Yatan hastalarda malnütrisyon yüksek oranda görülen önemli bir sorundur. Malnütrisyon oluşturduğu doku harabiyeti ve organ fonksiyon bozukluğu nedeniyle hastaların morbidite ve mortalite oranlarını artırırken, diğer yandan hastanede kalış sürelerinin uzamasına yol açmaktadır. Son yılların en popüler konularından biri olan nütrisyonal destek günümüzde tedaviyi destekleyen bir önlemden ziyade tedavinin önemli bir bileşeni olarak kabul edilmektedir. Nütrisyonel destek programlarının iyi organize olmuş ve özel bir ekip tarafından yürütülmesi komplikasyon oranını önemli ölçüde azaltmıştır. Beslenme desteğinin uygulanması dinamik bir süreçtir. Program hastanın fizik aktivitesi, yeni komplikasyon gelişmesi, vücut ısısındaki değişiklikler ve enfeksiyon gibi en son klinik değişkenlerin ışığı altında düzenli olarak gözden geçirilmelidir.
Malnutrition is an important and common problem among hospitalized patients. Malnutrition increases patients morbidity and mortlity due to tissue damage and organ dysfunction, also it leads to long hospital stay. One of the most popular issues recently, nutritional support is considered as not only a supportive measure of therapy but also a major component of treatment. Nutritional support programs which applied by well organized and specialized teams significantly decreases complication rates. Administration of nutritional support is a dynamic process. This program should be regularly overwieved on the light of the latest clinical variables such as patient’s physical activity, development of new complication, body temperature changes and infection.
1. Thibault R, Pichard C. Nutrition and clinical outcome in intensive care patients. Curr Opin Clin Nutr Metab Care 2010; 13: 177-83.
2. Pichard C, Kyle UG, Morabia A, Perrier A, Vermeulen B, Unger P. Nutritional assessment: lean body mass depletion at hospital admission is associated with an increased length of stay. Am J Clin Nutr 2004; 79: 613-8.
3. Pirlich M, Schütz T, Norman K et al. The German hospital malnutrition study. Clin Nutr 2006; 25: 563-72.
4. Reid CL, Campbell IT, Little RA. Muscle wasting and energy balance in critical illness. Clin Nutr 2004; 23: 273-80.
5. Villet S, Chiolero RL, Bollmann MD et al. Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients. Clin Nutr 2005; 24: 502-9.
6. Petros S, Engelmann L. Enteral nutrition delivery and energy expenditure in medical intensive care patients. Clin Nutr 2006; 25: 51-9.
7. Dvir D, Cohen J, Singer P. Computerized energy balance and complications in critically ill patients: an observational study. Clin Nutr 2006; 25: 37-44.
8. Amaral TF, Matos LC, Tavares MM et al. The economic impact of disease-related malnutrition at hospital admission. Clin Nutr 2007; 26: 778-84.
9. Anthony PS. Nutrition screening tools for hospitalized patients. Nutr Clin Pract 2008; 23: 373-82.
10. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M; Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). ESPEN guidelines for nutrition screening 2002. Clin Nutr 2003; 22: 415-21.
11. Putwatana P, Reodecha P, Sirapo-ngam Y, Lertsithichai P, Sumboonnanonda K. Nutrition screening tools and the prediction of postoperative infectious and wound complications: comparison of methods in presence of risk adjustment. Nutrition 2005; 21: 691-7.
12. Raslan M, Gonzalez MC, Gonçalves Dias MC et al. Comparison of nutritional risk screening tools for predicting clinical outcomes in hospitalized patients. Nutrition 2010; 26: 721-6.
13. 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. Br J Nutr 2004; 92: 799-808.
14. Kyle UG, Kossovsky MP, Karsegard VL, Pichard C. Comparison of tools for nutritional assessment and screening at hospital admission: a population study. Clin Nutr 2006; 25: 409-17.
15. Vellas B, Guigoz Y, Garry PJ et al. The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition 1999; 15: 116-22.
16. Compan B, di Castri A, Plaze JM, Arnaud-Battandier F. Epidemiological study of malnutrition in elderly patients in acute, sub-acute and long-term care using the MNA. J Nutr Health Aging 1999; 3: 146-51.
17. Cohen G, Jose SM, Ahronheim JC. Body mass index: pitfalls in elderly people. J Am Geriatr Soc 2009; 57: 170-2.
18. Cook Z, Kirk S, Lawrenson S, Sandford S. Use of BMI in the assessment of undernutrition in older subjects: reflecting on practice. Proc Nutr Soc 2005; 64: 313-7.
19. Ferguson M, Capra S, Bauer J, Banks M. Development of a valid and reliable malnutrition screening tool for adult acute hospital patients. Nutrition 1999; 15: 458-64.
20. Kruizenga HM, de Jonge P, Seidell JC et al. Are malnourished patients complex patients? Health status and care complexity of malnourished patients detected by the Short Nutritional Assessment Questionnaire (SNAQ). Eur J Intern Med 2006; 17: 189-94.
21. Kruizenga HM, de Vet HC, Van Marissing CM et al. The SNAQ(RC), an easy traffic light system as a first step in the recognition of undernutrition in residential care. J Nutr Health Aging 2010; 14: 83-9.
22. Wu BW, Yin T, Cao WX et al. Clinical application of subjective global assessment in Chinese patients with gastrointestinal cancer. World J Gastroenterol 2009; 15: 3542-9.
