Thomas Jolene, Delaney Christopher, Suen Jenni, Miller Michelle
Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia.
Vascular and Endovascular Surgery, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia.
Asia Pac J Clin Nutr. 2019;28(1):64-71. doi: 10.6133/apjcn.201903_28(1).0010.
Undernutrition in vascular surgery patients has a significant impact on clinical outcomes. This observational study aimed to investigate the nutritional status of a heterogeneous sample of vascular surgery inpatients and to determine the prevalence of nutritional risk, malnutrition (including nutrient deficiencies) and sarcopenia.
All participants were screened for risk of malnutrition using the Malnutrition Universal Screening Tool (MUST) and assessed using the Patient-Generated Subjective Global Assessment (PG-SGA). Micronutrient status was examined via plasma/serum samples. The presence of sarcopenia was explored using an accepted algorithm incorporating gait speed, muscle mass (DEXA) and grip strength.
322 participants (69% male, mean age 67.6±14.1y) consented to the study. 12.5% were identified as at risk of malnutrition by the MUST while 15.8% were deemed malnourished by the PG-SGA. Only 5% were diagnosed as sarcopenic. Prevalence of malnutrition was much higher when micronutrients were examined with 79% showing low vitamin C, 56% low vitamin D and over 40% having low zinc, vitamin B-12 and folate. A smaller proportion were also low in selenium (19%).
Patients with vascular disease are a nutritionally vulnerable group. The MUST and PG-SGA did not identify the full extent of nutritional deficiencies. Further investigation is warranted to assess tool validity in this group. A number of micronutrients are crucial in these patients and hence a more comprehensive assessment that encompasses a wider range of parameters, including micronutrient status appears warranted.
血管外科患者的营养不良对临床结局有重大影响。本观察性研究旨在调查血管外科住院患者异质性样本的营养状况，并确定营养风险、营养不良（包括营养素缺乏）和肌肉减少症的患病率。
使用营养不良通用筛查工具（MUST）对所有参与者进行营养不良风险筛查，并使用患者主观全面评定法（PG-SGA）进行评估。通过血浆/血清样本检查微量营养素状况。使用一种公认的算法，结合步速、肌肉质量（双能X线吸收法）和握力来探究肌肉减少症的存在情况。
322名参与者（69%为男性，平均年龄67.6±14.1岁）同意参与本研究。MUST筛查出12.5%的参与者有营养不良风险，而PG-SGA评定15.8%的参与者为营养不良。只有5%的参与者被诊断为肌肉减少症。在检查微量营养素时，营养不良的患病率要高得多，79%的人维生素C水平低，56%的人维生素D水平低，超过40%的人锌、维生素B-12和叶酸水平低。还有较小比例的人硒水平低（19%）。
血管疾病患者是营养脆弱群体。MUST和PG-SGA并未完全识别出营养缺乏的情况。有必要进一步研究以评估这些工具在该群体中的有效性。多种微量营养素对这些患者至关重要，因此似乎有必要进行更全面的评估，涵盖更广泛的参数，包括微量营养素状况。
