de Ulíbarri Pérez José Ignacio, Fernández Guillermo, Rodríguez Salvanés Francisco, Díaz López Ana María
Director of CONUT Project..
Unit of Clinical and Assistance Information Admissions and Clinical Documentation Service. University Hospital La Princesa. Madrid..
Nutr Hosp. 2014 Jan 13;29(4):797-811. doi: 10.3305/nh.2014.29.4.7275.
To update the system for nutritional screening. The high prevalence of nutritional unstability that causes the Clinical Undernutrition (CU), especially within the hospitals and assisted residencies, makes it necessary to use screening tools for the constant control of undernutrition to combat it during its development. CU is not so much due to a nutritional deficiency but to the illness and its treatments. However, the screening systems currently used are aimed at detecting an already established undernutrition rather than at detecting any nutritional risk that may be present. The metabolic changes of the nutritional status that have a trophopathic effect, can be easily and automatically detected in plasma, which allows to make the necessary changes in treatments that might be too aggressive, as well as to apply nutritional support according to each case. The manual screening systems can detect those somatic changes typical of undernutrition only after many days or weeks, which might be too late. Plasma albumin is a very reliable parameter for nutritional control. A lowered amount of it, due to whatever reason, is a clear sign of a possible deficit as well as of a nutritional risk suffered by the cell way before the somatic signs of undernutrition will become apparent. A fast detection of nutritional risk, anticipating undernutrition, offers prognostic abilities, which makes screening tools based on analytic parameters the most useful, ergonomic, reliable and efficient system for nutritional screening and prognosis in the clinical practice.
It is necessary to update some concepts, to leave behind old myths and to choose modern screening systems that have proven to be efficient. This is the only way achieving the dream of controlling CU among ill and vulnerable patients.
更新营养筛查系统。营养不稳定的高患病率导致临床营养不良(CU),尤其是在医院和辅助居住机构中,这使得有必要使用筛查工具持续控制营养不良,以便在其发展过程中进行应对。CU与其说是由于营养缺乏,不如说是由于疾病及其治疗。然而,目前使用的筛查系统旨在检测已经确立的营养不良,而不是检测可能存在的任何营养风险。具有营养病变作用的营养状况的代谢变化可以在血浆中轻松且自动地检测到,这使得能够对可能过于激进的治疗进行必要的调整,并根据具体情况提供营养支持。手动筛查系统只有在数天或数周后才能检测到营养不良典型的躯体变化,这可能为时已晚。血浆白蛋白是营养控制的一个非常可靠的参数。无论何种原因导致其含量降低,都是可能存在缺乏以及细胞在营养不良的躯体体征明显之前就已遭受营养风险的明显迹象。快速检测营养风险、预测营养不良具有预后能力,这使得基于分析参数的筛查工具成为临床实践中最有用、最符合人体工程学、最可靠且最有效的营养筛查和预后系统。
有必要更新一些观念,摒弃旧的误区,选择已被证明有效的现代筛查系统。这是在患病和脆弱患者中实现控制CU这一梦想的唯一途径。