or older. The study was cross-sectional with 64 elderly persons (80 - 100 years old) living in NHs (n = 35) or in ordinary housing (n = 29). Their nutritional status was assessed with the Mini Nutritional Assessment. Among the elderly people living in NHs, half were at risk and one fourth were suffering from malnutrition. Ten percent of the elderly persons in ordinary housing were found to be at risk;none were malnourished. Thirty-one percent had BMI values <23. The majority of the participants ate 2 - 3 meals per day and were prescribed more than three medications daily. Although not statistically significant, well-nourished participants were more likely to be married, and to rate their psychological and physical health very good/good compared to participants who were at risk of becoming malnourished or were malnourished. In conclusion, the results indicate that special attention regarding nutritional intake is required for those aged 80 years and older irrespective of type of accommodation. The RNs have a responsibility to identify the problems and needs and to implement and evaluate nutritional care in this age group. There is a further need for knowledge regarding the effects of both nutritional interventions and of their optimum timing.

不同营养评估法在老年长期卧床患者预后评价中的应用

目的探讨2种不同营养评估法在老年长期卧床患者预后评价中的应用对比。方法选择2022年1月至2022年12月接治的80例老年长期卧床患者作为本次研究对象,均采取营养风险筛查2002(NRS2002)、微型营养评估简表(MNA-SF)对患者预后营养状况评估,以膳食回顾、人体测量(BMI<18.5 kg/m^(2))和体成分分析(或白蛋白<35 g/L)等营养评定指标作为评定营养不良的标准作为金标准,并对NRS2002、MNA-SF量表与金标准评估情况进行对比,明确适合老年长期卧床患者预后营养状况的筛查方法。结果80例患者经金标准评估,其中49例判定为营养不良;NRS2002判定45例为营养不良,MNA-SF量表评定49例营养不良,与金标准对比,2组评估结果并无明显统计学差异(P<0.05)。2种营养评估方案评估营养不良发生率对比差异无统计学意义(P<0.05)。NRS2002、微型营养评估简表对患者预后营养状况评估结果显示,2种评估方案与传统血液检验指标对比差异无统计学意义(P<0.05);不同疾病长期卧床老年患者预后NRS2002评分对比差异无统计学意义(P<0.05);不同疾病长期卧床老年患者预后MNA-SF量表评分对比差异无统计学意义(P<0.05)。结论MNA-SF与NRS2002评估方案均具有全面、准确等优势,操作便捷,无创安全,评估耗时较短,可适用于老年长期卧床患者的预后营养预估。

微型营养评定法简表在老年脑卒中患者营养筛查中的应用

目的应用微型营养评定法简表(MNA-SF)评价老年脑卒中患者营养状况,探讨MNA-SF在老年脑卒中患者营养评估中的可行性及其相关因素。方法采用便利抽样方法,选取2018年4~10月在某三甲医院神经内科住院的320例老年脑卒中患者为研究对象,运用MNA-SF和传统营养指标测定对其营养状况进行评价。并应用日常生活活动能力量表(ADL)、简易精神状态量表(MMSE)、老年抑郁量表(GDS)、匹兹堡睡眠质量指数(PSQI)对老年脑卒中患者进行评估,分析其与营养状况的相关性。结果应用MNA-SF评估结果营养不良者占5.62%,存在营养风险者占39.38%,营养良好者占55%。18<体重指数(BMI)<23占67.9%,BMI、血红蛋白(HB)、白蛋白(ALB)、前白蛋白(PA)、红细胞计数(RBC)作为传统评价指标,患者营养不良发生率分别为2.19%、4.69%、13.13%、8.75%、11.56%。MNA-SF与患者自理能力、认知能力、抑郁状态、睡眠状态呈显著相关(P<0.05)。结论老年脑卒中患者营养不良及营养风险率高,临床中应对老年脑卒中患者进行营养筛查,为临床医生选择合理的营养支持方式提供依据。

