Applicability of Modified Pediatric Nutritional Risk Screening Tool in children with cerebral palsy / 中华实用儿科临床杂志

Objective:To explore the scheme of assigning rational scores to the Modified Pediatric Nutritional Risk Screening Tool for children with cerebral palsy(CP) at different Gross Motor Function Classification System(GMFCS) levels.Methods:The clinical data of 360 children with CP hospitalized in the Department of Children′s Rehabilitation, the Third Affiliated Hospital of Zhengzhou University from January to October 2019 were analyzed retrospectively.All the CP children at different GMFCS levels who met the inclusion criteria were subject to nutrition screening and assessment by using the Modified Pediatric Nutritional Risk Screening Tool and the Subjective Global Nutritional Assessment(SGNA) scale.The distribution of malnutrition rates assessed by the SGNA scale among the children at different GMFCS levels was examined.Data between groups were compared by the χ2 test.Children at different GMFCS levels were divided into different subgroups according to the statistical difference.Then, 0 or 1 score was assigned to the Modified Pediatric Nutritional Risk Screening Tool in different subgroups, and different combinations were formed.The nutritional risk screening results of different combinations were evaluated by using the SGNA scale assessment results as a reference. Results:In children with CP, the risk detection rate and incidence rate of malnutrition were 58.1%(209/360) and 36.9%(133/360), respectively.There was no significant difference in the incidence rate of malnutrition between GMFCS Ⅱ and GMFCS Ⅲ, as well as between GMFCS Ⅳ and GMFCS Ⅴ(all P>0.05). Therefore, children with CP were divided into 3 subgroups, namely, group Ⅰ, group Ⅱ to Ⅲ, and group Ⅳ to Ⅴ.Different CP disease scores were given to the Modified Pediatric Nutritional Risk Screening Tool in 3 subgroups, forming 3 different protocols[protocol 1 (0, 0, 1 point); protocol 2(0, 1, 1 point); current protocol (1, 1, 1 point)]. Taking the SGNA scale assessment results as a reference, the sensitivity of protocol 1, protocol 2 and current protocol were 85.7%, 92.5%, and 93.2% respectively.The specificity protocol 1, protocol 2 and current protocol were 81.1%, 78.0%, and 62.6%, respectively.And the Youden indexes of above three protocols were 0.668, 0.705, and 0.558, respectively.The Youden index of protocol 2 was relatively high. Conclusions:The Modified Pediatric Nutritional Risk Screening Tool can effectively identify the risk of malnutrition in children with CP.The scheme of assigning 0 points to children with GMFCS grade Ⅰ and 1 point to children with GMFCS grade Ⅱ to Ⅴ is more reasonable.

A survey of Changes in nutritional risk and incidence of malnutrition among patients with chronic cardiovascular disease during 7-30 days hospitalization in 3 tertiary hospitals in Beijing / 中华临床营养杂志

Objective To investigate the changes of nutritional status of chronic cardiovascular patients during hospitalization by using nutritional risk screening 2002 (NRS 2002) and subjective global assessment (SGA).Methods A prospective,parallel multicenter study was can-ied out in 3 tertiary A hospitals in Beijing from June 2014 to September 2014.Subjects in the study had been hospitalized for 7-30 days for various types of chronic cardiovascular diseases.Physical indexes and laboratory examination results were recorded within 24 hours after admission and 24 hours before discharge.The nutritional status was evaluated using NRS 2002 and SGA.Results 454 inpatients were enrolled in this study.Prevalence of undernutrition,defined as body mass index＜ 18.5 kg/m2 with poor general condition,was 7.0％ on admission.Prevalence of nutritional risk (NRS 2002 score≥3) was 27.9％.Patients with heart valve disease (34.6％) and arrhythmia (47.5％) had higher prevalence of nutritional risk,which decreased on discharge.At admission,the prevalence of SGA-based moderate and severe undernutrition (grade B+C) was 16.7％.In particular,this prevalence was higher in patients with heart valve disease (30.7％) and arrhythmia (22.5％).At discharge,the proportion of patients (except patients with coronary heart disease) with moderate and severe dystrophy,especially severe dystrophy,decreased significantly.Conclusions Patients with chronic cardiovascular disease were likely to have comorbid nutritional risk at the time of admission,including undernutrition,as defined by body mass index＜ 18.5 kg/m2 plus poor general condition,and SGA-based moderate or severe malnutrition,which was partially improved on discharge.Attention should be paid to nutritional status screening and evaluation on admission.Reasonable nutrition intervention should be done to correct malnutrition and improve clinical outcomes.

