Mangelernährung: Welches ist das geeignete Screeninginstrument?

Zusammenfassung

Die Protein-Energie-Mangelernährung von Patienten stellt auch in den industrialisierten Ländern ein zunehmend relevantes Problem dar. Sowohl bei ca. 20–60 % der hospitalisierten als auch der ambulanten medizinischen oder chirurgischen Patienten wird eine Mangelernährung beobachtet. Diese hat beträchtliche Folgen auf verschiedensten Ebenen. Sie beeinträchtigt unter anderem die Lebensqualität, das Immunsystem, schwächt die Muskulatur und verschlechtert die Prognose von Patienten. Interventionen zur Erkennung und Behandlung der Mangelernährung sind wirksam und kostensparend. Aus diesem Grunde sind im Alltag einfache standardisierte Screeningtests für die Erfassung der Risikopatienten sehr nützlich. Die systematische Identifikation von Patienten mit potenzieller oder manifester Mangelernährung ist aus diesen Überlegungen fundamental, um eine adäquate Ernährungstherapie so schnell als möglich aufzunehmen. Das Screening sollte vom betreuenden medizinischen Team durchgeführt werden, damit dessen Mitglieder die ernährungsbezogenen Probleme interdisziplinär und interprofessionell erkennen und lösen können. Die Personenbezeichnungen gelten sinngemäß für beide Geschlechter.

Abstract

Protein-energy-malnutrition of patients represents a relevant and increasing problem also in the industrialised countries. Many studies have shown a prevalence of malnutrition between 20 and 60 % in hospitalized medical or surgical patients but also in out-patients. Malnutrition causes many consequences at various levels and negatively influences quality of life, immune system, muscle strength and worsens the prognosis of the patient. As malnutrition is a largely treatable co-morbidity, rapid and simple identification and effective management of this condition are essential and cost-saving. For this reason, using a simple and standardised screening tool for the identification of patients at nutritional risk in the daily practice is very important. If the risk of malnutrition is recognised early, many cases could be treated or could even be prevented, with beneficial effects on patient outcome and accompanying reductions in health costs. The medical team in charge should perform the nutritional risk screening to recognize the nutritional problems and to solve them with an interdisciplinary approach.

Mangelernährung - Screening - Malnutrition Universal Screening Tool - Nutritional Risk Screening – 2002 - Mini Nutritional Assessment – Short Form

malnutrition - screening - Malnutrition Universal Screening Tool - Nutritional Risk Screening – 2002 - Mini Nutritional Assessment – Short Form