老年骨质疏松症患者营养状况评估及影响因素分析

目的:分析老年骨质疏松症患者营养状况及影响因素。方法:回顾性分析2019年2月至2022年5月该院骨科收治的75例老年骨质疏松症患者的临床资料,统计老年骨质疏松症患者营养状况,比较不同临床资料类别患者营养不良发生率,采用多因素Logistic回归分析老年骨质疏松症患者营养不良的影响因素。结果:75例老年骨质疏松症患者中,营养状况良好30例(40.00%),存在营养不良风险37例(49.33%),存在明确的营养不良8例(10.67%)。男性、年龄≥70岁、离异或丧偶、月收入低、吸烟、饮酒、不经常运动、独居、中重度骨质疏松患者的营养不良发生率更高,与其他类别比较,差异有统计学意义(P<0.05)。不同文化程度、职业类型患者营养不良发生率比较,差异无统计学意义(P>0.05)。Logistic回归分析结果显示,男性、年龄≥70岁、离异或丧偶、月收入低、吸烟、饮酒、不经常运动、独居、中重度骨质疏松均为老年骨质疏松症患者营养不良的独立危险因素(OR>1,P<0.05)。结论:老年骨质疏松症患者营养不良发生率较高,男性、年龄≥70岁、离异或丧偶、月收入低、吸烟、饮酒、不经常运动、独居、中重度骨质疏松均属于老年骨质疏松症患者营养不良的独立危险因素。

MNA-SF和GLIM标准在住院老年COPD患者营养评估中的应用

目的 比较微型营养评定(MNA-SF)和全球领导人营养不良倡议(GLIM)标准在住院老年慢性阻塞性肺疾病(COPD)患者营养不良诊断中的一致性。方法 采用方便抽样选取2020年1月至2021年12月于宜宾市第二人民医院住院老年COPD患者489例,采用MNA-SF和GLIM标准进行营养不良评估,并分析其结果的一致性。结果 采用MNA-SF诊断营养良好、营养不良风险和营养不良者分别为172例(35.17%)、228例(46.63%)和89例(18.20%),不同年龄段、是否合并慢性病及病程MNA-SF评分和营养不良情况差异有统计学意义(P<0.05)。通过营养风险筛查2002(NRS 2002)得到营养风险发生率为50.31%,GLIM标准诊断营养不良发生率为28.83%,<70岁患者营养风险和营养不良发生率高于≥70岁患者,合并慢性病患者营养风险和营养不良发生率高于未合并慢性病患者,病程越长营养风险和营养不良发生率越高(P<0.05)。MNA-SF和GLIM标准诊断营养不良的Kappa值为0.675,NRS 2002与MNA-SF诊断营养不良风险的Kappa值为0.619,将MNA-SF与GLIM诊断的营养不良等级进行相关性分析,其Kappa值为0.348(P<0.05)。结论 住院老年COPD患者营养风险和营养不良发生率高,MNA-SF和GLIM标准均可用于住院老年COPD患者营养不良诊断。

三种方法对住院老年稳定性冠心病患者的营养风险状况筛查分析

目的采用营养风险筛查2002(nutritional risk screening 2002,NRS2002)、微型营养评定简表(mini nutritional assessment short form,MNA-SF)和老年营养风险指数(geriatric nutritional risk index,GNRI)筛查老年冠心病患者的营养风险,探讨适合住院老年冠心病患者营养风险筛查的工具。方法选取2019年1月至2022年12月宜宾市第一人民医院住院治疗的311例老年稳定性冠心病患者作为研究对象,采用NRS2002评分、MNA-SF评分和GNRI评估患者营养风险,分析3种方法筛查结果的一致性。结果NRS2002评分营养风险发生率为37.62%,MNA-SF评分营养良好、营养不良风险和营养不良发生率分别为22.83%、60.77%和16.40%,GNRI高、中、低和无营养风险发生率分别为9.97%、34.08%、26.69%和29.26%,年龄>70岁与年龄≤70岁患者3种评分及营养风险发生率比较,有显著差异(P<0.01)。有共病患者与非共病患者3种评分及营养风险发生率比较,有显著差异(P<0.05,P<0.01)。以NRS2002评分≥3分、MNA-SF评分≤11分和GNRI≤98定义为有营养风险,其一致性Kappa值分别为0.259(NRS2002评分vs MNA-SF评分)、0.375(NRS2002评分vs GNRI)和0.691(MNA-SF评分vs GNRI)。以白蛋白<30 g/L为阳性金标准,NRS2002评分、MNA-SF评分和GNRI与阳性标准诊断的Kappa值分别为0.647、0.146和0.268(P<0.01)。结论GNRI与NRS2002评分和MNA-SF评分比较,更适合用于老年冠心病患者营养风险筛查。

