Fang Yun, Liu Min-Jie, Zhang Wei-Wei, Xie Chen, Liu Zhun-Zhun
Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Medical Faculty of Heidelberg, University of Heidelberg, Heidelberg, Germany.
Curr Med Sci. 2020 Aug;40(4):691-698. doi: 10.1007/s11596-020-2231-z. Epub 2020 Aug 29.
It has been identified that malnutrition can influence the immune system and time of engraftment, and it's also associated with increased incidence of complications, prolonged length of hospital stays, and transplant mortality and morbidity in patients undergoing hematopoietic stem cell transplantation (HSCT), so dynamic nutrition care is highly important. The aim of this study was to better understand the differences between clinical nutrition practices and international recommendations as well as possible barriers to the use of nutrition support in HSCT patients. An evidence-based nutrition support pathway was constructed through a systematic literature review to identify evidence and recommendations relating to the relevant issues. Then, a questionnaire consisting of 28 questions that focused on the 4 topics, namely, assessment and screening for malnutrition, nutrition support interventions, nutrition support in gastrointestinal graft-versus-host disease (GVHD) and neutropenic diet was developed by the study authors and used for data collection. Responses of 18 HSCT centers from 17 provinces were received. General assessment for malnutrition was performed at 72% (13/18) centers. Parenteral nutrition (PN) was given as the first option to HSCT patients in the majority of centers, despite the fact that current guidelines recommend enteral nutrition (EN) over PN. As many as 72% (13/18) of the centers considered a neutropenic diet in the management of HSCT patients, but only one center had a formal neutropenic diet protocol in place for transplant recipients. Criteria for initiating nutrition support in patients with gastrointestinal GVHD were heterogeneous among the centers, and PN was the most widely used technique. The survey results revealed significant heterogeneity with regard to nutrition support practices among the centers, as well as between the practices and the guidelines. Standard nutrition support guidelines or protocols for nutrition support practices were absent in most of the centers.
已确定营养不良会影响免疫系统和植入时间，并且它还与接受造血干细胞移植（HSCT）患者的并发症发生率增加、住院时间延长以及移植死亡率和发病率相关，因此动态营养护理非常重要。本研究的目的是更好地了解临床营养实践与国际建议之间的差异，以及HSCT患者使用营养支持可能存在的障碍。通过系统的文献综述构建了基于证据的营养支持路径，以确定与相关问题有关的证据和建议。然后，研究作者编制了一份由28个问题组成的问卷，该问卷聚焦于4个主题，即营养不良的评估和筛查、营养支持干预、胃肠道移植物抗宿主病（GVHD）中的营养支持和中性粒细胞减少饮食，并用于数据收集。收到了来自17个省份的18个HSCT中心的回复。72%（13/18）的中心对营养不良进行了常规评估。尽管当前指南推荐肠内营养（EN）而非肠外营养（PN），但大多数中心仍将肠外营养作为HSCT患者的首选。多达72%（13/18）的中心在HSCT患者的管理中考虑采用中性粒细胞减少饮食，但只有一个中心为移植受者制定了正式的中性粒细胞减少饮食方案。各中心对于胃肠道GVHD患者启动营养支持的标准存在差异，肠外营养是使用最广泛的技术。调查结果显示，各中心之间以及实践与指南之间在营养支持实践方面存在显著差异。大多数中心缺乏营养支持实践的标准营养支持指南或方案。
