Nightingale J M, Walsh N, Bullock M E, Wicks A C
Leicester General Hospital NHS Trust, England.
J R Soc Med. 1996 Mar;89(3):144-8. doi: 10.1177/014107689608900308.
Malnutrition in hospital is often unrecognized. A nutrition team aims to teach simple methods of detecting malnutrition. On a single day all medical in-patients underwent a nutritional assessment. Eighty-four patients (43 men), median age 71 years (range 28-97), were assessed. The most common diagnoses were cardiac disease (26), stroke/dementia (12), non-malignant lung disease (9) and malignancy (6). A weight loss of more than 10% (%WL) was found in 17/65 (26%) and a body mass index (BMI) of less than 19 kg/m2 in 13/69 (19%). A mid-arm muscle circumference (MAMC) less than the fifth percentile occurred in 16/83 (19%) patients. Percentage weight loss alone detected seven patients of whom four were overweight (BMI > 25 kg/m2), BMI alone detected three patients, and MAMC alone eight patients of whom three could not be weighed and three had fluid retention. There was fluid retention in 35/84 (42%) patients of whom nine were malnourished (six detected by BMI and/or %WL, and three by MAMC alone). All three measurements were made in 64 patients, six (9%) of whom were detected as malnourished by all three methods. Combining the three measurements 29/84 (35%) of patients were malnourished and only 28% of these patients had been assessed by a dietitian. BMI and %WL detect most patients but fluid retention may limit their accuracy. MAMC is useful in those who cannot be weighed or who have fluid retention.
医院中的营养不良常常未被识别。一个营养团队旨在教授检测营养不良的简单方法。在某一天，所有内科住院患者都接受了营养评估。共评估了84名患者（43名男性），年龄中位数为71岁（范围28 - 97岁）。最常见的诊断为心脏病（26例）、中风/痴呆（12例）、非恶性肺病（9例）和恶性肿瘤（6例）。65名患者中有17名（26%）体重减轻超过10%（%WL），69名患者中有13名（19%）体重指数（BMI）低于19kg/m²。83名患者中有16名（19%）的上臂中部肌肉周长（MAMC）低于第五百分位数。仅通过体重减轻百分比检测出7名患者，其中4名超重（BMI > 25kg/m²）；仅通过BMI检测出3名患者；仅通过MAMC检测出8名患者，其中3名无法称重，3名有液体潴留。84名患者中有35名（42%）有液体潴留，其中9名营养不良（6名通过BMI和/%WL检测出，3名仅通过MAMC检测出）。对64名患者进行了所有三项测量，其中6名（9%）通过所有三种方法均被检测为营养不良。综合三项测量结果，84名患者中有29名（35%）营养不良，而这些患者中只有28%曾由营养师进行过评估。BMI和%WL能检测出大多数患者，但液体潴留可能会限制其准确性。MAMC对无法称重或有液体潴留的患者有用。
