Faculty of Health, Medicine and Life Sciences, Department of Health Care and Nursing Science, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands.
Nutrition. 2010 Apr;26(4):432-40. doi: 10.1016/j.nut.2009.06.012. Epub 2009 Dec 1.
Although screening for malnutrition in health care has expanded enormously, a gold standard for the optimal definition and operationalism of malnutrition is still lacking. This report reflects expert opinions on the elements of the definition and operationalism of malnutrition and is meant to trigger further debate within the nutritional societies.
A Delphi study was performed consisting of three phases. After a literature review (phase 1), questions for a semistructured interviews (phase 2) were formulated. Subsequently, the results of these semistructured interviews were used to develop the final list of elements (for defining and operationalism of malnutrition). In phase 3 (final phase), experts were asked to provide written feedback regarding the ranking of elements concerning the importance of these elements.
Twenty-two experts (response 73.3%) were included in the final phase of this Delphi study. No overall agreement could be reached. The elements deficiencies of energy or protein and decrease in fat-free mass were most often mentioned to be particularly important in defining malnutrition. Elements mentioned to be important in operationalism of malnutrition were involuntary weight loss, body mass index, and no nutritional intake. Opinions on cutoff points regarding these elements differed strongly among experts.
This study shows that there is no full agreement among experts on the elements defining and operationalism of malnutrition. The results of this study may fuel the discussion within the nutritional societies, which will most ideally lead to an international consensus on a definition and operationalism of malnutrition.
尽管医疗保健中的营养不良筛查已经大大扩展，但仍缺乏最佳定义和操作营养不良的金标准。本报告反映了专家对营养不良定义和操作要素的意见，旨在引发营养学会内部的进一步辩论。
进行了一项德尔菲研究，包括三个阶段。在文献复习（第 1 阶段）之后，制定了半结构化访谈的问题（第 2 阶段）。随后，使用这些半结构化访谈的结果来制定最终的要素清单（用于定义和操作营养不良）。在第 3 阶段（最后阶段），要求专家就这些要素的重要性对要素的排名提供书面反馈。
共有 22 名专家（响应率 73.3%）被纳入这项德尔菲研究的最后阶段。无法达成总体共识。能量或蛋白质缺乏以及无脂肪组织质量减少是营养不良定义中最常被提及的特别重要的要素。在营养不良操作中被认为重要的要素包括非自愿体重减轻、体重指数和无营养摄入。专家对这些要素的截止点意见存在很大差异。
本研究表明，专家们在营养不良的定义和操作要素方面没有完全达成一致。本研究的结果可能会激发营养学会内部的讨论，这最理想地将导致国际上对营养不良的定义和操作达成共识。
