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Hastanede Yatan Hastaların Beslenme Durumlarının Nutrisyonel Risk Skoru 2002 ve Subjektif Global Değerlendirme ile Taranması

Yıl 2021, Cilt 11, Sayı 6, 864 - 869, 20.11.2021
https://doi.org/10.16899/jcm.975869

Öz

Giriş: Hastanede yatan hastaların beslenme durumlarının değerlendirilmesi, malnütrisyon riski altında olan hastaların ve malnutrisyonla ilişkili diğer durumların tespit edilmesi için önemlidir. Çalışmada, hastanede yatan hastaların beslenme durumlarının Nutrisyonel Risk Skoru 2002 (NRS-2002) ve Subjektif Global Değerlendirme (SGD) tarama araçları ile taranması ve malnütrisyonun belirlenmesinde iki tarama yönteminin sonuçlarının karşılaştırılması amaçlanmıştır.
Gereç ve Yöntem: NRS-2002 ve SGD, hastaneye kabulün ilk günlerinde 134 kritik olmayan servis hastasına uygulanmıştır. Malnütrisyonun tespitinde tarama aracının etkinliği ve hastanede kalış süresi ile ilişkisi analiz edilmiştir.
Bulgular: NRS-2002 ile tarandığında hastaların %22,4'ü (n=30) beslenme riski altında olduğu, SGA ile tarama yapıldığında hastaların %35,8'inin (n=48) malnütrisyonlu olduğu saptanmıştır (p=0,015). NRS-2002'ye göre yetersiz beslenen hastaların ve yetersiz beslenen hastaların hastanede kalış süreleri (gün) benzerdi. Ancak SGD taramasına göre malnütrisyonlu hastaların hastanede kalma süreleri malnütrisyonsuz hastalara göre daha uzundu (sırasıyla; 17,90±16,93 ve 10,79±11,23) (p=0,004). Her iki tarama aracında da yetersiz beslenen hastaların çoğu aşırı kilolu veya obezdi (toplam aşırı kilolu ve obez hastalar NRS-2002 ve SGD'ya göre sırasıyla; %70 ve %75). Malnütrisyon ile ilişkili bulunan faktörler sadece yaş ve hastanede kalış süresiydi (p<0,05).
Sonuç: NRS-2002, beslenme riski için mevcut kriterler göz önüne alındığında, son derece güçlü bir araç olarak, nesnel bir değerlendirme için iyi bir verim sağlamaktadır. Bunun yanı sıra, SGD uygulanarak değerlendirmeye subjektif parametrelerin eklenmesi, kapsamlı bir beslenme değerlendirmesi için hastanede yatan hastaların beslenme riskini tespit etme kabiliyetini artırabilir. 

