肿瘤是由基因和环境共同作用的一种复杂疾病，是目前造成人类死亡的主要原因。肿瘤患者由于疾病本身消耗增加、饮食消化障碍以及抗肿瘤药物的副作用，极易出现体重下降和营养不良，据估计有15%~40%的肿瘤患者有不同程度的体重下降，40%~80%的肿瘤患者存在营养不良。营养不良会影响患者治疗效果、延长伤口愈合时间、增加术后并发症，同时也会降低药物治疗耐受性，导致住院时间延长、治疗中断、病死率增加。患者的营养状态与疾病预后密切相关，需要对患者进行正确的营养筛查、评估和合理的营养干预。合理营养干预通过营养咨询是否使用口服营养补充或通过人工喂养（肠内、肠外营养）来预防和治疗营养不良，从而解决影响患者康复和生存的代谢及营养状况相关问题，尽管营养干预是肿瘤患者治疗的关键因素，但临床上并不是所有营养不良的患者都获得了合理的营养干预。本文结合2017年欧洲临床营养和代谢学会（ESPEN）抗肿瘤相关营养不良的举措和我院的临床实践，重点阐述临床医师及营养（医）师在肿瘤患者的疾病发展过程中进行的一系列营养管理过程。
Tumor is a complex disease that results from multiple interactions between genes and the environment， it is regarded as one of the crucial leading causes of mortality worldwide. Patients with tumor often experience the classic symptoms of weight loss and malnutrition because of the increased consumption related to its diagnosis/digestive disorders and anti-tumor drugs use. Weight loss is highly prevalent in patients with tumor， about 15% to 40% at diagnosis. It is estimated that 40% to 80% of patients will be malnourished during the course of the disease. Furthermore， malnutrition can influence treatment outcomes， delay wound healing and increase the risk of post-operative complications. It can also impair response to antineoplastic treatments， which can in turn lead to extended hospital stay， increase the risk for treatment interruptions， and possible reduced survival. Its been reported that nutrition status may be associated with its outcomes. Therefore， nutrition screening/evaluation and intervention proved essential in the process of curing. Nutritional intervention in patients with tumor aims to prevent and treat malnutrition through nutritional counselling or oral nutritional supplements or via artificial nutrition， i.e.， enteral or parenteral nutrition， as well as to address metabolic and nutritional alterations that influence patients recovery and survival. Despite nutritional intervention is a key component， nutritional support is not widely accessible to all patients at nutritional risk. This article reviews the whole process management of nutritional support offered by clinicians and dieticians combined 2017 ESPEN Guidelines on nutritional support in patients with tumor and clinical practice in our hospital.
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