营养评估的现状
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中国临床营养杂志000123The Current Status of Nutritional Assessment
Akira Okads, MD
(Osaka University, Medical School)
Alogn with progress on parenteral and enteral nutrition support, the nutritional treatment system of the in and out-patients has gradually been regulated, and in parallel with this, assessment of the nutritional status has come to the forefront as a key issue in the clinical management of paitnets. The nutritional status, particularly protein nutrition of the patient. Was formerly assessed in a vague manner by means of simply external appearance, weight or serum total protein. Now, every physioian is aware of the need to objectively assess the nutritional status in a simple, sensitive or accurate manner according to the specific purpose. Various paramenters have been advocated in the past and their usefulness and limitations were exsmined by a number of clinical and basic studies. At present, those paramenters can be divided into anthropometric measures, biochemical measures, immunological measures, physiological measures, radionucleid meausures and others. Anthropometric measures are simple, and inexpensive, so that they are suited to screening for many indiyisuals, but lack in accuracy and sensitivity. Of hiochemical measures, serum albumin is useful for accuracy and stability, however lacks in sensitivity. In a way serum rapid turnover proteins or urinary 3-methylhistidine are sensitive as compared to albumin, however unstable when suffering from dietary intake and strees burden. Immunological measures are sometimes sensitive and appropriate, however, not always respresnet nutritional status. Physiological measures, ie, the degree of wound healing and respiratory muscle strength can be similar as the above measures. As such, it is likely that there are no single adequate paramenters. Recenly several instrumental devices brought about new measures for fat-free mass (lean body mass)as more sophisticated and precise methods of measuring body composition. As such devices, bioelectrical impedance analysis (BIA), total body electrical conductivity (TOBEC), dual enersy X-ray absorptiometry (DEXA), in vivo neutron activation analysis (IVNAA), and near infrared reflectance method (NIR) are clinically in use in certain institutions. The goal is to throughly understand the merits and disadvantages of currently available methods of nutritional assessment and to apply those to patients' management with properly selected nutritional support.
, 百拇医药
随着肠外和肠内营养支持的进展，住院和门诊病人营养支持治疗的管理也有调整，相应地，营养状况的评估也成为临床营养支持的关键问题。以往常用一些简单的指标模糊地评价病人的营养状况，特别是蛋白质营养情况，如体重和血清总蛋白。现在，我们都认识到使用简单、灵敏和准确的方法客观评价病人营养状况是非常必要的。已经有临床和基础的研究检验了以往使用的各种方法的实用性和局限性。这些测定指标可分为人类学、生化学、免疫学、生理学、放射核医学等。人类学测定指标简单易行，花费少，适合作为大群体的筛选，但缺乏精确度和灵敏度。生化指标中，血清白蛋白准确且稳定，但灵敏度差。血清中快速更新的蛋白或3-甲基组氨酸较白蛋白灵敏，但会受饮食和应激的影响而不稳定。免疫学指标有时很灵敏准确，但不总是能反应机体的营养状况。生理学指标，如伤口愈合情况、呼吸肌力量等，与上面情况类似。因此，目前看来还没有一个能准确反应营养状况的指标。最近，一些仪器提供了测定瘦体组织(lean body mass)的新方法，可以更准确地测定人体组成。在一些研究机构已经在临床使用了生物电阻抗分析(BIA)、电传导性测定(TOBEC)、双能量X线吸收测定(DEXA)、体内中子活化分析(IVNAA)、近红外线反射方法(NIR)等技术。
了解目前使用的营养评估方法的优点和不足，有助于我们正确使用，为病人选择合理的营养支持方案。, 百拇医药
单位：
关键词：
中国临床营养杂志000123The Current Status of Nutritional Assessment
Akira Okads, MD
(Osaka University, Medical School)
Alogn with progress on parenteral and enteral nutrition support, the nutritional treatment system of the in and out-patients has gradually been regulated, and in parallel with this, assessment of the nutritional status has come to the forefront as a key issue in the clinical management of paitnets. The nutritional status, particularly protein nutrition of the patient. Was formerly assessed in a vague manner by means of simply external appearance, weight or serum total protein. Now, every physioian is aware of the need to objectively assess the nutritional status in a simple, sensitive or accurate manner according to the specific purpose. Various paramenters have been advocated in the past and their usefulness and limitations were exsmined by a number of clinical and basic studies. At present, those paramenters can be divided into anthropometric measures, biochemical measures, immunological measures, physiological measures, radionucleid meausures and others. Anthropometric measures are simple, and inexpensive, so that they are suited to screening for many indiyisuals, but lack in accuracy and sensitivity. Of hiochemical measures, serum albumin is useful for accuracy and stability, however lacks in sensitivity. In a way serum rapid turnover proteins or urinary 3-methylhistidine are sensitive as compared to albumin, however unstable when suffering from dietary intake and strees burden. Immunological measures are sometimes sensitive and appropriate, however, not always respresnet nutritional status. Physiological measures, ie, the degree of wound healing and respiratory muscle strength can be similar as the above measures. As such, it is likely that there are no single adequate paramenters. Recenly several instrumental devices brought about new measures for fat-free mass (lean body mass)as more sophisticated and precise methods of measuring body composition. As such devices, bioelectrical impedance analysis (BIA), total body electrical conductivity (TOBEC), dual enersy X-ray absorptiometry (DEXA), in vivo neutron activation analysis (IVNAA), and near infrared reflectance method (NIR) are clinically in use in certain institutions. The goal is to throughly understand the merits and disadvantages of currently available methods of nutritional assessment and to apply those to patients' management with properly selected nutritional support.
, 百拇医药
随着肠外和肠内营养支持的进展，住院和门诊病人营养支持治疗的管理也有调整，相应地，营养状况的评估也成为临床营养支持的关键问题。以往常用一些简单的指标模糊地评价病人的营养状况，特别是蛋白质营养情况，如体重和血清总蛋白。现在，我们都认识到使用简单、灵敏和准确的方法客观评价病人营养状况是非常必要的。已经有临床和基础的研究检验了以往使用的各种方法的实用性和局限性。这些测定指标可分为人类学、生化学、免疫学、生理学、放射核医学等。人类学测定指标简单易行，花费少，适合作为大群体的筛选，但缺乏精确度和灵敏度。生化指标中，血清白蛋白准确且稳定，但灵敏度差。血清中快速更新的蛋白或3-甲基组氨酸较白蛋白灵敏，但会受饮食和应激的影响而不稳定。免疫学指标有时很灵敏准确，但不总是能反应机体的营养状况。生理学指标，如伤口愈合情况、呼吸肌力量等，与上面情况类似。因此，目前看来还没有一个能准确反应营养状况的指标。最近，一些仪器提供了测定瘦体组织(lean body mass)的新方法，可以更准确地测定人体组成。在一些研究机构已经在临床使用了生物电阻抗分析(BIA)、电传导性测定(TOBEC)、双能量X线吸收测定(DEXA)、体内中子活化分析(IVNAA)、近红外线反射方法(NIR)等技术。
了解目前使用的营养评估方法的优点和不足，有助于我们正确使用，为病人选择合理的营养支持方案。, 百拇医药