Evaluation of Nutritional Status in Hospitalized Patients_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHEN Bo , WU Xiaoting.

Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China;

Corresponding?author：

Keywords：

Malnutrition; Nutritional risk; Nutritional risk screening 2002; Nutritional support; Hospitalized patient

Video：

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ObjectiveTo introduce the progresses and applications of nutritional status assessment in hospitalized patients. MethodsThe related literatures of nutritional status assessment were reviewed. ResultsThe rates of malnutrition and nutritional risk were high in hospitalized patients worldwide. Traditional nutrition assessment tools were not in common use in all hospitalized patients. All clinical health care workers should use the most suitable tool when faced with different patients. ConclusionAll hospitalized patients should be screened for nutritional risk on admission in order to improve clinical outcomes and reduce overall treatment costs.

Citation： CHEN Bo,WU Xiaoting.. Evaluation of Nutritional Status in Hospitalized Patients. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(4): 449-454. doi: Copy

1.	Kondrup J, Rasmussen HH, Hamberg O, et al; Ad Hoc ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials [J]. Clin Nutr, 2003, 22(3): 321336．.
2.	Lochs H, Allison SP, Meier R, et al. Introductory to the ESPEN Guidelines on Enteral Nutrition: Terminology, definitions and general topics [J]. Clin Nutr, 2006, 25(2): 180186.
3.	王艷, 蔣朱明, Nolan MT, 等. 營養風險的概念分析 [J]. 中華臨床營養雜志, 2009, 17(2): 104106.
4.	Johansen N, Kondrup J, Plum LM, et al. Effect of nutritional support on clinical outcome in patients at nutritional risk [J]. Clin Nutr, 2004, 23(4): 539550.
5.	中華醫學會. 臨床技術操作規范－腸外腸內營養學分冊 [M]. 北京: 人民軍醫出版社, 2008: 159.
6.	Green SM, Watson R. Nutritional screening and assessment tools for use by nurses: literature review [J]. J Adv Nurs, 2005, 50(1): 6983.
7.	Bistrian BR, Blackburn GL, Vitale J, et al. Prevalence of malnutrition in general medical patients [J]. JAMA, 1976, 235(15): 15671570.
8.	Blackburn GL, Bistrian BR, Maini BS, et al. Nutritional and metabolic assessment of the hospitalized patient [J]. JPEN J Parenter Enteral Nutr, 1977, 1(1): 1122.
9.	McWhirter JP, Pennington CR. Incidence and recognition of malnutrition in hospital [J]. BMJ, 1994, 308(6934): 945948.
10.	Fettes SB, Davidson HI, Richardson RA, et al. Nutritional status of elective gastrointestinal surgery patients pre and postoperatively [J]. Clin Nutr, 2002, 21(3): 249254.
11.	蔣朱明，陳偉，張澍田．中國11個城市大醫院6個臨床專科5 303例住院患者營養不良風險篩查(期中小結摘要) [J]. 中國臨床營養雜志, 2006, 14(4): 263.
12.	蔣朱明，陳偉，朱賽楠，等．我國東、中、西部大城市三甲醫院營養不良（不足）、營養風險發生率及營養支持應用狀況調查 [J]. 中國臨床營養雜志, 2008, 16(6): 335337.
13.	蔣朱明，于康，朱賽楠，等．我國東、中、西部中小醫院住院患者營養不良（不足）、營養風險、超重和肥胖發生率及營養支持應用狀況調查（中期小結） [J]. 中國臨床營養雜志, 2008, 16(6): 338340.
14.	Oliveira MR, Fogaa KC, LeandroMerhi VA. Nutritional status and functional capacity of hospitalized elderly [J]. Nutr J, 2009, 8: 54.
15.	Liang X, Jiang ZM, Nolan MT, et al. Comparative survey on nutritional risk and nutritional support between Beijing and Baltimore teaching hospitals [J]. Nutrition, 2008, 24(10): 969976.
