上海市134例老年肺结核患者营养状况评价
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摘要
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,B_1,B_2,B_6,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.
[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,B_1,B_2,B_6,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.
引文
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[3]高宁,郭元霞,张小云.肺结核患者营养风险状况及其影响因素的研究[J].中华护理杂志,2014,49(5):552-555.
[4]KIM DK,KIM HJ,KWON SY,et al.Nutirtional deficit as anegative prognostic factor in patients with miliary tuberculosis[J].Eur Respir J,2008,32(4):1031-1036.
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[9]LEANDRO MVA,AQUINO JL.A nthropometric parameters of nutrition a lasse ssment as predictive factors of the Mini Nutritional Assessnmnt(MNA)of hospitalized elderly patients[J].The J Nutr,Health Aging,2011,15(3):181-186.
[10]王玉萍,倪小元.老年肺结核患者营养风险与营养不足分析[J].浙江预防学,2014,26(1):59-61.
[11]侯婧,张妍蓓.536例老年肺结核患者血清白蛋白、血红蛋白等相关指标分析.实用医学杂志[J],2016,32(1):134-136.
[12]SORENSEN J,KONDRUP J,PROKOPOWICZ J,et a1.Euro00PS:an international,multicentre study to implement nutritional risk screening and evaluate clinical outcome[J].Clin Nutr,2008,27(3):340-349.
[13]JIE B,JIANG ZM,NOLAN MT,et a1.Impact of nutritional support on clinical outcome in patients at nutritional risk:a multicenter,prospective cohort study in Baltimore and Beijing teaching hospitals[J].Nutrition,2010,26(11/12):1088-1093.
[14]JIE B,JIANG ZM,NOLAN MT,et a1.Impact of preparative nutritional support on clinical outcome in abdominal surgical patients at nutritional risk[J].Nutrition,2012,28(10):1022-1027.
[15]JEEJEEBHOY KN,KELLE H,GRAMLICH L,et al.Nutritional assessment:comparison of clinical assessment and objective variables for the prediction of length of hospital stay and readmission[J].AJCN,2015,101(5):956-965.
[16]中国营养学会.中国居民膳食营养素参考摄入量速查手册(2013版)[M].北京:中国标准出版社,2014:12-31.
[17]DENT E,CHAPMAN IM,PIANTADOSI C,et al.Performanceof nutritional screening tools in predicting poor six-month outcome in hospitalised older patients[J].APJCN,2014,23(3):394-399.
[18]吴道宏,昊本俨.低热量营养支持用于高龄老年患者的可行性[J].中华临床营养杂志,2010,18(1):9-11.
[19]中国营养学会.中国居民膳食指南2016:科普版[M].北京:人民卫生出版社,2016:91-95.
[20]肖和平,沙巍,成诗明.结核病专科医师培训教程[M].北京:科学出版社,2017:313.
[21]中华医学会.第十届(2017)全国“老年疾病与营养支持”学术大会会议纪要[J].中华临床营养杂志,2017,25(5):325-326.
[22]李润娜,赵滢.56例老年肺结核合并糖尿病的营养健康教育[J].中国医药指南,2017,15(9):288-289.
[2]全国第五次结核病流行病学抽样调查技术指导组.2010年全国第五次结核病流行病学抽样调查报告[J].中国防痨杂志,2012,34(8):485-508.
[3]高宁,郭元霞,张小云.肺结核患者营养风险状况及其影响因素的研究[J].中华护理杂志,2014,49(5):552-555.
[4]KIM DK,KIM HJ,KWON SY,et al.Nutirtional deficit as anegative prognostic factor in patients with miliary tuberculosis[J].Eur Respir J,2008,32(4):1031-1036.
[5]李亮,李琦,许绍发.结核病治疗学[M].北京:人民卫生出版社,2013:136-138.
[6]中华人民共和国国家卫生健康委员会.肺结核诊断WS 288-2017[S/OL].(2017-11-09)[2018-05-01].http://www.nhc.gov.cn/ewebeditor/uploadfile/2017/11/20171128164254246.pdf.
[7]全国科学技术名词审定委员会.《肠外肠内营养学名词》预公布[Z/OL].(2016-05-01)[2018-12-03].http://www.cnctst.cn/xwdt/tzgg/201605/t20160520_335857.html.
[8]MARTINS CPAL,CORREIA JR,AMARAL TF.Undernutrition risk screening and length of stay of hospitalized elderly[J].J of Nutr For the Elderly,2005,25(2):5-21.
[9]LEANDRO MVA,AQUINO JL.A nthropometric parameters of nutrition a lasse ssment as predictive factors of the Mini Nutritional Assessnmnt(MNA)of hospitalized elderly patients[J].The J Nutr,Health Aging,2011,15(3):181-186.
[10]王玉萍,倪小元.老年肺结核患者营养风险与营养不足分析[J].浙江预防学,2014,26(1):59-61.
[11]侯婧,张妍蓓.536例老年肺结核患者血清白蛋白、血红蛋白等相关指标分析.实用医学杂志[J],2016,32(1):134-136.
[12]SORENSEN J,KONDRUP J,PROKOPOWICZ J,et a1.Euro00PS:an international,multicentre study to implement nutritional risk screening and evaluate clinical outcome[J].Clin Nutr,2008,27(3):340-349.
[13]JIE B,JIANG ZM,NOLAN MT,et a1.Impact of nutritional support on clinical outcome in patients at nutritional risk:a multicenter,prospective cohort study in Baltimore and Beijing teaching hospitals[J].Nutrition,2010,26(11/12):1088-1093.
[14]JIE B,JIANG ZM,NOLAN MT,et a1.Impact of preparative nutritional support on clinical outcome in abdominal surgical patients at nutritional risk[J].Nutrition,2012,28(10):1022-1027.
[15]JEEJEEBHOY KN,KELLE H,GRAMLICH L,et al.Nutritional assessment:comparison of clinical assessment and objective variables for the prediction of length of hospital stay and readmission[J].AJCN,2015,101(5):956-965.
[16]中国营养学会.中国居民膳食营养素参考摄入量速查手册(2013版)[M].北京:中国标准出版社,2014:12-31.
[17]DENT E,CHAPMAN IM,PIANTADOSI C,et al.Performanceof nutritional screening tools in predicting poor six-month outcome in hospitalised older patients[J].APJCN,2014,23(3):394-399.
[18]吴道宏,昊本俨.低热量营养支持用于高龄老年患者的可行性[J].中华临床营养杂志,2010,18(1):9-11.
[19]中国营养学会.中国居民膳食指南2016:科普版[M].北京:人民卫生出版社,2016:91-95.
[20]肖和平,沙巍,成诗明.结核病专科医师培训教程[M].北京:科学出版社,2017:313.
[21]中华医学会.第十届(2017)全国“老年疾病与营养支持”学术大会会议纪要[J].中华临床营养杂志,2017,25(5):325-326.
[22]李润娜,赵滢.56例老年肺结核合并糖尿病的营养健康教育[J].中国医药指南,2017,15(9):288-289.