病程早期迷你营养评估简表评分与脓毒症患者预后的关系

目的探讨病程早期迷你营养评估简表(MNA-SF)评分与脓毒症患者预后的关系。方法选取2022年1月1日—12月31日首都医科大学附属北京潞河医院急诊危重症中心收治的142例脓毒症患者为研究对象,根据住院28 d全因死亡情况将患者分为存活组和死亡组。比较2组基线资料、临床数据、MNA-SF评分、序贯器官衰竭评估(SOFA)评分、快速SOFA(qSOFA)评分、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分。采集患者抗菌药物使用时间、住院时间及住院费用。分析脓毒症患者住院28 d全因死亡的影响因素;绘制受试者工作特征(ROC)曲线分析MNA-SF、SOFA、APACHEⅡ评分对脓毒症患者预后的预测价值。结果住院期间共40例患者死亡(死亡组),其余102例患者存活(存活组)。死亡组MNA-SF评分、白蛋白水平、体重指数、淋巴细胞计数、抗菌药物使用时间、住院时间均低于/短于存活组,qSOFA评分、SOFA评分、APACHEⅡ评分、住院费用均高于存活组(均P<0.05)。多因素Logistic回归分析结果显示,MNA-SF评分、SOFA评分、APACHEⅡ评分是脓毒症患者住院28 d全因死亡的独立影响因素(均P<0.05)。ROC曲线分析结果显示,MNA-SF评分预测脓毒症患者住院28 d全因死亡曲线下面积(AUC)为0.875(95%置信区间:0.802~0.947),SOFA评分的AUC为0.888(95%置信区间:0.831~0.944),APACHEⅡ评分的AUC为0.870(95%置信区间:0.804~0.935)。结论MNA-SF评分是脓毒症患者住院28 d全因死亡的独立影响因素,且对其具有较高的预测价值。

老年结直肠癌行回肠造口术患者术前和术后营养评估

目的评估老年结直肠癌患者行回肠造口术前后的营养状况,分析影响患者营养状况变化的相关因素。方法选取2020年1月至2021年12月结直肠癌行回肠造口术的老年患者37例。应用微型营养评价(MNA)评估患者术前、术后第7、21天的营养状况。结果与术前比较,所有患者MNA评分在术后第7、21天均下降。包括体重、活动能力、体重指数(BMI)、每天正餐次数、每天摄入的水果和蔬菜的比例以及上臂中点围,差异均有统计学意义(P<0.05)。术前,33例(89.2%)患者能外出活动。术后第21天,24例(64.9%)患者能外出活动。BMI>23 kg/m^(2)的患者术前为29例(78.4%),术后第21天为11例(29.7%)。对于患者每天摄入的水果和蔬菜次数,15例(40.5%)患者术前每天至少摄入2次,而术后第21天5例(13.5%)患者每天仅1次。术前所有患者臂围均>22 cm。而在术后第21天仅13例(35.1%)患者臂围>22 cm。结论回肠造口术后前21 d,老年结直肠癌患者的营养状况因营养的摄入总量和成分减少将受到显著影响。临床医师和护士需要在这期间警惕患者的营养状况,共同监测营养参数,并在需要时提供临床治疗和护理指导。

R+营养师小程序在癌症患者营养风险评估中的价值研究

目的 验证在线营养风险自我筛查工具--R+营养师小程序在癌症患者营养评估中的有效性。方法 随机纳入131位癌症患者,扫描小程序后按步骤填写得出营养评分数据。同时按照NRS2002量表和PG-SGA量表对其做出标准营养评估。统计分析小程序营养评分数据与研究人员得出的标准得分数据的相关性和一致性,前瞻性地评估R+营养师在癌症患者中进行营养风险筛查的有效性。结果 小程序中PG-SGA评估灵敏度81%,特异度72%,阳性预测值38%,阴性预测值94%。NRS2002评估灵敏度79%,特异度81%,阳性预测值47%,阴性预测值95%。小程序在癌症患者营养评估中准确性高(P<0.05)。小程序PG-SGA评分与量表PG-SGA评分有中等的一致性、较强的相关性;小程序NRS2002评分与NRS2002量表评分有中等的一致性、较强的相关性。年龄差异可能造成NRS2002营养评分的差异(P=0.002),但性别差异对癌症患者营养评分无明显影响(P>0.05)。结论 运用R+营养师小程序来评估癌症患者营养状况可以作为快速营养评估的手段。