23. Sungurtekin H, Sungurtekin U, Oner O, Okke D. Nutrition assessment in critically ill patients. Nutr Clin Pract 2008-2009; 23: 635-41.
24. Atalay BG, Yagmur C, Nursal TZ, Atalay H, Noyan T. Use of subjective global assessment and clinical outcomes in critically ill geriatric patients receiving nutrition support. JPEN J Parenter Enteral Nutr 2008; 32: 454-9.
25. Smith RC, Ledgard JP, Doig G, Chesher D, Smith SF. An effective automated nutrition screen for hospitalized patients. Nutrition 2009; 25: 309-15.
26. Guo W, Ou G, Li X, Huang J, Liu J, Wei H. Screening of the nutritional risk of patients with gastric carcinoma before operation by NRS 2002 and its relationship with postoperative results. J Gastroenterol Hepatol 2010; 25: 800-3.
27. Drescher T, Singler K, Ulrich A et al. Comparison of two malnutrition risk screening methods (MNA and NRS 2002) and their association with markers of protein malnutrition in geriatric hospitalized patients. Eur J Clin Nutr 2010; 64: 887-93.
28. Amaral TF, Antunes A, Cabral S, Alves P, Kent-Smith L. An evaluation of three nutritional screening tools in a Portuguese oncology centre. J Hum Nutr Diet 2008; 21: 575-83.
29. Gur AS, Atahan K, Aladag I et al. The efficacy of Nutrition Risk Screening-2002 (NRS-2002) to decide on the nutritional support in general surgery patients. Bratisl Lek Listy 2009; 110: 290-2.
30. Karl A, Rittler P, Buchner A et al. Prospective assessment of malnutrition in urologic patients. Urology 2009; 73: 1072-6.
31. Bischoff SC, Kester L, Meier R, Radziwill R, Schwab D, Thul P. Working group for developing the guidelines for parenteral nutrition of The German Association for Nutritional Medicine. Organisation, regulations, preparation and logistics of parenteral nutrition in hospitals and homes; the role of the nutrition support team - Guidelines on Parenteral Nutrition, Chapter 8. Ger Med Sci 2009; 18; 7: 20.
32. Fettes SB, Lough M. An audit of the provision of parenteral nutrition in two acute hospitals: team versus non-team. Scott Med J 2000; 45: 121-5.
33. Gales BJ, Gales MJ. Nutritional support teams: a review of comparative trials. Ann Pharmacother 1994; 28: 227-35.
34. Pichard C, Mühlebach S, Maisonneuve N, Sierro C. Prospective survey of parenteral nutrition in Switzerland: a three-year nation-wide survey. Clin Nutr 2001; 20: 345-50.
35. Frankenfield D, Hise M, Malone A, Russell M, Gradwell E, Compher C. Evidence Analysis Working Group. Prediction of resting metabolic rate in critically ill adult patients: results of a systematic review of the evidence. J Am Diet Assoc 2007; 107: 1552-61.
36. Kreymann G, Adolph M, Mueller MJ. Working group for developing the guidelines for parenteral nutrition of The German Association for Nutritional Medicine. Energy expenditure and energy intake - Guidelines on Parenteral Nutrition, Chapter 3. Ger Med Sci 2009; 18; 7: 25.
37. Compher C, Frankenfield D, Keim N, Roth-Yousey L. Evidence Analysis Working Group. Best practice methods to apply to measurement of resting metabolic rate in adults: a systematic review. J Am Diet Assoc 2006; 106: 881-903.
38. Boullata J, Williams J, Cottrell F, Hudson L, Compher C. Accurate determination of energy needs in hospitalized patients. J Am Diet Assoc 2007; 107: 393-401.
39. Frankenfield DC, Rowe WA, Smith JS, Cooney RN. Validation of several established equations for resting metabolic rate in obese and nonobese people. J Am Diet Assoc 2003; 103: 1152-9.
40. Fung EB. Estimating energy expenditure in critically ill adults and children. AACN Clin Issues 2000; 11: 480-97.
41. Malone AM. Methods of assessing energy expenditure in the intensive care unit. Nutr Clin Pract 2002; 17: 21-8.
42. Ireton-Jones CS, Turner WW Jr, Liepa GU, Baxter CR. Equations for the estimation of energy expenditures in patients with burns with special reference to ventilatory status. J Burn Care Rehabil 1992; 13: 330-3.
43. Ireton-Jones CS, Borman KR, Turner WW Jr. Nutrition considerations in the management of ventilator-dependent patients. Nutr Clin Pract 1993; 8: 60-4.
44. Fontaine E, Müller MJ. Adaptive alterations in metabolism: practical consequences on energy requirements in the severely ill patient. Curr Opin Clin Nutr Metab Care 2011; 14: 171-5.
45. Ishibashi N, Plank LD, Sando K, Hill GL. Optimal protein requirements during the first 2 weeks after the onset of critical illness. Crit Care Med 1998; 26: 1529-35.
46. Plank LD, Hill GL. Sequential metabolic changes following induction of systemic inflammatory response in patients with severe sepsis or major blunt trauma. World J Surg 2000; 24: 630-8.
47. Plank LD, Metzger DJ, McCall JL et al. Sequential changes in the metabolic response to orthotopic liver transplantation during the first year after surgery. Ann Surg 2001; 234: 24.