Kaynakça

  • 1. Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clin Nutr 2008;27(1):5-15.
  • 2. Planas M, Audivert S, Pérez-Portabella C et al. Nutritional status among adult patients admitted to a university-affiliated hospital in Spain at the time of genoma. Clin Nutr 2004;23(5):1016-24.
  • 3. Wooley JA. American Dietetic Association endorses A.S.P.E.N. enteral nutrition practice recommendations. J Am Diet Assoc 2010;110(5):683-5.
  • 4. McClave SA, Taylor BE, Martindale RG et al. Society of Critical Care Medicine; American Society for Parenteral and Enteral Nutrition. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). J Parenter Enteral Nutr 2016;40(2):159-211.
  • 5. 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(4):415-21.
  • 6. Field LB, Hand RK. Differentiating malnutrition screening and assessment: a nutrition care process perspective. J Acad Nutr Diet 2015;115(5):824-8.
  • 7. Sungurtekin H, Sungurtekin U, Oner O, Okke D. Nutrition assessment in critically ill patients. Nutr Clin Pract 2008;23(6):635-41.
  • 8. Gultekin A, Memis D, Inal MT, Uzundere O, Turan FN. The impact of nutritional risk screening 2002 and subjective global assessment upon prognosis for intensive care patients Prog Nutr 2016; 18(1):47-5.
  • 9. Weir CB, Jan A. BMI Classification Percentile And Cut Off Points. [Updated 2020 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): Stat Pearls Publishing; 2020 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541070/
  • 10. Cederholm T, Barazzoni R, Austin P, Ballmer P, Biolo G, Bischoff SC, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr 2017;36(1):49-64. 11. Javid Mishamandani Z, Norouzy A, Hashemian SM et al. Nutritional status of patients hospitalized in the intensive care unit: A comprehensive report from Iranian hospitals, 2018. J Crit Care 2019;54:151-158.
  • 12. Canales C, Elsayes A, Yeh DD et al. Nutrition Risk in Critically Ill Versus the Nutritional Risk Screening 2002: Are They Comparable for Assessing Risk of Malnutrition in Critically Ill Patients? J Parenter Enteral Nutr 2019;43(1):81-87.
  • 13. Pineda JCC, Gómez García A, Velasco N, Graf JIDP, Adámes AM, Torre AM. Nutritional assessment of hospitalized patients in Latin America: association with prognostic variables. The ENHOLA study. Nutr Hosp 2016; 33(3):655-662.
  • 14. Fernández AC, Casariego AV, Rodríguez IC Pomar MDB. Eficaciay efectividad de las distintas herramientas de cribado nutricional en un hospital de tercer nivel. Nutr Hosp 2015;31:2240-2246.
  • 15. Konturek PC, Herrmann HJ, Schink K, Neurath MF, Zopf Y. Malnutrition in Hospitals: It Was, Is Now, and Must Not Remain a Problem! Med Sci Monit 2015;21:2969-75. doi: 10.12659/MSM.894238.
  • 16. Olivares J, Ayala L, Salas-Salvadó J et al. Assessment of risk factors and test performance on malnutrition prevalence at admission using four different screening tools. Nutr Hosp 2014;29:674-680 doi:10.3305/nh.2014.29.3.7120.
  • 17. Raslan M, Gonzalez MC, Torrinhas RS, Ravacci GR, Pereira JC, Waitzberg DL. Complementarity of Subjective Global Assessment (SGA) and Nutritional Risk Screening 2002 (NRS 2002) for predicting poor clinical outcomes in hospitalized patients. Clin Nutr 2011;30(1):49-53.
  • 18. Borek P, Chmielewski M, Małgorzewicz S, Slizie´n DA. Analysis of outcomes of the NRS 2002 in patients hospitalized in nephrology wards. Nutrients 2017;9:287. 19. Tangvik RJ, Tell GS, Guttormsen AB et al. Nutritional risk profile in a university hospital population. Clin Nutr 2015;34(4):705-11.
  • 20. Kandiah J, Stinnett L, Lutton D. Visual plate waste in hospitalized patients: length of stay and diet order. J Am Diet Assoc 2006;106(10):1663-6.
  • 21. Raslan M, Gonzalez MC, Dias MC et al. Comparison of nutritional risk screening tools for predicting clinical outcomes in hospitalized patients. Nutrition 2010;26(7-8):721-6.
  • 22. Ozkalkanli MY, Ozkalkanli DT, Katircioglu K, Savaci S. Comparison of tools for nutrition assessment and screening for predicting the development of complications in orthopedic surgery. Nutr Clin Pract 2009;24(2):274-80.
  • 23. Correia MI, Campos AC; ELAN Cooperative Study. Prevalence of hospital malnutrition in Latin America: the multicenter ELAN study. Nutrition 2003t;19(10):823-5.
  • 24. Olveira G, Tapia JM, Ocón J et al. Study Group of Hyperglycemia in Parenteral Nutrition; Nutrition Area of the Spanish Society of Endocrinology and Nutrition (SEEN). The subjective global assessment predicts in-hospital mortality better than other nutrition-related risk indexes in noncritically ill inpatients who receive total parenteral nutrition in Spain (prospective multicenter study). J Acad Nutr Diet 2013;113(9):1209-18.
  • 25. Velasco C, García E, Rodríguez V et al. Comparison of four nutritional screening tools to detect nutritional risk in hospitalized patients: a multicentre study. Eur J Clin Nutr 2011;65(2):269-74.

