Nascent to novel methods to evaluate malnutrition and frailty in the surgical patient.
Nascent to novel methods to evaluate malnutrition and frailty in the surgical patient.
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DOI：
10.1002/jpen.2420
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发表时间：
2023-02
影响因子：
3.4
通讯作者：
Lobo, Dileep N.
中科院分区：
文献类型：
--
作者：
Prado, Carla M.;Ford, Katherine L.;Gonzalez, M. Cristina;Murnane, Lisa C.;Gillis, Chelsia;Wischmeyer, Paul E.;Morrison, Chet A.;Lobo, Dileep N.
关键词：
术前营养状况是手术结果的重要决定因素，但营养不良评估并没有整合到所有的手术路径。鉴于其重要性，以及接受外科手术的患者营养不良的高患病率，需要进行术前营养筛查、评估和干预，以改善术后结局。这篇叙述性综述讨论了评估外科病人营养不良和虚弱的新方法。全球营养不良领导倡议（GLIM）标准越来越多地用于外科手术，并大力鼓励进一步推广和实施，以帮助标准化营养不良的诊断。身体成分的使用（即，肌肉质量减少）作为GLIM中的表型标准可能导致更多的患者被鉴定为患有营养不良，如果通过其他诊断工具进行筛查，则可能无法检测到营养不良。骨骼肌损失是营养不良和虚弱的定义标准。在临床环境中评估肌肉质量的新的直接和间接方法可能有助于识别营养不良或有营养不良风险的患者。选定的成像技术有额外的优势，确定肌肉脂肪变性，这是一个独立的预测发病率和死亡率的手术患者。筛查和评估虚弱的可行途径已经到位，并可能决定手术的成本/效益、长期独立性和生产力，以及采取有针对性的干预措施的价值。最后，营养风险和状态的评估对于预测和减轻手术结果至关重要。新生儿的新方法是客观地识别围手术期营养风险的患者，并指导治疗达到最佳围手术期护理标准的未来。
Preoperative nutritional status is an important determinant of surgical outcomes yet malnutrition assessment is not integrated into all surgical pathways. Given its importance, and the high prevalence of malnutrition in patients undergoing surgical procedures, preoperative nutritional screening, assessment and intervention are needed to improve postoperative outcomes. This narrative review discusses novel methods to assess malnutrition and frailty in the surgical patient. The Global Leadership Initiative for Malnutrition (GLIM) criteria are being increasingly used in surgical settings, and their further spread and implementation is strongly encouraged to help standardize the diagnosis of malnutrition. The use of body composition (i.e., reduced muscle mass) as a phenotypic criterion in GLIM may lead to a greater number of patients identified as having malnutrition, which may otherwise be undetected if screened by other diagnostic tools. Skeletal muscle loss is a defining criterion of malnutrition and frailty. Novel direct and indirect approaches to assess muscle mass in clinical settings may facilitate the identification of patients with or at-risk for malnutrition. Selected imaging techniques have the additional advantage of identifying myosteatosis, which is an independent predictor of morbidity and mortality for surgical patients. Feasible pathways for screening and assessing frailty are in place and may determine the cost/benefit of surgery, long-term independence and productivity, as well as the value of undertaking targeted interventions. Finally, the evaluation of nutritional risk and status are essential to predict and mitigate surgical outcomes. Nascent to novel approaches are the future of objectively identifying patients at perioperative nutritional risk, and guiding therapy towards optimal perioperative standards of care.
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影响因子：
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