MNA和MNA-SF评价老年人营养状况比较

目的 比较简易营养评价法 (MNA)和简易营养评价精法 (MNA SF) 2种评价老年人营养状况方法 ,以及 2种方法和传统营养指标的相关性。 方法 利用MNA、MNA SF量表对住院老年人进行调查 ,同时测定传统营养指标。 结果 MNA量表测试结果 :住院老年人营养不良患病率为 3 6 1% ;潜在营养不良的有 46 5 % ;营养正常的有 17 4% ;MNA SF量表测试结果 :住院老年人营养不良患病率为 71 5 % ;营养正常的为 2 8 5 %。MNA SF与MNA相比 ,敏感性为 85 7% ,特异性 96 0 % ,准确性 87 5 % ,相关系数为 0 93 3 ,且与传统营养指标的相关性一致。 结论 MNA与MNA SF是快捷、简便、可靠的老年营养状况评价方法 ,且MNA SF更简便、更适用于临床调查。

微型营养评定法在老年慢性阻塞性肺疾病患者中的应用及其与BODE指数的相关性

目的探讨微型营养评定法（MNA）在老年慢性阻塞性肺疾病（COPD）患者中的应用,分析其与BODE指数的相关性。方法选择2012年4月~10月南方医科大学珠江医院呼吸内科门诊稳定期COPD老年患者139例,采用MNA评估营养状态并分为营养良好组、营养风险组及营养不良组。测定患者的体测指标、肺功能、6分钟步行距离（6MWD）,采用MMRC评估呼吸困难程度。按BODE指数评分标准进行评分,并分析其与MNA评分间的相关性。结果 3组间性别构成无统计学意义（P〉0.05）,年龄及体测指标差异具统计学意义（P〈0.001）。3组间BODE指数参数FEV1%Pred、BMI、MMRC、6MWD的评分情况差异均有统计学意义（P〈0.001）。MNA评分与BODE指数呈负相关（r=-0.605,P〈0.001）。结论 MNA与体测指标、BODE指数密切相关,适用于COPD人群;营养是COPD患者症状的重要影响因素,改善营养状态是缓解症状的有效措施之一。

应用微型营养评价法及微型营养评价精法评价恶性肿瘤患者的营养状况

目的探讨微型营养评价法(MNA)及微型营养评价精法(MNA-SF)对恶性肿瘤患者营养状况的评价作用,了解其与传统营养评价指标的相关性。方法对167例恶性肿瘤患者同时应用MNA及MNA-SF进行营养评价,并且测量人体学指标和实验室指标,分析MNA及MNA-SF与传统评价指标的相关性。结果根据MNA值评定为营养不良者101例(60.5%),潜在营养不良者34例(20.4%),营养正常者32例(19.1%);根据MNA-SF值评定为营养不良者117例(70.1%),营养正常者50例(29.9%)。MNA法与MNA-SF法有高度相关性(r=0.948,P<0.01)。MNA法和MNA-SF法均与传统营养评价法中的体质指数(r=0.646、0.723)、肱三头肌皮褶厚度(r=0.493、0.571)、上臂肌围(r=0.559、0.459)、腓肠肌围(r=0.675、0.680)、血红蛋白(r=0.539、0.492)、总蛋白(r=0.634、0.555)、白蛋白(r=0.585、0.543)、前白蛋白(r=0.593、0.541)、总淋巴细胞计数(r=0.418、0.371)呈正相关(P值均<0.01)。结论恶性肿瘤患者营养不良的发生率高,MNA法和MNA-SF法均是评价恶性肿瘤患者营养状况的有效方法。

