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Malnutrition

Malnutrition. 實習生：曾郁涵 指導老師：林京美營養師 報告日期： 2012/12/21. 2. Clinical Nutrition 29 (2010) 151–153 journal homepage: http://www.elsevier.com/locate/clnu. 3. Recent evidence suggests that varying degrees of acute or chronic inflammation are key contributing factors .

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Malnutrition

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  1. Malnutrition 實習生：曾郁涵 指導老師：林京美營養師 報告日期：2012/12/21

  2. 2 Clinical Nutrition 29 (2010) 151–153 journal homepage: http://www.elsevier.com/locate/clnu

  3. 3 • Recent evidence suggests that varying degrees of acute or chronic inflammation are key contributing factors. • Malnutrition has measurable and important adverse effects on clinical outcomes. • It is important to recognize the presence or absence of a systemic inflammatory response.

  4. Methods 4 • An International Guideline Committee was constituted to develop a consensus approach todefining malnutrition syndromes for adults in the clinical setting. Consensus was achieved through a series of meetings held at the ASPEN and ESPEN Congresses.

  5. 5 S R M D R M C A D R M

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  8. 8 • Translation of this diagnostic approach toroutine clinical practice will require validation. • 2.These transitions may be blunted by nutritional intervention, early recognition of the process isimperative. • 3. Patient with SRM or CDRM is prone to deteriorate quickly with any additional acute inflammatory event. • 4. Sarcopenic obesity may represent a chronic low level inflammatory state.

  9. 9 Clinical Nutrition 30 (2011) 194-201

  10. Introduction 10 • In German hospitals, every fourth adult patient at admission is already malnourished or has a risk. • To improve patient outcome and to decrease costs for the health care systems. • Aim to develop and evaluate a routinely manageable concept for an improved nutritional care of malnourished in-hospital patients.

  11. Under nutrition risk (NRS ≧ 3) IG CG individualized nutritional support (5 to maximum 28 days) standard hospital care • Detailed nutritional assessment • Individual food supply • Fortification of meals （maltodextrin, rapeseed oil, cream, protein powder） • In-between snacks and oral nutritional supplements Prescribed by physician independently. 11 Intervention trial between January 2007 and November 2007 (follow up until June 2008) Exclusion criteria : • no informed consent • terminal condition • expected stay <5 days • previous participation in this study • patient on starvation • PN • being on dialysis

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  13. 13 • average daily energy and protein intake • changes in bodyweight during hospitalization • number of complications • number of antibiotic therapies due to infectious complications • length of hospital stay（LOS） • quality of life Short Form 36 Questions (SF-36) Score • hospital readmission (after six months) • mortality (hospital and six months after discharge) • oral nutrition standard supplement consumption • plasma concentrations of 25-OH-D3, ascorbic acid and glutathione

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  15. I G: 83% CG: 30% ≧75%TEE 15

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  17. 17 p=0.002 66.1 → 68.1 →

  18. Ascorbic acid IG Glutathione - 25-OH-D3 - 18 • Both are low compliance with Oral nutrutional supplement(ONS). • In-hospital complications was lower in IG than in CG. • Antibiotics treatment were more often prescribed to patients of CG than IG. • Patients of CG were more often re-hospitalized.

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  21. 21 • Body weight attribute a major effect to energy intake. • ＜75% TEE, was associated with weight loss. • Acute or chronic disease has to consider an higher metabolic rate. • Lack of energy and protein is accompanied with micronutrient deficiencies . • Food quality shall still be considered apart from food quantity.

  22. 22 • Nutritional care has to follow a tight algorithm in order to guarantee that the daily individual needs. • Malnourished patients profit from nutrition support regarding nutrition status and quality of life. • They have fewer complications, need fewer antibiotics and are less often re-hospitalised

  23. 23 Clinical Nutrition 31 (2012) 637-646

  24. Introduction 24 • If nutritional therapy is not adequately provided, these patients have a higher risk of diminished physiological function, complications, longer length of hospital stay, decreased quality of life, and mortality. • This study aimed at exploring food sensory quality as experienced and perceived by patients at nutritional risk during various meals.

  25. NRS-2002 ≧ 3 • Food intake ＜ 75% 25 • Meal observations • food records • open-ended question (experiences and preferences)

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  28. 28 • Food sensory perception and eating ability • Food sensory needs

  29. 29 • Motivation to eat • Pleasure • Comfort • Survival • Hospital admission versus post-discharge

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  33. 33 • The study generated a model for optimizing food sensory quality and even developing innovative foods to promote intake in patients at nutritional risk.

  34. Summary • The commentary present a simple etiology-based construct for the diagnosis of adult malnutrition in the clinical setting. • To develop and evaluate a routinely manageable concept for an improved nutritional care of malnourished in-hospital patients. • A model for optimizing food sensory quality and developing innovative foods to promote intake in patients at nutritional risk.

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