Screening Nutritional Status of Hospitalized Patients with Nutritional Risk Screening 2002 and Subjective Global Assessment Tools

Yıl 2021, Cilt 11, Sayı 6, 864 - 869, 20.11.2021
https://doi.org/10.16899/jcm.975869

Öz

Aim: The assessment of the nutritional status of hospitalized patients is important to detect individuals who are under malnourishment risk and malnutrition-related conditions. The present study aimed to screen the nutritional status of hospitalized patients with Nutritional Risk Screening 2002 (NRS-2002) and Subjective Global Assessment (SGA) screening and to compare the results of two screening methods in predicting malnutrition. Materials and Methods: NRS-2002 and SGA were administered to 134 non-critical service patients within the first days of hospital admission. Tool performance in predicting malnutrition and the association with length of hospital stay (LOS) were analyzed. Results: 22.4% (n=30) of the patients were at nutritional risk when screened with NRS-2002; when screened with SGA, 35.8% (n=48) of the patients were found to be malnourished (p=0.015). The hospital LOS (day) of malnourished patients and non-malnourished patients according to NRS-2002 were similar. However, according to SGA screening, the hospital LOS of malnourished patients was longer than non-malnourished patients (17.90±16.93 vs 10.79±11.23) (p=0.004). In both screening tools most of the malnourished patients were overweight or obese (the total overweight and obese patients rate 70% and 75% according to NRS-2002 and SGA; respectively). Factors associated with malnutrition were only age and hospital LOS (p<0.05). Conclusion: Considering current criteria for nutritional risk, NRS-2002, as an objective and remarkably powerful tool, seems to provide a better yield for an objective assessment. Besides this, adding subjective parameters to the assessment by applying SGA could increase the capability of detecting the nutrition risk of hospitalized patients for a comprehensive nutritional assessment.

