School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia.
Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.
J Hum Nutr Diet. 2018 Dec;31(6):818-824. doi: 10.1111/jhn.12572. Epub 2018 Jun 27.
Malnutrition is prevalent across acute care facilities, particularly in older patients, and contributes to poor surgical outcomes. Clinical practice guidelines recommend the early reintroduction of a full oral diet post-operatively. The present study aimed to compare estimated energy (EEI) and protein (EPI) intake of patients who received early diet upgrade with those who did not.
Patients ≥65 years admitted post-operatively to general surgical wards were included. EEI and EPI were calculated and dichotomised as meeting ≥50% or <50% estimated energy (EER) and protein (EPR) requirements. Mean intake and proportion of patients meeting <50% estimated requirements were compared between those who received early upgrade and those who did not at post-operative day (POD)2.
Thirty-four patients [mean (SD) age 72.9 (5.7) years, 59% male] were analysed at POD2 [EEI: mean 4.2 (2.6) MJ day , 56% (n = 19) met ≥50% EER; EPI: mean 38.7 (29.5) g day , 26% (n = 9) met ≥50% EPR]. The majority (n = 25, 74%) were upgraded to a nonfluid diet by POD2. More patients on fluid diets consumed <50% EER (P = 0.025) and <50% EPR (P = 0.073). No patient on a fluid diet met ≥50% of EPR.
Although the majority of older patients received early diet upgrade and these patients consumed more energy and protein than those on fluid diets, as a whole, older patients ate poorly post-operatively. Fluid diets should therefore not be used indiscriminately and other approaches to improve post-operative intake of older patients, such as fortified diets, oral nutritional supplements and meal environment interventions, should be adopted.
营养不良在急性护理机构中普遍存在，特别是在老年患者中，这会导致手术结果不佳。临床实践指南建议术后尽早重新引入全口服饮食。本研究旨在比较接受早期饮食升级的患者与未接受早期饮食升级的患者的估计能量（EEI）和蛋白质（EPI）摄入量。
纳入术后入住普通外科病房的年龄≥65 岁的患者。计算 EEI 和 EPI，并将其分为满足≥50%或<50%估计能量（EER）和蛋白质（EPR）需求的二分法。在术后第 2 天（POD2），比较接受早期升级和未接受早期升级的患者的平均摄入量和<50%估计需求量的患者比例。
在 POD2 分析了 34 例患者[平均（SD）年龄 72.9（5.7）岁，59%为男性] [EEI：平均 4.2（2.6）MJ·天，56%（n=19）满足≥50% EER；EPI：平均 38.7（29.5）g·天，26%（n=9）满足≥50% EPR]。大多数患者（n=25，74%）在 POD2 时升级为非流质饮食。在接受液体饮食的患者中，更多的患者消耗<50%的 EER（P=0.025）和<50%的 EPR（P=0.073）。没有接受液体饮食的患者满足≥50%的 EPR。
尽管大多数老年患者接受了早期饮食升级，但这些患者消耗的能量和蛋白质多于接受液体饮食的患者，但总体而言，老年患者术后饮食不佳。因此，不应滥用液体饮食，应采用其他方法改善老年患者术后的摄入，如强化饮食、口服营养补充剂和膳食环境干预。