16.	Mackintosh MA, Hankey CR. Reliability of a nutrition screening tool for use in elderly day hospitals [J]. J Hum Nutr Diet, 2001, 14(2): 129136.
17.	Campbell SE, Avenell A, Walker AE. Assessment of nutritional status in hospital inpatients [J]. QJM, 2002, 95(2): 8387.
18.	張明鳴, 周勇, 伍曉汀. 生長激素短期應用對胃腸外科手術后患者營養狀況和血清IGF1的影響 [J]. 中國普外基礎與臨床雜志, 2009, 16(12): 968973.
19.	黃承鈺. 實用臨床營養學 [M]. 成都: 四川大學出版社, 2006： 6983.
20.	Kudsk KA, Tolley EA, DeWitt RC, et al. Preoperative albumin and surgical site identify surgical risk for major postoperative complications [J]. JPEN J Parenter Enteral Nutr, 2003, 27(1): 19.
21.	Jones JM. The methodology of nutritional screening and assessment tools [J]. J Hum Nutr Diet， 2002, 15(1): 5971.
22.	Buzby GP, Mullen JL, Matthews DC, et al. Prognostic nutritional index in gastrointestinal surgery [J]. Am J Surg, 1980, 139(1): 160167.
23.	Detsky AS, McLaughlin JR, Baker JP, et al. What is subjective global assessment of nutritional status? [J]. JPEN J Parenter Enteral Nutr, 1987, 11(1): 813.
24.	Sacks GS, Dearman K, Replogle WH, et al. Use of subjective global assessment to identify nutritionassociated complications and death in geriatric longterm care facility residents [J]. J Am Coll Nutr, 2000, 19(5): 570577.
25.	Thoresen L, Fjeldstad I, Krogstad K, et al. Nutritional status of patients with advanced cancer: the value of using the subjective global assessment of nutritional status as a screening tool [J]. Palliat Med, 2002, 16(1): 3342.
26.	Norman K, Schütz T, Kemps M, et al. The subjective global assessment reliably identifies malnutritionrelated muscle dysfunction [J]. Clin Nutr, 2005, 24(1): 143150.
27.	Sungurtekin H, Sungurtekin U, Balci C, et al. The influence of nutritional status on complications after major intraabdominal surgery [J]. J Am Coll Nutr, 2004, 23(3): 227232.
28.	Sungurtekin H, Sungurtekin U, Hanci V, et al. Comparison of two nutrition assessment techniques in hospitalized patients [J]. Nutrition, 2004, 20(5): 428432.
29.	Ryu SW, Kim IH. Comparison of different nutritional assessments in detecting malnutrition among gastric cancer patients [J]. World J Gastroenterol, 2010, 16(26): 33103317.
30.	Guigoz Y, Vellas BJ, Garry PJ. Mini nutritional assessment: a practical assessment tool for grading the nutritional state of elderly patients [J]. Facts Res Gerontol, 1994, 4(Suppl 2): 1559.
31.	Guigoz Y, Vellas B, Garry PJ. Assessing the nutritional status of the elderly: The mini nutritional assessment as part of the geriatric evaluation [J]. Nutr Rev, 1996, 54(1 Pt 2): S59S65.
32.	Shum NC, Hui WW, Chu FC, et al. Prevalence of malnutrition and risk factors in geriatric patients of a convalescent and rehabilitation hospital [J]. Hong Kong Med J, 2005, 11(4): 234242.
33.	Barone L, Milosavljevic M, Gazibarich B. Assessing the older person: is the MNA a more appropriate nutritional assessment tool than the SGA? [J]. J Nutr Health Aging, 2003, 7(1): 1317.
34.	Vedantam A, Subramanian V, Rao NV, et al. Malnutrition in freeliving elderly in rural south India: prevalence and risk factors [J]. Public Health Nutr, 2010, 13(9): 13281332.