Evidências para o uso da avaliação nutricional subjetiva global nos pacientes com doença arterial periférica / Evidence for use of subjective global assessment of the nutritional status of patients with peripheral arterial disease

A desnutrição é uma doença extremamente prevalente em pacientes internados, chegando a acometer 50% deles, 47% dos pacientes cirúrgicos e entre 39 e 73% dos portadores de doença arterial periférica, com grande impacto na morbimortalidade desses pacientes. A desnutrição possui grande relevância no desfecho clínico desses pacientes durante a internação, estando associada a maior incidência de infecções, demora na cicatrização das feridas, diminuição do status de deambulação, maior tempo de internação e mortalidade. Entretanto, o diagnóstico de desnutrição ou risco nutricional desses pacientes tem sido um desafio. A avaliação nutricional subjetiva global revelou-se, até o momento, o padrão ouro como método de triagem de pacientes cirúrgicos internados devido à sua praticidade e acurácia. O objetivo deste trabalho é revisar métodos utilizados na avaliação do estado nutricional e da triagem nutricional de pacientes internados e caracterizar a importância dessa avaliação nos desfechos clínicos dos pacientes com arteriopatias.

Malnutrition is an extremely common disease among hospitalized patients, with prevalence rates as high as 50% overall, 47% among surgical patients and from 39 to 73% among patients with peripheral arterial disease. It has a major impact on morbidity and mortality among these patients. Malnutrition is very relevant to these patients’ clinical outcomes and is associated with a higher incidence of infections, slower wound healing, lower rates of mobility, longer hospital stays and greater mortality. However, diagnosing malnutrition or nutritional risk in these patients has proven to be a challenge. To date, subjective global nutritional assessment remains the gold standard screening method for use with hospitalized surgical patients because of its practicality and accuracy. The objective of this study is to review methods used for assessment of nutritional status and for nutritional screening of hospitalized patients and determine the importance of these assessments to the clinical outcomes of patients with arteriopathies.

Concordância interavaliadores no diagnóstico nutricional de pacientes hospitalizados por meio da avaliação nutricional subjetiva global / Inter-evaluator agreement in the nutritional diagnosis of hospitalized patients using the subjective global nutritional assessment / Acuerdo de interés para evaluar el diagnóstico nutricional de pacientes hospitalizados, mediante la evaluación nutricional subjetiva global

A avaliação nutricional é o instrumento de diagnóstico de distúrbios nutricionais que determina o estado nutricional de uma pessoa e, no caso de adultos hospitalizados, deve ser capaz de descartar ou confirmar uma possível desnutrição. O objetivo desta pesquisa é avaliar a concordância interavaliadores, na obtenção do diagnóstico nutricional de pacientes hospitalizados, com a utilização da avaliação nutricional subjetiva global (ANSG). Foi realizada uma avaliação do estado nutricional em todos os 50 pacientes internados em um hospital público na cidade de Fortaleza, Ceará, no período de agosto a setembro de 2008. Utilizou-se o formulário da ANSG, em cada paciente, por duas avaliadoras independentes e em momentos diferentes.O diagnóstico nutricional de cada paciente foi estabelecido com base na pontuação obtida em cada formulário,e a concordância entre os diagnósticos das duas avaliadoras foi verificada pelo coeficiente Kappa. Participaram da pesquisa: 31 (62por cento) pacientes do sexo masculino e 19 (38por cento) do sexo feminino, com idade de 37,08 mais ou menos 11,92 anos. Nas avaliações realizadas pela avaliadora I, foram diagnosticados 41 (82por cento) pacientes bem nutridos e 9 (18por cento) com desnutrição. Resultados semelhantes foram obtidos pela avaliadora II, que diagnosticou 43(86por cento) pacientes bem nutridos e 7 (14por cento) com desnutrição, sendo obtida uma concordância quase perfeita (K igual 0,852) entre as duas avaliadoras. Conclui-se que, a despeito de ser um método subjetivo, a ANSG apresentou um grau de concordância Kappa quase perfeito no diagnóstico nutricional de pacientes hospitalizados, quando aplicado por avaliadores treinados

