Department of Endocrinology and Nutrition, Clinic University Hospital of Valladolid, Valladolid, Spain; Investigation Institute of Endocrinology and Nutrition, Clinic University Hospital of Valladolid, Valladolid, Spain.
Department of Endocrinology and Nutrition, Clinic University Hospital of Valladolid, Valladolid, Spain; Investigation Institute of Endocrinology and Nutrition, Clinic University Hospital of Valladolid, Valladolid, Spain.
Nutrition. 2018 Apr;48:67-72. doi: 10.1016/j.nut.2017.11.010. Epub 2017 Nov 28.
The aim of this study were to understand the influence of a multidisciplinary care protocol in amyotrophic lateral sclerosis (ALS) on the change in the delay of remission to the nutrition specialist and the initial nutritional status.
A cohort study was performed in 43 patients with ALS who were referred to the Nutrition Unit between April 2015 and April 2017. Anthropometric parameters and diagnostic times were collected, and the nutritional status was studied through subjective global assessment (SGA). Patients who were included before (control cohort [NoP]) and after (protocol cohort [P]) a multidisciplinary protocol were compared. The mean age of the participants was 66.79 y (10.86 y). Of the patients, 62.8% belonged to the protocol cohort.
Patients who started the protocol had a lower delay in initial assessment by a nutrition specialist (P:2 [1-6] mo/NoP:12 [10-29] mo; P = 0.03). When the nutritional status was analyzed according to the SGA, more patients who did not initiate protocol were in the state of severe malnutrition (C) (P 22.2% versus NoP 60%; P = 0.01). Entry into the protocol was an independent protective factor of the presence of severe malnutrition at the beginning of the nutritional follow-up (odds ratio, 0.20; 95% confidence interval, 0.03-0.73; P = 0.02).
The implementation of a multidisciplinary protocol in ALS allowed patients to present a lower percentage of severe malnutrition in an initial assessment by the nutrition specialist. This protocol is a protective factor for the presence of malnutrition at the beginning of support.
本研究旨在了解肌萎缩侧索硬化（ALS）多学科护理方案对缓解至营养专家的延迟时间以及初始营养状况变化的影响。
对 2015 年 4 月至 2017 年 4 月期间转诊至营养科的 43 例 ALS 患者进行了队列研究。收集了人体测量参数和诊断时间，并通过主观整体评估（SGA）研究营养状况。将纳入多学科方案之前（对照组[NoP]）和之后（方案组[P]）的患者进行比较。参与者的平均年龄为 66.79 岁（10.86 岁）。患者中，62.8%属于方案组。
开始方案的患者首次接受营养专家评估的延迟时间更短（P：2 [1-6] 个月/NoP：12 [10-29] 个月；P=0.03）。根据 SGA 分析营养状况时，更多未启动方案的患者处于严重营养不良状态（C）（P：22.2%对比 NoP：60%；P=0.01）。进入方案是营养随访开始时存在严重营养不良的独立保护因素（比值比，0.20；95%置信区间，0.03-0.73；P=0.02）。
在 ALS 中实施多学科方案可使患者在营养专家首次评估时表现出较低的严重营养不良百分比。该方案是开始支持时存在营养不良的保护因素。