35.	Bauer JM, Vogl T, Wicklein S, et al. Comparison of the Mini Nutritional Assessment, Subjective Global Assessment, and Nutritional Risk Screening (NRS 2002) for nutritional screening and assessment in geriatric hospital patients [J]. Z Gerontol Geriatr, 2005, 38(5): 322327.
36.	吳萍, 卞大榮. 微型營養評價法與主觀全面評價法的比較 [J]. 同濟大學學報(醫學版), 2009, 30(3): 125128.
37.	Rubenstein LZ, Harker JO, Salvà A, et al. Screening for undernutrition in geriatric practice: developing the shortform mininutritional assessment (MNASF) [J]. J Gerontol A Biol Sci Med Sci, 2001, 56(6): M366M372.
38.	Kuzuya M, Kanda S, Koike T, et al. Evaluation of MiniNutritional Assessment for Japanese frail elderly [J]. Nutrition, 2005, 21(4): 498503.
39.	Phillips MB, Foley AL, Barnard R, et al. Nutritional screening in communitydwelling older adults: a systematic literature review [J]. Asia Pac J Clin Nutr, 2010, 19(3): 440449.
40.	Malnutrition Advisory Group. A consistent and reliable tool for malnutrition screening [J]. Nurs Times, 2003, 99(46): 2627.
41.	Stratton RJ, Hackston A, Longmore D, et al. Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the “malnutrition universal screening tool” (“MUST”) for adults [J]. Br J Nutr, 2004, 92(5): 799808.
42.	Stratton RJ, King CL, Stroud MA, et al. “Malnutrition Universal Screening Tool” predicts mortality and length of hospital stay in acutely ill elderly [J]. Br J Nutr, 2006, 95(2): 325330.
43.	Amaral TF, Antunes A, Cabral S, et al. An evaluation of three nutritional screening tools in a Portuguese oncology centre [J]. J Hum Nutr Diet, 2008, 21(6): 575583.
44.	傅曉瑾, 路潛. 三種營養篩查工具在外科術前患者中的應用 [J]. 中國臨床營養雜志, 2008, 16(6): 353356.
45.	Kondrup J, Allison SP, Elia M, et al, Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). ESPEN guidelines for nutrition screening 2002 [J]. Clin Nutr, 2003, 22(4): 415421.
46.	Sorensen J, Kondrup J, Prokopowicz J, et al; EuroOOPS study group. EuroOOPS: an international, multicentre study to implement nutritional risk screening and evaluate clinical outcome [J]. Clin Nutr, 2008, 27(3): 340349.
47.	Schiesser M, Müller S, Kirchhoff P, et al. Assessment of a novel screening score for nutritional risk in predicting complications in gastrointestinal surgery [J]. Clin Nutr, 2008, 27(4): 565570.
48.	Valero MA, Díez L, El Kadaoui N, et al. Are the tools recommended by ASPEN and ESPEN comparable for assessing the nutritional status? [J]. Nutr Hosp, 2005, 20(4): 259267.
49.	Kyle UG, Kossovsky MP, Karsegard VL, et al. Comparison of tools for nutritional assessment and screening at hospital admission: a population study [J]. Clin Nutr, 2006, 25(3): 409417.
50.	Raslan M, Gonzalez MC, Dias MC, et al. Comparison of nutritional risk screening tools for predicting clinical outcomes in hospitalized patients [J]. Nutrition, 2010, 26(78): 721726.
51.	于康, 夏瑩, 王孟昭, 等. 營養風險篩查和主觀全面評定用于肺癌非手術患者營養篩查的比較 [J]. 中國臨床營養雜志， 2008, 16(6): 349352.
52.	Jie B, Jiang ZM, Nolan MT, et al. Impact of nutritional support on clinical outcome in patients at nutritional risk: a multicenter, prospective cohort study in Baltimore and Beijing teaching hospitals [J]. Nutrition, 2010, 26(1112): 10881093.