Nutritional assessment is the diagnostic tool of nutritional disorders that determines the nutritional status of a person and, in the case of hospitalized adults, should be able to rule out or confirm a possible diagnosis of malnutrition. The objective of thisresearch was to assess inter-evaluator agreement in obtaining a nutritional diagnosis of hospitalized patients with the use of subjective global nutritional assessment (SGA). An evaluation was made of nutritional status in all 50 patients admitted to a public hospital in Fortaleza, Ceará, from August to September 2008. A SGA form was used for each patient and was evaluated by two independent evaluators at different times. The nutritional status of each patient was based on their score on each form, and agreement between the diagnoses of the two evaluators was measured by Kappa coefficient. Of those who participated in the survey, 31 (62percent) were male and 19 (38percent) were female,aged 37.08 more or less 11.92 years. In the evaluations performed by one evaluator, 41 (82percent) were diagnosed as ?well-nourished? patients and 9 (18percent) were diagnosed as ?malnourished.? Similar results were obtained in the alternate evaluation, in which 43 (86percent) patients were diagnosed as ?well nourished? and 7 (14percent) as ?malnourished.? A near perfect agreement (K equal 0.852) was seen between the two evaluations. It was concluded that, despite being a subjective method, the SGA, using the Kappa coefficient, presented a degree of concordance that was near perfect in the nutritional diagnosis of hospitalized patients when applied by trained evaluators.

La evaluación nutricional es la herramienta de diagnóstico de los trastornos nutricionales que determina el estado nutricional de una persona y, en el caso de los adultos hospitalizados, debe ser capaz de descartar o confirmar una posible desnutrición. El objetivo de esta investigación es evaluar el acuerdo entre evaluadores, para obtener el diagnóstico nutricional de los pacientes hospitalizados, con el uso de la evaluación nutricional subjetiva global (SGA). Fue realizada una evaluación del estado nutricional en los 50 pacientes ingresados en un hospital público de Fortaleza, Ceará, entre agosto y septiembre de 2008. Se utilizó el formulario de la SGA, en cada paciente, por dos evaluadores independientes y en diferentes momentos. El estado nutricional de cada paciente fue obtenido con base en la puntuación alcanzada en cada formulario, y el acuerdo entre los diagnósticos de los dos evaluadores se midió mediante el coeficiente kappa. Participaron en la investigación: 31 (62por ciento) pacientes del sexo masculino y 19 (38por ciento) mujeres, con edades 37,08 más o menos 11,92 años. En los resultados obtenidos por el evaluador I, fueron diagnosticados 41 (82por ciento) pacientes bien nutridos y 9 (18por ciento) com desnutrición. Resultados similares fueron obtenidos por el evaluador II, quien diagnosticó 43 (86por ciento) pacientes bien nutridos y 7 (14por ciento) con desnutrición, obteniendo una concordancia casi perfecta (K igual 0,852) entre los dos evaluadores. Se concluye que, a pesar de ser un método subjetivo, el SGA presentó un grado de concordancia Kappa, de diagnóstico nutricional em pacientes hospitalizados, casi perfecto, cuando es aplicado por evaluadores entrenados.

Assessment of nutritional status in chronic kidney disease patients / 中国基层医药

Objective To investigate good nutritional measurements of CKD patients.In order to diagnose malnutrition early in CKD patients.Methods Clinical data of 125 CKD patients have been collected.The glomerular filtration rate(GFR)was estimated from the modification of diet in renal disease(MDRD).According to the results of GFR,all CKD patients were divided into five groups.The levels of biochemical markers were assayed.At the same time,bioelectrical impedance analysis(BIA)were measured.We analyzed the relationship between nutritional parameters and GFR.Results According to SGA,malnutrition rate in fifth CKD stage is 29%.Impedance of leg is significantly correlated to GFR in 1kHz,50kHz and 500kHz,impedance of truck is also significantly correlated to GFR in 50kHz and 500kHz.The values of impedance reduced with the decreasing of GFR.Conclusion SGA and BIA all can be used to evaluate nutritional status of CKD patients.BIA is a more sensitive method to detect early malnutrition and may be useful in monitoring nutrition changes in CKD patients.

Evaluation of nutritional status on maintenance hemodialysis patients / 肠外与肠内营养

Objective: The subjective global assessment(SGA) was used in maintenance hemodialysis patients(MHD)to evaluate the nutritional status. Methods: The subjective global nutritional assessment(SGA) and the combination of biochemical markers,anthropometric indices and dietary assessment were taken in 127 cases of hemodialysis patients. Result: In 127 cases of dialysis patients,75 cases were well-nourished persons,39 cases were mild to moderate malnutrition,13 cases were severe malnutrition,and the total incidence of malnutrition was 40.9%.The serum albumin,prealbumin,creatinine,triceps skinfold thickness,dietary protein intake and protein catabolic rate were different in different groups of nutritional status,while there was no significant difference of Kt/V in three groups. Conclusion: The higher incidence of malnutrition is related with the inadequate protein intake,inflammation and blood dialysis process in hemadialysis patients.