Planas M, Audivert S, Pérez-Portabella C, Burgos R, Puiggrós C, Casanelles J M, Rosselló J
Nutritional Support Unit, University Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, Barcelona 08035, Spain.
Clin Nutr. 2004 Oct;23(5):1016-24. doi: 10.1016/j.clnu.2004.01.003.
Although malnutrition in hospitalized patients is generally associated with increasing morbidity and mortality, it is yet a widely unknown problem in hospitals.
The aim of this study was to assess the nutritional status of patients admitted to a university-affiliated hospital in Spain using anthropometry measurements and the Subjective Global Assessment (SGA) technique.
We enrolled 400 patients selected at random using a computer software program. The primary end-point was nutritional status determined within 48 h of admission by anthropometric data (body mass index, triceps skinfold thickness, and upper arm muscle circumference) and by the SGA technique. Using anthropometric data, patients were considered to have normonutrition or malnutrition. Those with malnutrition, were subdivided in patients with low (undernutrition) or high (overnutrition) body weight. Through SGA patients were classified as having normonutrition or malnutrition (moderate and severe). Secondary end-points were hospital length of stay (LOS), mortality, and readmissions (total and non-elective readmissions) over the next 6 months. Overall population, patients scheduled admitted, patients admitted from emergency room, and those with any cancer were individually analyzed.
The frequency of malnutrition varied from 72.7% assessed by anthropometry (undernutrition in 26.7% and overnutrition in 46.0%), to 46% using SGA. Malnutrition was not related to the type of admission neither to the diagnosis of cancer. Of 400 patients analyzed, two patients died (0.5%). Using SGA, LOS was significantly higher in patients with malnutrition vs. those with normonutrition, in the overall population and in patients scheduled admitted, and there were more total and non-elective readmissions in patients with malnutrition than in patients with normonutrition in the overall population, in patients scheduled admitted and in those with cancer. When we used anthropometric data, LOS was superior in undernutrition compared to normo and overnutrition in scheduled admitted patients alone. Although there were more total readmissions in undernutrition than in normonutrition and overnutrition in overall population, no significant differences were observed with the non-elective readmission rate.
A high prevalence of malnutrition was found in this study. At a time, a high prevalence of overnutrition was observed. Anthropometric data and SGA technique are not concordant, reflecting the limitations of markers of nutritional status. While with SGA malnutrition was detected in patients with normal to high BMI, with anthropometry overnutrition was diagnosed. SGA seems to be more accurate than anthropometry to anticipate hospital LOS and readmission rate. Due to the increased LOS and readmission rates found in patients with malnutrition, further steps among health care professionals are warranted to identify and control them.
尽管住院患者的营养不良通常与发病率和死亡率的增加相关，但在医院中这仍是一个普遍不为人知的问题。
本研究的目的是使用人体测量学方法和主观全面评定（SGA）技术评估西班牙一家大学附属医院收治患者的营养状况。
我们使用计算机软件程序随机招募了400名患者。主要终点是入院48小时内通过人体测量数据（体重指数、三头肌皮褶厚度和上臂肌肉周长）和SGA技术确定的营养状况。根据人体测量数据，患者被认为具有正常营养或营养不良。营养不良的患者又被细分为体重低（营养不良）或高（营养过剩）的患者。通过SGA，患者被分类为具有正常营养或营养不良（中度和重度）。次要终点是接下来6个月的住院时间（LOS）、死亡率和再入院率（总再入院率和非择期再入院率）。对总体人群、计划入院患者、急诊室入院患者以及任何癌症患者进行了单独分析。
通过人体测量法评估的营养不良发生率从72.7%（26.7%为营养不良，46.0%为营养过剩）到使用SGA的46%不等。营养不良与入院类型和癌症诊断均无关。在分析的400名患者中，有两名患者死亡（0.5%）。使用SGA时，总体人群和计划入院患者中，营养不良患者的LOS显著高于正常营养患者，并且总体人群、计划入院患者和癌症患者中，营养不良患者的总再入院率和非择期再入院率均高于正常营养患者。当我们使用人体测量数据时，仅在计划入院患者中，营养不良患者的LOS优于正常营养和营养过剩患者。尽管总体人群中营养不良患者的总再入院率高于正常营养和营养过剩患者，但非择期再入院率未观察到显著差异。
本研究发现营养不良的患病率很高。同时，观察到营养过剩的患病率也很高。人体测量数据和SGA技术不一致，反映了营养状况指标的局限性。使用SGA时，在BMI正常至高的患者中检测到营养不良，而使用人体测量法时诊断为营养过剩。SGA似乎比人体测量法更准确地预测住院LOS和再入院率。由于营养不良患者的LOS和再入院率增加，医疗保健专业人员有必要采取进一步措施来识别和控制这些情况。