3种营养筛查工具在老年压疮高危患者中的应用比较

目的明确微型营养评价法(mini-nutritional assessment,MNA)、微型营养评价精法(short-form mini-nu-tritional assessment,MNA-SF)和营养风险筛查方案(nutrition risk screening2002,NRS2002)对老年压疮高危患者进行营养风险筛查的适用性。方法应用3种营养筛查工具对684例消化科老年压疮高危患者进行营养风险筛查,2χ检验比较3种营养筛查工具评定结果及应用营养支持组间压疮发生率的差异;用Kappa值、敏感性及特异性分析比较3种营养筛查工具的评定效果。结果 MNA、MNA-SF、NRS2002对684例老年住院患者营养风险检出率分别为74.9%、71.1%和53.5%,3种营养筛查评定结果及应用营养支持压疮发生率组间差异均有统计学意义。以传统营养评价为标准,MNA、MNA-SF、NRS2002的灵敏性分别为92.6%、87.2%和80.1%;特异性分别为42.2%、44.5%和72.1%;Kappa值分别为0.35、0.32和0.52。以压疮发生为标准,MNA、MNA-SF和NRS2002的灵敏性分别为97.5%、94.3%和90.2%;特异性分别为30.1%、34.0%和54.5%;Kappa值分别为0.13、0.12和0.25。结论在判别营养与压疮关系方面,3种量表灵敏性相差不显著,准确性以NRS2002最高,适用于老年压疮高危患者营养风险筛查。

老年胃肠肿瘤患者术前营养状况及营养支持的调查与分析

目的调查并分析老年胃肠肿瘤患者的术前营养状况及营养支持情况,为临床营养管理提供科学依据。方法采用定点连续抽样法,选择2014年7月至2015年2月就诊于中南大学湘雅二医院老年外科的146例老年胃肠肿瘤拟手术治疗的患者为研究对象,运用简易营养评价精法(short-form mini nutritional assessment,MNA-SF)评估其术前营养状况,分析MNA-SF评价结果与传统营养指标的关系,同时调查患者接受营养支持的情况。结果146例患者中,营养正常者66例(45.21%),其中17例接受了营养支持。有营养问题者共80例(54.79%),其中:潜在营养不良62例(42.47%),有38例接受了营养支持;营养不良18例(12.33%),有16例接受了营养支持。营养正常、潜在营养不良和营养不良3组患者的年龄、白蛋白(albumin,ALB)、前白蛋白(pre-albumin,PA)、血红蛋白(hemoglobin,Hb)、淋巴细胞总数(LC)及身体质量指数(body mass index,BMI)经比较,差异均有统计学意义(均P<0.01)。结论老年胃肠肿瘤患者术前营养问题较为普遍,医护人员应在营养评估的基础上予以合理的营养支持,MNA-SF简便、有效,适用于老年胃肠肿瘤患者术前的营养筛查和评估。

简易营养评估法评估老年腹膜透析患者的营养状况

目的:采用简易营养评估法(mininutritional assessment,MNA)对老年腹膜透析患者进行营养评估,并与传统的主观综合营养评估(subjective global assessment,SGA)方法进行比较。方法:采用横断面调查的方法,对我院腹膜透析中心的45例患者(60岁以上)进行问卷调查以及人体测量,分别用SGA与MNA两种方法,同时检测患者血液中白蛋白、前白蛋白水平、血常规,检测了与标化的蛋白质相当的总氮呈现率(nPNA),进行饮食调查。结果:(1)根据SGA,无营养不良22例(49%),轻至中度营养不良14例(31%),重度营养不良9例(20%);根据MNA,无营养不良18例(40%),存在营养不良风险17例(38%),营养不良10例(22%)。(2)依据SGA与MNA评分,分别在不同营养状态的三组间进行以下指标的比较:平均每日每公斤体重能量与蛋白质摄入(DEI、DPI)、血白蛋白、nPNA、透析月龄、残余肾功能,透析充分性指标(Kt/V、Ccr)差异均有显著性统计学意义(P<0.05)。但无营养不良组的DEI、DPI异常率在SGA评分时达到了64%,而MNA评分时降至28%(P<0.05);存在营养不良的两组患者,血白蛋白与前白蛋白的正常率,SGA评分时为43%与60%,MNA评分为44%与59%。存在明显营养不良时,两种评分的指标异常均明显升高。(3)无论采用SGA还是MNA方法,两种分类法的统计学结果是一致的。(4)在评估结果与各指标相关性研究中,发现SGA与MNA评分结果与一系列客观指标显著相关,MNA法较优。结论:(1)SGA与MNA皆是评价老年腹膜透析营养状况的简单有效方法,但还需结合其它的营养评估指标,如DEI、DPI、血白蛋白、前白蛋白、nPNA。(2)在某些方面,MNA评估法优于SGA评分。SGA对于评价已有的营养不良有效,而MNA更有利于早期发现需要营养干预的患者。MNA评估法简单易行,值得推广,需进一步研究。