Incalzi R A, Gemma A, Capparella O, Cipriani L, Landi F, Carbonin P
Department of Geriatrics, Catholic University of the Sacred Heart, Rome, Italy.
Arch Intern Med. 1996 Feb 26;156(4):425-9.
Malnutrition is a common finding in the acute-care hospital.
To assess the adequacy of nutritional intake to individual needs and the effects of the hospitalization on nutritional status and to identify the reasons for inadequate energy intake.
A total of 286 patients with a mean ( +/- SD) age of 79 +/- 6 years (range, 70 to 99 years), consecutively admitted to the geriatrics and internal medicine wards of an acute-care university hospital, underwent multidisciplinary assessment on admission and at discharge and daily dietary data collection. The needed, prescribed, and actual daily energy intake for each individual was measured. Nutritional depletion was diagnosed if midarm circumference decreased by 3.6% or more from admission to discharge.
Nutritional depletion occurred in 27% of the patients and correlated with anorexia (86.4% vs 65.5% and 40% in patients whose midarm circumference was unchanged and increased, respectively; P < .001), Mini-Mental State Examination score (21.6 +/- 8.3 vs 23 +/- 6.9 and 26.5 +/- 3.6; P < .05), simplified premorbid Activities of Daily Living score (4.4 +/- 2.2 vs 5.1 +/- 1.8 and 5.0 +/- 1.8; P < .03), lymphocyte count (1.32 +/- 0.63 x 10(9)/L vs 1.62 +/- 0.88 x 10(9)/L and 1.47 +/- 0.50 x 10(9)/L; P < .03), serum albumin level (38 +/- 5g/L vs 40 +/- 4 g/L and 39 +/- 8 g/L; P < .002), ratio of actual to needed energy intake (56.9% +/- 22.1% vs 69.3% +/- 30.4% and 60.0% +/- 14.1%; P < .01), ratio of actual to prescribed energy intake (50.5% +/- 16.9% vs 60.5% +/- 20.%% and 65.5% +/- 15.7%; P < .001). Patients who consumed less than 40% of the prescribed food complained of anorexia and masticatory inefficiency and were unsatisfied with quality and timing of meals compared with other patients.
In-hospital starvation affects mainly patients with baseline nutritional, functional, and cognitive deficits and is strongly related to the inadequate energy intake.
营养不良在急症医院中很常见。
评估营养摄入量是否满足个体需求以及住院对营养状况的影响，并确定能量摄入不足的原因。
共有286例患者，平均（±标准差）年龄为79±6岁（范围70至99岁），连续入住一所急症大学医院的老年病科和内科病房，入院时和出院时接受多学科评估，并收集每日饮食数据。测量每个个体的每日所需、规定和实际能量摄入量。如果上臂围从入院到出院减少3.6%或更多，则诊断为营养消耗。
27%的患者出现营养消耗，且与厌食相关（上臂围未改变、增加的患者中，厌食发生率分别为86.4%、65.5%和40%；P<.001）、简易精神状态检查表评分（21.6±8.3 vs 23±6.9和26.5±3.6；P<.05）、病前简化日常生活活动评分（4.4±2.2 vs 5.1±1.8和5.0±1.8；P<.03）、淋巴细胞计数（1.32±0.63×10⁹/L vs 1.62±0.88×10⁹/L和1.47±0.50×10⁹/L；P<.03）、血清白蛋白水平（38±5g/L vs 40±4g/L和39±8g/L；P<.002）、实际与所需能量摄入比（56.9%±22.1% vs 69.3%±30.4%和60.0%±14.1%；P<.01）、实际与规定能量摄入比（50.5%±16.9% vs 60.5%±20.%和65.5%±15.7%；P<.001）。与其他患者相比，摄入规定食物量不足40%的患者抱怨有厌食和咀嚼效率低下的问题，并且对饮食质量和时间不满意。
住院期间的饥饿主要影响有基线营养、功能和认知缺陷的患者，并且与能量摄入不足密切相关。
