Schlegel-UW Research Institute for Aging, University of Waterloo, 200 University Avenue, West Waterloo, ON, N2L 3G1, Canada.
Department of Medicine, Division of Gastroenterology, Toronto General Hospital, 585 University Avenue, 9N-973, Toronto, ON, M5G 2C4 Canada.
Clin Nutr. 2015 Dec;34(6):1141-5. doi: 10.1016/j.clnu.2014.11.011. Epub 2014 Nov 29.
BACKGROUND & AIM: Guidelines promote dietitian consult (DC) for nutrition support. In Canada, dietitians are involved in the assessment of malnutrition and provide specialized dietary counseling. It is unknown however, what leads to a DC for patients fed orally. This study identifies independent predictors for a DC and determines what is the proportion of malnourished patients seeing a dietitian.
The Canadian Malnutrition Task Force conducted a prospective cohort study in medical and surgical wards of 18 Canadian hospitals. 947 patients who did not receive enteral or parenteral nutrition were analyzed. At admission, subjective global assessment (SGA), body mass index, patient demography were collected. During hospitalization clinical data, including dietary intake and presence of a DC were obtained. Multivariate logistic regression was completed with dietitian consult ≤ 3 days and 4 + days as the outcome variables.
The prevalence of malnutrition (SGA B + C) was 45%. Dietitians were consulted for 23% of patients, and of these consults 44% were well nourished (SGA-A), 37% were mildly/moderately malnourished (SGA-B), and 19% were severely malnourished (SGA-C). DC missed 75% of the SGA-B and 60% of SGA-C patients. Predictors of consultation within 3 days of hospitalization were: renal diet (OR 5.75) modified texture diet (OR 5.38), metabolic diagnosis (3.91), ONS use pre-admission (OR 2.33), severe malnutrition (SGA-C, OR 1.88) and age (OR 0.98). Predictors for 4 + days were: dysphagia (OR 11.4), a new medical diagnosis (OR 2.3), severe malnutrition (OR 2.17), constipation (OR 2.16), more than one diagnosis (OR 1.8), antibiotic use (OR 1.6), and male gender (OR 1.6). Consuming < 50% of food in the first week was not a predictor as only 19% of those with low intake had a DC at 4 + days.
Overall predictors of DC were appropriate but SGA B and C patients and those eating <50% were missed. Screening at admission with algorithms of care that include referral to the dietitian are needed to improve the process of nutrition care.
指南提倡营养师咨询（DC）以提供营养支持。在加拿大，营养师参与营养不良的评估，并提供专门的饮食咨询。然而，尚不清楚导致患者口服喂养的原因。本研究确定了 DC 的独立预测因素，并确定了接受营养师咨询的营养不良患者的比例。
加拿大营养不良工作组在 18 家加拿大医院的内科和外科病房进行了一项前瞻性队列研究。分析了 947 名未接受肠内或肠外营养的患者。入院时，采集主观全面评估（SGA）、体重指数、患者人口统计学资料。住院期间，获取临床数据，包括饮食摄入和 DC 的存在。将营养师咨询≤3 天和 4+天作为因变量进行多变量逻辑回归。
营养不良的患病率（SGA B+C）为 45%。23%的患者接受了营养师咨询，其中 44%的患者营养良好（SGA-A），37%的患者轻度/中度营养不良（SGA-B），19%的患者严重营养不良（SGA-C）。DC 漏诊了 75%的 SGA-B 和 60%的 SGA-C 患者。住院 3 天内咨询的预测因素包括：肾脏饮食（OR 5.75）、改良质地饮食（OR 5.38）、代谢诊断（3.91）、入院前使用 ONS（OR 2.33）、严重营养不良（SGA-C，OR 1.88）和年龄（OR 0.98）。4+天的预测因素包括：吞咽困难（OR 11.4）、新的医疗诊断（OR 2.3）、严重营养不良（OR 2.17）、便秘（OR 2.16）、多种诊断（OR 1.8）、抗生素使用（OR 1.6）和男性（OR 1.6）。第一周摄入<50%食物并不是一个预测因素，因为只有 19%的低摄入量患者在 4+天时接受了 DC。
总体而言，DC 的预测因素是恰当的，但 SGA B 和 C 患者以及摄入<50%的患者被漏诊。需要通过包括向营养师转诊的护理算法进行入院筛查，以改善营养护理流程。
