Clinical Nutrition and Dietetics Unit, Hospital "Maggiore della Carità, Novara, Italy.
Department of Internal Medicine, University Hospital Careggi, Florence, Italy.
Nutrition. 2022 Jun;98:111623. doi: 10.1016/j.nut.2022.111623. Epub 2022 Feb 2.
Patients hospitalized in internal medicine are frequently malnourished or at risk for malnutrition. The aim of this study, conducted by the Federation of Associations of Hospital Internists (FADOI) and the Italian Society of Artificial Nutrition and Metabolism (SINPE) was to assess the nutritional management of internal medicine inpatients in Italy, to identify critical issues and formulate practical proposals to improve nutritional treatment.
From February to April 2021, FADOI and SINPE conducted a national web-based survey, including a 13 multiple-choice item questionnaire related to three key areas: screening and assessment of malnutrition and associated/overlapping sarcopenia and dysphagia; specialist consultations; and management of nutritional support.
Responding to the questionnaire were 266 physicians among FADOI members (10.76%). Screening for malnutrition is performed with validated tests, within standardized care pathways, or routinely, only by 22% of participants. Global Leadership Initiative on Malnutrition criteria for diagnosis of malnutrition are little used (20%). Screening for sarcopenia was insufficient as the systematic use of assessment tools (handgrip/chair test) was minimal (3%). Screening for dysphagia is not a routine procedure for at-risk patients according to 33% of participants. Systematic involvement of clinical nutrition services/units in the management of malnourished/sarcopenic patients was reported by only 17% of internists.
To overcome the critical issues that emerged from the present study, FADOI and SINPE experts proposed practical solutions to promote the application of the most recent guidelines and to improve awareness and sensitivity to nutritional management in internal medicine real-life settings.
内科住院患者经常存在营养不良或有营养不良风险。本研究由医院内科医师联合会（FADOI）和意大利人工营养与代谢学会（SINPE）开展，旨在评估意大利内科住院患者的营养管理情况，识别关键问题，并提出切实可行的建议以改善营养治疗。
2021 年 2 月至 4 月，FADOI 和 SINPE 开展了一项全国性的网络调查，包括与三个关键领域相关的 13 个多项选择题问卷：营养不良及其相关/重叠的肌少症和吞咽困难的筛查和评估；专家会诊；以及营养支持的管理。
FADOI 成员中有 266 名医生回应了问卷（10.76%）。只有 22%的参与者会使用验证过的测试、在标准化护理路径内或常规进行营养不良筛查。很少使用全球营养不良领导倡议（GLIM）营养不良诊断标准（20%）。肌少症筛查也不足，因为只有 3%的参与者会系统使用评估工具（握力/椅子测试）。根据 33%的参与者的报告，对于有风险的患者，筛查吞咽困难并不是常规程序。只有 17%的内科医生报告称临床营养服务/单位会系统参与营养不良/肌少症患者的管理。
为了解决本研究中出现的关键问题，FADOI 和 SINPE 的专家提出了切实可行的解决方案，以促进最新指南的应用，并提高内科真实环境下对营养管理的认识和敏感性。
