Malnutrition
實習生：曾郁涵
指導老師：林京美營養師
報告日期：2012/12/21
2
Clinical Nutrition 29 (2010) 151–153
journal homepage: http://www.elsevier.com/locate/clnu
3
Recent evidence suggests that varying
degrees of acute or chronic
inflammation are key contributing
factors.
 Malnutrition has measurable and
important adverse effects on clinical
outcomes.
 It is important to recognize the
presence or absence of a systemic
inflammatory response.

Methods
An International Guideline Committee was
constituted to develop a consensus approach
to defining malnutrition syndromes for adults
in the clinical setting. Consensus was
achieved through a series of meetings held at
the ASPEN and ESPEN Congresses.
4
5
chronic starvation
without inflammation
S tarvation - Related M alnutrition
inflammation is
chronic and of mild to Chronic D isease- R elated M alnutrition
moderate degree
inflammation is acute
A cute D isease- R elated M alnutrition
and of severe degree
6
7
8
1. Translation of this diagnostic approach to
routine clinical practice will require
validation.
2.These transitions may be blunted by
nutritional intervention, early recognition of
the process is imperative.
3. Patient with SRM or CDRM is prone to
deteriorate quickly with any additional acute
inflammatory event.
4. Sarcopenic obesity may represent a chronic
low level inflammatory state.
9
Clinical Nutrition 30 (2011) 194-201
Introduction
In German hospitals, every fourth adult
patient at admission is already malnourished
or has a risk.
To improve patient outcome and to decrease
costs for the health care systems.
Aim to develop and evaluate a routinely
manageable concept for an improved
nutritional care of malnourished in-hospital
patients.
10
11
Intervention trial between January 2007 and November 2007 (follow up until June 2008)
Under nutrition risk
(NRS ≧ 3)
CG
standard hospital care
I
individualized nutritional
support
G
(5 to maximum 28 days)
Exclusion criteria :
•no informed consent
•terminal condition
Detailed
nutritional assessment
Prescribed by physician
•expected stay <5
days
Individual
food supply
in this study
independently. •previous participation
•patient on starvation
Fortification of meals
•PN
（maltodextrin, rapeseed oil,
•being on dialysis
cream, protein powder）
In-between snacks and oral
nutritional supplements
12
13
•
•
•
•
•
•
•
•
•
•
average daily energy and protein intake
changes in bodyweight during hospitalization
number of complications
number of antibiotic therapies due to infectious
complications
length of hospital stay（LOS）
quality of life Short Form 36 Questions (SF-36) Score
hospital readmission (after six months)
mortality (hospital and six months after discharge)
oral nutrition standard supplement consumption
plasma concentrations of 25-OH-D3, ascorbic acid
and glutathione
14
15
≧75%TEE
I G: 83%
CG: 30%
16
17
66.1 →
68.1 →
p=0.002
18

Both are low compliance with Oral nutrutional
supplement(ONS).
IG



Ascorbic acid
Glutathione 25-OH-D3
-
In-hospital complications was lower in IG than in CG.
Antibiotics treatment were more often prescribed to
patients of CG than IG.
Patients of CG were more often re-hospitalized.
19
20
21




Body weight attribute a major effect to energy intake.
◦ ＜75% TEE, was associated with weight loss.
Acute or chronic disease has to consider an
higher metabolic rate.
Lack of energy and protein is accompanied with
micronutrient deficiencies .
Food quality shall still be considered apart from food
quantity.
22



Nutritional care has to follow a tight
algorithm in order to guarantee that the daily
individual needs.
Malnourished patients profit from nutrition
support regarding nutrition status and quality
of life.
They have fewer complications, need fewer
antibiotics and are less often re-hospitalised
23
Clinical Nutrition 31 (2012) 637-646
Introduction
If nutritional therapy is not adequately
provided, these patients have a higher risk of
diminished physiological function,
complications, longer length of hospital stay,
decreased quality of life, and mortality.
This study aimed at exploring food sensory
quality as experienced and perceived by
patients at nutritional risk during various
meals.
24
25
• NRS-2002 ≧ 3
•Food intake ＜ 75%
Meal observations
 food records
 open-ended question
(experiences and preferences)

26
27
28


Food sensory perception and eating ability
Food sensory needs
Appearance
Aroma
ACCEPT: garnished /plain and simple
DISLIKE: haphazardly
ACCEPT: cold with limited smell
(strawberry, forest berry and orange)
DISLIKE: warm dishes / citrus flavoured supplement
ACCEPT: natural, neutral flavour (Sour) →varity
Taste
DISLIKE: bitter tastes
Specific foods (e.g., coffee, tea, dark chocolate, wine,
red meat) due to heightened bitter flavours or metallic
tastes
29
ACCEPT: soft and fluid (moisture)foods
Texture
Temperature
Variety

DISLIKE: dairy products(sickly film)
difficult to cut, troublesome packaging
PREFER: hot meals
drinks→ice cold
•Mose patients prefer variety of food.
•Difficulty eating patient tended to eat similar foods
and a more fixed diet.
Motivation to eat
◦ Pleasure
◦ Comfort
◦ Survival

Hospital admission versus post-discharge
30
31
32
33

The study generated a model for optimizing
food sensory quality and even developing
innovative foods to promote intake in
patients at nutritional risk.
34
Summary
• The commentary present a simple etiologybased construct for the diagnosis of adult
malnutrition in the clinical setting.
• To develop and evaluate a routinely
manageable concept for an improved
nutritional care of malnourished in-hospital
patients.
• A model for optimizing food sensory quality
and developing innovative foods to promote
intake in patients at nutritional risk.