1. Kondrup J, Rasmussen HH, Hamberg O, et al; Ad Hoc ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials [J]. Clin Nutr, 2003, 22(3): 321336．.
2. Lochs H, Allison SP, Meier R, et al. Introductory to the ESPEN Guidelines on Enteral Nutrition: Terminology, definitions and general topics [J]. Clin Nutr, 2006, 25(2): 180186.
3. 王艷, 蔣朱明, Nolan MT, 等. 營養風險的概念分析 [J]. 中華臨床營養雜志, 2009, 17(2): 104106.
4. Johansen N, Kondrup J, Plum LM, et al. Effect of nutritional support on clinical outcome in patients at nutritional risk [J]. Clin Nutr, 2004, 23(4): 539550.
5. 中華醫學會. 臨床技術操作規范－腸外腸內營養學分冊 [M]. 北京: 人民軍醫出版社, 2008: 159.
6. Green SM, Watson R. Nutritional screening and assessment tools for use by nurses: literature review [J]. J Adv Nurs, 2005, 50(1): 6983.
7. Bistrian BR, Blackburn GL, Vitale J, et al. Prevalence of malnutrition in general medical patients [J]. JAMA, 1976, 235(15): 15671570.
8. Blackburn GL, Bistrian BR, Maini BS, et al. Nutritional and metabolic assessment of the hospitalized patient [J]. JPEN J Parenter Enteral Nutr, 1977, 1(1): 1122.
9. McWhirter JP, Pennington CR. Incidence and recognition of malnutrition in hospital [J]. BMJ, 1994, 308(6934): 945948.
10. Fettes SB, Davidson HI, Richardson RA, et al. Nutritional status of elective gastrointestinal surgery patients pre and postoperatively [J]. Clin Nutr, 2002, 21(3): 249254.
11. 蔣朱明，陳偉，張澍田．中國11個城市大醫院6個臨床專科5 303例住院患者營養不良風險篩查(期中小結摘要) [J]. 中國臨床營養雜志, 2006, 14(4): 263.
12. 蔣朱明，陳偉，朱賽楠，等．我國東、中、西部大城市三甲醫院營養不良（不足）、營養風險發生率及營養支持應用狀況調查 [J]. 中國臨床營養雜志, 2008, 16(6): 335337.
13. 蔣朱明，于康，朱賽楠，等．我國東、中、西部中小醫院住院患者營養不良（不足）、營養風險、超重和肥胖發生率及營養支持應用狀況調查（中期小結） [J]. 中國臨床營養雜志, 2008, 16(6): 338340.
14. Oliveira MR, Fogaa KC, LeandroMerhi VA. Nutritional status and functional capacity of hospitalized elderly [J]. Nutr J, 2009, 8: 54.
15. Liang X, Jiang ZM, Nolan MT, et al. Comparative survey on nutritional risk and nutritional support between Beijing and Baltimore teaching hospitals [J]. Nutrition, 2008, 24(10): 969976.
16. Mackintosh MA, Hankey CR. Reliability of a nutrition screening tool for use in elderly day hospitals [J]. J Hum Nutr Diet, 2001, 14(2): 129136.
17. Campbell SE, Avenell A, Walker AE. Assessment of nutritional status in hospital inpatients [J]. QJM, 2002, 95(2): 8387.
18. 張明鳴, 周勇, 伍曉汀. 生長激素短期應用對胃腸外科手術后患者營養狀況和血清IGF1的影響 [J]. 中國普外基礎與臨床雜志, 2009, 16(12): 968973.
19. 黃承鈺. 實用臨床營養學 [M]. 成都: 四川大學出版社, 2006： 6983.
20. Kudsk KA, Tolley EA, DeWitt RC, et al. Preoperative albumin and surgical site identify surgical risk for major postoperative complications [J]. JPEN J Parenter Enteral Nutr, 2003, 27(1): 19.
21. Jones JM. The methodology of nutritional screening and assessment tools [J]. J Hum Nutr Diet， 2002, 15(1): 5971.
22. Buzby GP, Mullen JL, Matthews DC, et al. Prognostic nutritional index in gastrointestinal surgery [J]. Am J Surg, 1980, 139(1): 160167.
23. Detsky AS, McLaughlin JR, Baker JP, et al. What is subjective global assessment of nutritional status? [J]. JPEN J Parenter Enteral Nutr, 1987, 11(1): 813.
24. Sacks GS, Dearman K, Replogle WH, et al. Use of subjective global assessment to identify nutritionassociated complications and death in geriatric longterm care facility residents [J]. J Am Coll Nutr, 2000, 19(5): 570577.
25. Thoresen L, Fjeldstad I, Krogstad K, et al. Nutritional status of patients with advanced cancer: the value of using the subjective global assessment of nutritional status as a screening tool [J]. Palliat Med, 2002, 16(1): 3342.
26. Norman K, Schütz T, Kemps M, et al. The subjective global assessment reliably identifies malnutritionrelated muscle dysfunction [J]. Clin Nutr, 2005, 24(1): 143150.
27. Sungurtekin H, Sungurtekin U, Balci C, et al. The influence of nutritional status on complications after major intraabdominal surgery [J]. J Am Coll Nutr, 2004, 23(3): 227232.
28. Sungurtekin H, Sungurtekin U, Hanci V, et al. Comparison of two nutrition assessment techniques in hospitalized patients [J]. Nutrition, 2004, 20(5): 428432.
29. Ryu SW, Kim IH. Comparison of different nutritional assessments in detecting malnutrition among gastric cancer patients [J]. World J Gastroenterol, 2010, 16(26): 33103317.
