Computer Systems, Jožef Stefan Institute, Jamova c. 39, Ljubljana, Slovenia.
Institute of Oncology Ljubljana, Zaloška c. 2, Ljubljana, Slovenia.
Eur J Clin Nutr. 2020 Mar;74(3):419-426. doi: 10.1038/s41430-019-0485-y. Epub 2019 Aug 6.
Malnutrition has become a prevalent condition, with European and international studies reporting rates of approximately 25-40% in hospitals. We set out to perform a multi-center cross-sectional study to assess malnutrition rates in Slovenian hospitals and to convert the findings into a mobile application suitable for use by nurses and staff at the bedside. In addition, we examined the association of the results of this mobile application with parameters for body composition measured by bioimpedance method, muscle strength, anthropometrics, and specific blood markers.
We selected the Nutritional Risk Screening 2002 (NRS-2002) method, the second version of the modified short-form of Mini-Nutritional Assessment (MNA-SF), and the diagnostic criteria for cachexia proposed by Evans (CDE) as evidence-based methods for estimating the risk of and prevalence of malnutrition or/and cachexia. The methods were converted into the Android mobile application named MalNut that was used in three Slovenian hospitals by nurses and dietitians.
We applied NRS-2002 and MNA-SF to screen for malnutrition risk and to assess malnutrition in 207 individuals aged 18 years and older, regardless of gender or reason for hospitalization during 1-week periods. Totally, 98% of these patients consider nutrition an important part of medical treatment care. NRS-2002 estimated the malnutrition risk to be 66.3%, which includes both patients to be at risk for malnutrition and patients that are truly malnourished. The malnutrition risk in the elderly (65+) estimated by MNA-SF was 39.6% and malnutrition 42.5%. When applying the CDE score in these two categories, 66.7% were identified as cachectic and 21.4% as pre-cachectic. In the patients assessed with the CDE score, malnutrition risk increased with higher extracellular water and decreased body mass index, hemoglobin, phase angle, and muscle strength. In all, 75% of patients assessed as high risk for malnutrition by NRS-2002, were identified as cachectic and 15.7% as pre-cachectic. In NRS-2002 assessed patients, this risk increased with higher C-reactive protein and lower phase angle.
The study showed that both malnutrition and cachexia are largely overlapping notions and are common in hospitalized adults in Slovenia. The MNA-SF and NRS-2002 tools showed that malnutrition risk was not significantly correlated with age, gender, serum albumin, but was correlated with lower phase angle, CRP, and muscle strength in elderly patients. The results have been used to develop further nutritional interventions in Slovenia.
营养不良已成为一种普遍现象，欧洲和国际研究报告显示，医院中的营养不良率约为 25-40%。我们着手进行一项多中心横断面研究，以评估斯洛文尼亚医院的营养不良率，并将研究结果转化为适用于护士和床边工作人员使用的移动应用程序。此外，我们还研究了该移动应用程序的结果与通过生物阻抗法、肌肉力量、人体测量学和特定血液标志物测量的身体成分参数之间的关联。
我们选择了营养风险筛查 2002 版（NRS-2002）、改良迷你营养评估短表（MNA-SF）第二版和 Evans 提出的恶液质诊断标准（CDE）作为评估营养不良或/和恶液质风险和患病率的循证方法。这些方法被转化为名为 MalNut 的 Android 移动应用程序，由护士和营养师在斯洛文尼亚的三家医院使用。
我们应用 NRS-2002 和 MNA-SF 在一周内对 207 名 18 岁及以上的个体进行了营养不良风险筛查和评估，无论性别或住院原因如何。共有 98%的患者认为营养是医疗护理的重要组成部分。NRS-2002 估计营养不良风险为 66.3%，其中包括有营养不良风险和真正营养不良的患者。MNA-SF 估计老年人（65 岁及以上）的营养不良风险为 39.6%，营养不良为 42.5%。当在这两个类别中应用 CDE 评分时，66.7%的患者被认定为恶液质，21.4%的患者为恶液质前期。在接受 CDE 评分评估的患者中，随着细胞外液增加和身体质量指数、血红蛋白、相位角和肌肉力量下降，营养不良风险增加。共有 75%的 NRS-2002 评估为营养不良高风险的患者被认定为恶液质，15.7%的患者被认定为恶液质前期。在 NRS-2002 评估的患者中，这种风险随着 C-反应蛋白升高和相位角降低而增加。
研究表明，营养不良和恶液质在很大程度上是重叠的概念，在斯洛文尼亚住院的成年患者中很常见。MNA-SF 和 NRS-2002 工具表明，营养不良风险与年龄、性别、血清白蛋白无显著相关性，但与老年患者的较低相位角、C 反应蛋白和肌肉力量相关。研究结果已用于斯洛文尼亚进一步的营养干预。