Kaynakça

  • 1. Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clin Nutr 2008;27(1):5-15.
  • 2. Planas M, Audivert S, Pérez-Portabella C et al. Nutritional status among adult patients admitted to a university-affiliated hospital in Spain at the time of genoma. Clin Nutr 2004;23(5):1016-24.
  • 3. Wooley JA. American Dietetic Association endorses A.S.P.E.N. enteral nutrition practice recommendations. J Am Diet Assoc 2010;110(5):683-5.
  • 4. McClave SA, Taylor BE, Martindale RG et al. Society of Critical Care Medicine; American Society for Parenteral and Enteral Nutrition. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). J Parenter Enteral Nutr 2016;40(2):159-211.
  • 5. 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(4):415-21.
  • 6. Field LB, Hand RK. Differentiating malnutrition screening and assessment: a nutrition care process perspective. J Acad Nutr Diet 2015;115(5):824-8.
  • 7. Sungurtekin H, Sungurtekin U, Oner O, Okke D. Nutrition assessment in critically ill patients. Nutr Clin Pract 2008;23(6):635-41.
  • 8. Gultekin A, Memis D, Inal MT, Uzundere O, Turan FN. The impact of nutritional risk screening 2002 and subjective global assessment upon prognosis for intensive care patients Prog Nutr 2016; 18(1):47-5.
  • 9. Weir CB, Jan A. BMI Classification Percentile And Cut Off Points. [Updated 2020 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): Stat Pearls Publishing; 2020 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541070/
  • 10. Cederholm T, Barazzoni R, Austin P, Ballmer P, Biolo G, Bischoff SC, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr 2017;36(1):49-64. 11. Javid Mishamandani Z, Norouzy A, Hashemian SM et al. Nutritional status of patients hospitalized in the intensive care unit: A comprehensive report from Iranian hospitals, 2018. J Crit Care 2019;54:151-158.
  • 12. Canales C, Elsayes A, Yeh DD et al. Nutrition Risk in Critically Ill Versus the Nutritional Risk Screening 2002: Are They Comparable for Assessing Risk of Malnutrition in Critically Ill Patients? J Parenter Enteral Nutr 2019;43(1):81-87.
  • 13. Pineda JCC, Gómez García A, Velasco N, Graf JIDP, Adámes AM, Torre AM. Nutritional assessment of hospitalized patients in Latin America: association with prognostic variables. The ENHOLA study. Nutr Hosp 2016; 33(3):655-662.
  • 14. Fernández AC, Casariego AV, Rodríguez IC Pomar MDB. Eficaciay efectividad de las distintas herramientas de cribado nutricional en un hospital de tercer nivel. Nutr Hosp 2015;31:2240-2246.
  • 15. Konturek PC, Herrmann HJ, Schink K, Neurath MF, Zopf Y. Malnutrition in Hospitals: It Was, Is Now, and Must Not Remain a Problem! Med Sci Monit 2015;21:2969-75. doi: 10.12659/MSM.894238.
  • 16. Olivares J, Ayala L, Salas-Salvadó J et al. Assessment of risk factors and test performance on malnutrition prevalence at admission using four different screening tools. Nutr Hosp 2014;29:674-680 doi:10.3305/nh.2014.29.3.7120.
  • 17. Raslan M, Gonzalez MC, Torrinhas RS, Ravacci GR, Pereira JC, Waitzberg DL. Complementarity of Subjective Global Assessment (SGA) and Nutritional Risk Screening 2002 (NRS 2002) for predicting poor clinical outcomes in hospitalized patients. Clin Nutr 2011;30(1):49-53.
  • 18. Borek P, Chmielewski M, Małgorzewicz S, Slizie´n DA. Analysis of outcomes of the NRS 2002 in patients hospitalized in nephrology wards. Nutrients 2017;9:287. 19. Tangvik RJ, Tell GS, Guttormsen AB et al. Nutritional risk profile in a university hospital population. Clin Nutr 2015;34(4):705-11.
  • 20. Kandiah J, Stinnett L, Lutton D. Visual plate waste in hospitalized patients: length of stay and diet order. J Am Diet Assoc 2006;106(10):1663-6.
  • 21. Raslan M, Gonzalez MC, Dias MC et al. Comparison of nutritional risk screening tools for predicting clinical outcomes in hospitalized patients. Nutrition 2010;26(7-8):721-6.
  • 22. Ozkalkanli MY, Ozkalkanli DT, Katircioglu K, Savaci S. Comparison of tools for nutrition assessment and screening for predicting the development of complications in orthopedic surgery. Nutr Clin Pract 2009;24(2):274-80.
  • 23. Correia MI, Campos AC; ELAN Cooperative Study. Prevalence of hospital malnutrition in Latin America: the multicenter ELAN study. Nutrition 2003t;19(10):823-5.
  • 24. Olveira G, Tapia JM, Ocón J et al. Study Group of Hyperglycemia in Parenteral Nutrition; Nutrition Area of the Spanish Society of Endocrinology and Nutrition (SEEN). The subjective global assessment predicts in-hospital mortality better than other nutrition-related risk indexes in noncritically ill inpatients who receive total parenteral nutrition in Spain (prospective multicenter study). J Acad Nutr Diet 2013;113(9):1209-18.
  • 25. Velasco C, García E, Rodríguez V et al. Comparison of four nutritional screening tools to detect nutritional risk in hospitalized patients: a multicentre study. Eur J Clin Nutr 2011;65(2):269-74.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Bilimleri ve Hizmetleri
Bölüm Orjinal Araştırma
Yazarlar

Hazal AYDIN Bu kişi benim
ERCİYES ÜNİVERSİTESİ, SAĞLIK BİLİMLERİ ENSTİTÜSÜ, BESLENME VE DİYETETİK (YL) (TEZLİ)
0000-0002-3270-6513
Türkiye


Neşe KAYA (Sorumlu Yazar)
NUH NACİ YAZGAN ÜNİVERSİTESİ, SAĞLIK BİLİMLERİ FAKÜLTESİ, BESLENME VE DİYETETİK BÖLÜMÜ
0000-0002-5947-3238
Türkiye

Yayımlanma Tarihi 20 Kasım 2021
Kabul Tarihi 27 Ağustos 2021
Yayınlandığı Sayı Yıl 2021, Cilt 11, Sayı 6

Kaynak Göster

AMA Aydın H. , Kaya N. Screening Nutritional Status of Hospitalized Patients with Nutritional Risk Screening 2002 and Subjective Global Assessment Tools. J Contemp Med. 2021; 11(6): 864-869.