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[癌症患者的营养评估]

[Nutritional assessment for cancer patient].

作者信息

Valenzuela-Landaeta K, Rojas P, Basfi-fer K

机构信息

Programa de Magister en Nutrición, Facultad de Medicina, Universidad de Chile, Chile.

出版信息

Nutr Hosp. 2012 Mar-Apr;27(2):516-23. doi: 10.1590/S0212-16112012000200025.

Abstract

Weight loss and malnutrition is common in cancer patients, both origin of complications during the course of the disease. Although weight loss is predominantly due to loss of fat mass, the morbidity risk is given by the decrease in muscle mass. The causes of malnutrition are numerous, but the tumor cachexia and anorexia are the principals. The assessment of nutritional status is essential for a diagnosis of nutritional compromise and for the multidisciplinary management required. Subjective Global Assessment combines medical history, physical examination to classify patients as well nourished, moderately or severely malnourished. Subjective global assessment generated by the patient also includes nutritional symptoms and weight loss. Both instruments can serve as indicators of survival. The objective assessment, a significant weight loss (> 10%) for 6 months is considered an indicator of nutritional deficiency. BMI on the other hand has not proven to be a good indicator of malnutrition. Albumin and prealbumin, although widely used, should be used with caution. These are acute phase proteins, a situation that would alter specificity for diagnosis of visceral protein malnutrition. The bioelectrical impedance, in addition to determine body composition, has been linked to survival time and mortality. Although there are various methods, there is no "Gold Standard". The nutritional assessment instruments should be chosen according to the patient's condition.

摘要

体重减轻和营养不良在癌症患者中很常见,这两者都是疾病过程中并发症的根源。尽管体重减轻主要是由于脂肪量的减少,但发病风险是由肌肉量的减少所致。营养不良的原因众多,但肿瘤恶病质和厌食是主要原因。营养状况评估对于诊断营养状况受损以及所需的多学科管理至关重要。主观全面评定结合病史、体格检查将患者分类为营养良好、中度或重度营养不良。由患者进行的主观全面评定还包括营养症状和体重减轻。这两种方法都可作为生存指标。客观评估方面,6个月内体重显著减轻(>10%)被视为营养缺乏的指标。另一方面,体重指数尚未被证明是营养不良的良好指标。白蛋白和前白蛋白虽然广泛使用,但应谨慎使用。它们是急性期蛋白,这种情况会改变内脏蛋白营养不良诊断的特异性。生物电阻抗除了能确定身体成分外,还与生存时间和死亡率相关。虽然有多种方法,但没有“金标准”。应根据患者情况选择营养评估方法。

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