Department of Endocrinology, Diabetes and Clinical Nutrition, University Department of Internal Medicine, Kantonsspital Aarau, Switzerland.
Department of Endocrinology, Diabetes and Clinical Nutrition, University Department of Internal Medicine, Kantonsspital Aarau, Switzerland; The New York Academy of Sciences, New York, NY, USA.
Clin Nutr. 2020 Oct;39(10):3014-3018. doi: 10.1016/j.clnu.2020.01.023. Epub 2020 Feb 5.
Evidence-based medicine is the art of combining "best external evidence", "clinical judgement" and "patient values" for improved daily clinical decision making and is the ultimate goal in modern medicine. Historically, in the field of medical nutrition, there had been a lack of strong evidence from large and high-quality trials resulting in often weak guideline recommendations and therefore insufficient implementation in clinical practice. Particularly in the field of malnutrition, the medical community has long struggled to find evidence-based approaches for effective management by means of screening, assessment and treatment of patients. With recent trials showing that individual medical nutrition therapy has strong effects on clinical outcomes, we should now aim to practice "evidence-based medical nutrition" (EBMN) by combining clinical judgement (e.g., thorough clinical assessment of the malnourished patient), patient preferences (e.g., integration of perspectives of patients and relatives, consideration of comorbidities to define specific energy/protein goals and appropriate route of medical nutrition therapy) and the most current scientific evidence (e.g., trial-supported use of nutritional interventions for individual patients). Such an approach may certainly be helpful to improve clinical outcomes of the vulnerable population of malnourished medical inpatients.
循证医学是将“最佳外部证据”、“临床判断”和“患者价值观”相结合，以改善日常临床决策的艺术，是现代医学的最终目标。在医学营养领域，历史上缺乏来自大型高质量试验的有力证据，导致指南建议往往较弱，因此在临床实践中实施不足。特别是在营养不良领域，医学界长期以来一直努力寻找循证方法，通过对患者进行筛查、评估和治疗来进行有效管理。最近的试验表明，个体化医学营养治疗对临床结果有很强的影响，因此我们现在应该通过结合临床判断（例如，对营养不良患者进行全面的临床评估）、患者偏好（例如，综合患者和亲属的观点，考虑合并症以确定特定的能量/蛋白质目标和适当的医学营养治疗途径）和最新的科学证据（例如，支持使用营养干预措施的试验结果来个体化治疗患者）来实践“循证医学营养”（EBMN）。这种方法肯定有助于改善营养不良住院患者这一弱势群体的临床结局。
