Department of Internal Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX 79905, USA.
Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Nutrients. 2022 Feb 22;14(5):932. doi: 10.3390/nu14050932.
The present large scale study aimed to assess the prevalence and consequences of malnutrition, based on clinical assessment (body mass index and preoperative weight loss) and severe hypoalbuminemia (<3.1 g/L), in a representative US cohort undergoing IBD surgery. The American College of Surgeons National Quality improvement program (ACS-NSQIP) Public User Files (PUF) between 2005 and 2018 were assessed. A total of 25,431 patients were identified. Of those, 6560 (25.8%) patients had severe hypoalbuminemia, 380 (1.5%) patients met ESPEN 2 criteria (≥10% weight loss over 6 months PLUS BMI < 20 kg/m2 in patients <70 years OR BMI < 22 kg/m2 in patients ≥70 years), and 671 (2.6%) patients met both criteria (severe hypoalbuminemia and ESPEN 2). Patients who presented with malnutrition according to any of the three definitions had higher rates of overall, minor, major, surgical, and medical complications, longer LOS, higher mortality and higher rates of readmission and reoperation. The simple clinical assessment of malnutrition based on BMI and weight loss only, considerably underestimates its true prevalence of up to 50% in surgical IBD patients and calls for dedicated nutritional assessment.
本大规模研究旨在评估基于临床评估（体重指数和术前体重减轻）和严重低白蛋白血症（<3.1 g/L）的营养不良的流行率和后果，该研究纳入了接受 IBD 手术的美国代表性队列。评估了 2005 年至 2018 年期间美国外科医师学会国家质量改进计划（ACS-NSQIP）公共用户文件（PUF）。共确定了 25431 例患者。其中，6560 例（25.8%）患者存在严重低白蛋白血症，380 例（1.5%）患者符合 ESPEN 2 标准（≥6 个月体重减轻 10%以上，体重指数<70 岁患者<20 kg/m2或体重指数<22 kg/m2）≥70 岁），671 例（2.6%）患者符合这两个标准（严重低白蛋白血症和 ESPEN 2）。根据这三种定义中的任何一种出现营养不良的患者，其总体、轻微、主要、手术和医疗并发症发生率更高，住院时间更长，死亡率更高，以及再入院和再次手术的发生率更高。仅基于 BMI 和体重减轻的简单临床营养不良评估，严重低估了高达 50%的手术 IBD 患者的真实患病率，因此需要进行专门的营养评估。