30. Guigoz Y, Vellas BJ, Garry PJ. Mini nutritional assessment: a practical assessment tool for grading the nutritional state of elderly patients [J]. Facts Res Gerontol, 1994, 4(Suppl 2): 1559.
31. Guigoz Y, Vellas B, Garry PJ. Assessing the nutritional status of the elderly: The mini nutritional assessment as part of the geriatric evaluation [J]. Nutr Rev, 1996, 54(1 Pt 2): S59S65.
32. Shum NC, Hui WW, Chu FC, et al. Prevalence of malnutrition and risk factors in geriatric patients of a convalescent and rehabilitation hospital [J]. Hong Kong Med J, 2005, 11(4): 234242.
33. Barone L, Milosavljevic M, Gazibarich B. Assessing the older person: is the MNA a more appropriate nutritional assessment tool than the SGA? [J]. J Nutr Health Aging, 2003, 7(1): 1317.
34. Vedantam A, Subramanian V, Rao NV, et al. Malnutrition in freeliving elderly in rural south India: prevalence and risk factors [J]. Public Health Nutr, 2010, 13(9): 13281332.
35. Bauer JM, Vogl T, Wicklein S, et al. Comparison of the Mini Nutritional Assessment, Subjective Global Assessment, and Nutritional Risk Screening (NRS 2002) for nutritional screening and assessment in geriatric hospital patients [J]. Z Gerontol Geriatr, 2005, 38(5): 322327.
36. 吳萍, 卞大榮. 微型營養評價法與主觀全面評價法的比較 [J]. 同濟大學學報(醫學版), 2009, 30(3): 125128.
37. Rubenstein LZ, Harker JO, Salvà A, et al. Screening for undernutrition in geriatric practice: developing the shortform mininutritional assessment (MNASF) [J]. J Gerontol A Biol Sci Med Sci, 2001, 56(6): M366M372.
38. Kuzuya M, Kanda S, Koike T, et al. Evaluation of MiniNutritional Assessment for Japanese frail elderly [J]. Nutrition, 2005, 21(4): 498503.
39. Phillips MB, Foley AL, Barnard R, et al. Nutritional screening in communitydwelling older adults: a systematic literature review [J]. Asia Pac J Clin Nutr, 2010, 19(3): 440449.
40. Malnutrition Advisory Group. A consistent and reliable tool for malnutrition screening [J]. Nurs Times, 2003, 99(46): 2627.
41. Stratton RJ, Hackston A, Longmore D, et al. Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the “malnutrition universal screening tool” (“MUST”) for adults [J]. Br J Nutr, 2004, 92(5): 799808.
42. Stratton RJ, King CL, Stroud MA, et al. “Malnutrition Universal Screening Tool” predicts mortality and length of hospital stay in acutely ill elderly [J]. Br J Nutr, 2006, 95(2): 325330.
43. Amaral TF, Antunes A, Cabral S, et al. An evaluation of three nutritional screening tools in a Portuguese oncology centre [J]. J Hum Nutr Diet, 2008, 21(6): 575583.
44. 傅曉瑾, 路潛. 三種營養篩查工具在外科術前患者中的應用 [J]. 中國臨床營養雜志, 2008, 16(6): 353356.
45. Kondrup J, Allison SP, Elia M, et al, Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). ESPEN guidelines for nutrition screening 2002 [J]. Clin Nutr, 2003, 22(4): 415421.
46. Sorensen J, Kondrup J, Prokopowicz J, et al; EuroOOPS study group. EuroOOPS: an international, multicentre study to implement nutritional risk screening and evaluate clinical outcome [J]. Clin Nutr, 2008, 27(3): 340349.
47. Schiesser M, Müller S, Kirchhoff P, et al. Assessment of a novel screening score for nutritional risk in predicting complications in gastrointestinal surgery [J]. Clin Nutr, 2008, 27(4): 565570.
48. Valero MA, Díez L, El Kadaoui N, et al. Are the tools recommended by ASPEN and ESPEN comparable for assessing the nutritional status? [J]. Nutr Hosp, 2005, 20(4): 259267.
49. Kyle UG, Kossovsky MP, Karsegard VL, et al. Comparison of tools for nutritional assessment and screening at hospital admission: a population study [J]. Clin Nutr, 2006, 25(3): 409417.
50. Raslan M, Gonzalez MC, Dias MC, et al. Comparison of nutritional risk screening tools for predicting clinical outcomes in hospitalized patients [J]. Nutrition, 2010, 26(78): 721726.
51. 于康, 夏瑩, 王孟昭, 等. 營養風險篩查和主觀全面評定用于肺癌非手術患者營養篩查的比較 [J]. 中國臨床營養雜志， 2008, 16(6): 349352.
52. Jie B, Jiang ZM, Nolan MT, et al. Impact of nutritional support on clinical outcome in patients at nutritional risk: a multicenter, prospective cohort study in Baltimore and Beijing teaching hospitals [J]. Nutrition, 2010, 26(1112): 10881093.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Evaluation of Nutritional Status in Hospitalized Patients

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