Department of Dietetics, Singapore General Hospital, Singapore, Singapore.
Department of Renal Medicine, Singapore General Hospital, Singapore.
Nephrology (Carlton). 2016 Nov;21(11):944-949. doi: 10.1111/nep.12707.
Evidence has validated that the nutritional status of hospitalized patients on haemodialysis could be compromised because of admission-related and hospital-associated morbidities on the background of their kidney disease. However, nutritional status is not assessed and monitored routinely during the hospitalization period. The aim of the present study was to assess the nutritional status of hospitalized patients requiring haemodialysis with the subjective global assessment (SGA) tool during the hospitalization period.
This is a prospective cohort study conducted in an acute tertiary general hospital. Patients aged 21-75 years old, admitted for various illnesses and requiring haemodialysis between November 2011 and May 2012 were enrolled into this study. A trained dietician assessed patients' nutritional status with the SGA tool, which included historical data on weight change, dietary intake, gastrointestinal symptoms, functional capacity, comorbidities and physical examination on subcutaneous fat loss, muscle wasting and presence of oedema and/or ascites. Patients were categorized under three groups: SGA-A (well-nourished), SGA-B (moderately malnourished) and SGA-C (severely malnourished).
Eighty patients (mean ± SD age = 59 ± 10 years; 76% Chinese ethnicity) were assessed. Mean ± SD body mass index (BMI) was 25.1 ± 6.1 kg/m . SGA categories were 48% SGA-A, 46% SGA-B, and 6% SGA-C. Mean energy and protein intake (P < 0.001), length of hospitalization stay (P = 0.03) and BMI (P = 0.001) were significantly different across the three categories of nutritional status.
More than half of the hospitalized patients requiring haemodialysis were malnourished. It is important to incorporate SGA in the care of hospitalized haemodialysis patients for early detection of malnutrition and for medical nutrition therapy to optimise patients' nutritional status for better outcomes.
有证据表明，由于肾脏病背景下与住院相关和与医院相关的疾病，住院血液透析患者的营养状况可能受到损害。然而，在住院期间并没有常规评估和监测营养状况。本研究旨在使用主观整体评估（SGA）工具在住院期间评估需要血液透析的住院患者的营养状况。
这是一项在急性三级综合医院进行的前瞻性队列研究。2011 年 11 月至 2012 年 5 月期间，招募了年龄在 21-75 岁之间、因各种疾病入院并需要血液透析的患者。一名经过培训的营养师使用 SGA 工具评估患者的营养状况，该工具包括体重变化、饮食摄入、胃肠道症状、功能能力、合并症和皮下脂肪损失、肌肉消耗以及水肿和/或腹水的体格检查等历史数据。患者分为三组：SGA-A（营养良好）、SGA-B（中度营养不良）和 SGA-C（严重营养不良）。
共评估了 80 例患者（平均年龄±标准差为 59±10 岁；76%为华裔）。平均±标准差体重指数（BMI）为 25.1±6.1kg/m 。SGA 分类为 48%为 SGA-A，46%为 SGA-B，6%为 SGA-C。三个营养状况类别之间的能量和蛋白质摄入量（P<0.001）、住院时间（P=0.03）和 BMI（P=0.001）存在显著差异。
超过一半需要血液透析的住院患者存在营养不良。在对住院血液透析患者的护理中纳入 SGA 对于早期发现营养不良以及进行医学营养治疗以优化患者的营养状况以获得更好的结果非常重要。
