营养相关状况主要指与营养或营养治疗相关的疾病总称。主要包括营养不良（营养不足）、肌肉减少症、虚弱症、超重和肥胖、微量营养素异常和再喂养综合征。本文主要介绍了肿瘤患者更为常见的营养相关状况：营养不良、恶液质、肌肉减少症及体重丢失的诊断标准。营养不良主要依据体重、体质指数（BMI）及评估量表诊断，评估方法包括主观整体评估、微型营养评价及患者主观整体评估。恶液质主要通过检测体重和骨骼肌指数、BMI诊断。肌肉减少症主要通过肌肉质量和力量及身体活动能力诊断。体重丢失主要通过体重丢失率诊断，要注意3个因素，即丢失的量、丢失的时间及丢失的成分。营养不良分为轻度、中度及重度营养不良；恶液质分为恶液质前期、恶液质期、恶液质难治期；肌肉减少症分为原发性肌肉减少症和继发性肌肉减少症；体重丢失分为0~4级。肿瘤营养相关状况诊断有利于明确肿瘤患者营养状态。
Abstract
Nutrition-related conditions (NRC) mainly refer to diseases associated with nutrition or nutrition related therapies. NRC includes malnutrition (undernutrition), sarcopenia, asthenia, weight loss, over weight, fat, micronutrient abnormality and refeeding syndrome. This article mainly introducesdiagnostic criteria of the most common nutritional status in cancer patients： malnutrition, cachexia, sarcopenia, and weight loss. Malnutrition was diagnosed by weight, BMI and Assessment Scale. The methods include subjective global assessment (SGA), mini nutritional assessment (MNA), and patient-generated subjective global assessment (PG-SGA). Cachexia was diagnosed by weight, skeletal muscle index and BMI. Sarcopenia was mainly diagnosed by muscle mass, strength and physical activity. Weight loss was mainly diagnosed by the loss rate whose points are the amount, the time, and the components of loss. Malnutrition includes mild malnutrition, moderate malnutrition and severe malnutrition. Cachexia includes pre-cachexia, cachexia and bad cachexia. Sarcopenia includes primary sarcopenia and secondary sarcopenia. Weight loss includes 0 to 4 grades. The diagnosis of tumor nutrition related status is helpful to clarify the nutritional status of tumor patients.
关键词
营养相关状况 /
营养不良 /
恶液质 /
肌肉减少症 /
体重丢失
Key words
Nutrition-related conditions /
Malnutrition /
Cachexia /
Sarcopenia /
Weight loss
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参考文献
1.Cederholm T, Barazzoni R, Austin P, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr. 2017；36(1)：49-64.
2.Cederholm T, Bosaeus I, Barazzoni R, et al. Diagnostic criteria for malnutrition-An ESPEN Consensus Statement. Clin Nutr. 2015；34(3)：335-340.
3.Sobotka L. Basics in clinical nutrition. 4th ed. Galen；2012.
4.Song C, Cao J, Zhang F, et al.Nutritional risk assessment by Scored Patient-Generated Subjective Global Assessment associated with demographic characteristics in 23,904 common malignant tumors patients. Nutr Cancer. 2019：71(1)：50-60
5.石汉平,凌文华,李薇. 肿瘤营养学. 北京：人民卫生出版社, 2012.
6.石汉平，张晓伟，李薇，等. WS/T555—2017 肿瘤患者主观整体营养评估.北京：中国标准出版社，2017.
7.石汉平,张晓伟,李薇,等. 肿瘤患者主观整体营养评估.WS/T 555-2017.
8.Cederholm T, Jensen GL, Correia MITD, et al. GLIM core leadership committee； GLIM working group.GLIM criteria for the diagnosis of malnutrition-A consensus report from the global clinical nutrition community.Clin Nutr. 2019；38(1)：1-9.
9.Jensen GL, Cederholm T, Correia MITD, et al.GLIM criteria for the diagnosis of malnutrition： a consensus report from the global clinical nutrition community. JPEN J Parenter Enteral Nutr. 2019；43(1)：32-40.
10.Fearon K, Strasser F, Anker SD, et al. Definition and classification of cancer cachexia： an international consensus. Lancet Oncol, 2011, 12(5)：489-495.
11.Baracos VE, Mazurak VC, Bhullar AS. Cancer cachexia is defined by an ongoing loss of skeletal muscle mass.Ann Palliat Med. 2019；8(1)：3-12.
12.Yang QJ, Zhao JR, Hao J, et al. Serum and urine metabolomics study reveals a distinct diagnostic model for cancer cachexia. J Cachexia Sarcopenia Muscle. 2018；9(1)：71-85.
13.Zhou T, Wang B, Liu H, et al. Development and validation of a clinically applicable score to classify cachexia stages in advanced cancer patients.J Cachexia Sarcopenia Muscle. 2018；9(2)：306-314.
14.Alfonso J, Cruz-Jentoft, Jean Pierre Baeyens,et al. Bauer. Sarcopenia： european consensus on definition and diagnosis： report of the european working group on sarcopenia in older people. Age Ageing. 2010； 39(4)：412-423.
15.Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2. Sarcopenia： revised European consensus on definition and diagnosis. Age Ageing. 2019；48(1)：16-31.
16.Sayer AA, Syddall H, Martin H, et al. The developmental origins of sarcopenia.J Nutr Health Aging. 2008；12(7)：427-432.
17.Sayer AA, Syddall HE, Martin HJ, et al. Falls, sarcopenia, and growth in early life： findings from the Hertfordshire cohort study.Am J Epidemiol. 2006；164(7)：665-671.
18.陈梅梅, 石汉平. 肌肉功能评价方法. 肿瘤代谢与营养电子杂志. 2014；1(3)：49-52.
19.Mohd Nawi SN, Khow KS, Lim WS, et al. Screening tools for sarcopenia in community-dwellers： a scoping review. Ann Acad Med Singapore. 2019；48(7)：201-216.
20.Zhuang CL, Huang DD, Pang WY, et al. Sarcopenia is an independent predictor of severe postoperative complications and long-term survival after radical gastrectomy for gastric cancer： analysis from a large-scale cohort. Medicine (Baltimore). 2016；95(13)：e3164.
21.Huang DD, Zhou CJ, Wang SL, et al. Impact of different sarcopenia stages on the postoperative outcomes after radical gastrectomy for gastric cancer. Surgery. 2017；161(3)：680-693.
22.Chen XY, Li B, Ma BW, et al. Sarcopenia is an effective prognostic indicator of postoperative outcomes in laparoscopic-assisted gastrectomy.Eur J Surg Oncol. 2019；45(6)：1092-1098.
23.Fearon K, Strasser F, Anker SD, et al. Definition and classification of cancer cachexia： an international consensus. Lancet Oncol. 2011；12(5)：489-495.
24.Martin L, Senesse P, Gioulbasanis I, et al. Diagnostic criteria for the classification of cancer-associated weight loss. J Clin Oncol. 2015；33(1)：90-99.
25.Martin L. Diagnostic criteria for cancer cachexia： data versus dogma.Curr Opin Clin Nutr Metab Care. 2016；19(3)：188-198.
26.Crawford J. What are the criteria for response to cachexia treatment? Ann Palliat Med. 2019；8(1)：43-49.
基金
国家重点研发计划项目（2017YFC1309200）
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