Literatur

• 1 McWhirter J, Pennington C. Incidence and recognition of malnutrition in hospital.  BMJ. 1994;  308 945-948
• 2 Public Health Committee. Committee of Experts on Nutrition, Food Safety and Consumer Health .Food and nutrition care in hospitals: how to prevent undernutrition – report and recommendations. Ad hoc group – nutrition programmes in hospitals. Paris; Partial Agreement in the Social and Public Health Field, Council of Europe February 2002
• 3 Kyle U G, Pirlich M, Schuetz T. et al . Prevalence of malnutrition in 1760 patient at hospital admission: a controlled population study of body composiion.  Clin Nutr. 2003;  22 473-481
• 4 Pirlich M, Schutz T, Norman K. et al . The German hospital malnutrition study.  Clin Nutr. 2006;  25 563-572
• 5 Sorensen J, Kondrup J, Prokopowicz J. et al., EuroOOPS study group . EuroOOPS: an international, multicentre study to implement nutritional risk screening and evaluate clinical outcome.  Clin Nutr. 2008;  27 340-349
• 6 Keys A, Brozek J, Henschel A. The Biology of Human Starvation. Minneapolis; University of Minnesota Press 1950
• 7 Brozek J. Effects of Generalized Malnutrition on Personality.  Nutrition. 1990;  6 389-395
• 8 Correia M I, Waitzberg D L. The impact of malnutrition on morbidity, mortality, length of hospital stay and cost evaluated through a multivariate analysis.  Clin Nutr. 2003;  22 235-239
• 9 Imoberdorf R, Stanga Z, Ballmer P E. Malnutrition.  Swiss Medical Forum. 2001;  36 892-895
• 10 Frei A. Mangelernährung im Spital – medizinische Kosten und Kosteneffektivität bei Verhinderung. Bundesamt für Gesundheit Schweiz.  Bulletin BAG. 2007;  20 355
• 11 Mowe M, Bosaeus I, Rasmussen H H. et al., Scandinavian Nutrition Group . Insufficient nutritional knowledge among health care workers?.  Clin Nutr. 2008;  27 (2) 196-202
• 12 Kondrup J, Allison S P, Elia M. et al . ESPEN Guidelines for Nutrition Screening 2002.  Clin Nutr. 2003;  22 415-421
• 13 Jones J M. The methodology of nutritional screening and assessment tools.  J Hum Nutr Dietet. 2002;  15 59-71
• 14 Schütz T, Valentini L, Plauth M. Screening auf Mangelernährung nach den ESPEN-Leitlinien 2002.  Aktuel Ernaehr Med. 2005;  30 99-103
• 15 Schreier M M, Bartholomeyczik S. Die Rolle der Pflege bei der Ernährung im Krankenhaus.  Aktuel Ernaehr Med. 2008;  33 70-74
• 16 Malnutrition Advisory Group (MAG) .MAG – guidelines for Detection and Management of Malnutrition. Redditch, UK; British Association for Parenteral and Enteral Nutrition 2000
• 17 Windsor J A, Hill G A. Weight loss with physiological impairment. A basic indicator of surgical risk.  Ann Surg. 1988;  207 290-296
• 18 Öge A E, Boyaciyan A, Gökmen E. et al . Neuromuscular consequences of prolonged hunger strike: an electrophysiological study.  Clin Neurophysiol. 2000;  111 2064-2070
• 19 Fessler D MT. The implications of starving induced psychological changes for the ethical treatment of hunger strikers.  J Med Ethics. 2003;  29 243-247
• 20 Basoglu M, Yetimalar Y, Gürgör N. et al . Neurological complications of prolonged hunger strike.  Eur J Neurology. 2006;  13 1089-1097
• 21 Weekes C E, Elia M, Emery P W. The development, validation and reliability of a nutrition screening tool based on the recommendations of the British Association for Parenteral and Enteral Nutrition (BAPEN).  Clin Nutr. 2004;  23 1104-1112
• 22 Stratton R J, King C L, Stroud M A. et al . „Malnutrition Universal Screening Tool” predicts mortality and length of hospital stay in acutely ill elderly.  Br J Nutr. 2006;  95 325-330
• 23 Stratton R J, Hackston A, Longmore D. et al . Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the „malnutrition screening tool” („MUST”) for adults.  Br J Nutr. 2004;  92 799-808
• 24 Kondrup J, Rasmussen H H, Hamberg O. et al . Nutritional risk screening (NRS-2002): a new method based on an analysis of controlled clinical trials.  Clin Nutr. 2003;  22 321-336
• 25 Kondrup J, Johansen N, Plum L M. et al . Incidence of nutritional risk and causes of inadequate nutritional care in hospitals.  Clin Nutr. 2002;  21 461-468
• 26 Johansen N, Kondrup J, Plum L M. et al . Effect of nutritional support on clinical outcome in patients at nutritional risk.  Clin Nutr. 2004;  23 539-550
• 27 Schiesser M, Müller S, Kirchhoff P. et al . Assessment of a novel screening score for nutritional risk in predicting complications in gastro-intestinal surgery.  Clin Nutr. 2008;  27 565-570
• 28 Kyle U G, Kossovsky M P, Karsegard V L. et al . Comparison of tools for nutritional assessment and screening at hospital admission: A population study.  Clin Nutr. 2006;  25 409-417
• 29 Detsky A S, McLaughin J R, Baker J P. et al . What is subjective global assessment of nutritional status?.  J Parent Enteral Nutr. 1987;  11 8-13
• 30 Rubenstein L Z, Harker J O, Salvà A. et al . Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF).  J Gerontol A Biol Sci Med Sci. 2001;  56 M366-372
• 31 Vellas B, Guigoz Y, Garry P J. et al . The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients.  Nutrition. 1999;  15 116-122
• 32 Guigoz Y. The Mini-Nutritional Assessment (MNA®) review of the literature – what does it tell us?.  J Nutr Health Aging. 2006;  10 466-487
• 33 Compan B, di Castri A, Plaze J M. et al . Epidemiological study of malnutrition in elderly patients in acute, sub-acute and long-term care using the MNA.  J Nutr Health Aging. 1999;  3 146-151
• 34 Gazzotti C, Albert A, Pepinster A. et al . Clinical usefulness of the mini nutritional assessment (MNA) scale in geriatric medicine.  J Nutr Health Aging. 2000;  4 176-181
• 35 Beck A M, Ovesen L, Schroll M. A six months' prospective follow-up of 65+-y-old patients from general practice classified according to nutritional risk by Mini Nutritional Assessment.  Eur J Clin Nutr. 2001;  55 1028-1033
• 36 Lauque S, Arnaud-Battandier F, Mansourian R. et al . Protein-energy oral supplementation in malnourished nursing-home residents. A controlled trial.  Age Aging. 2000;  29 51-56
• 37 Beck A M, Ovesen L, Schroll M. Home-made oral supplement as nutritional support of old nursing home residents, who are undernourished or at risk of undernutrition based on the MNA. A pilot trial.  Aging Clin Exp Res. 2002;  14 212-215
• 38 Formiga F, Chivite D, Mascaro J. et al . No correlation between mini-nutritional assessment (short form) scale and clinical outcomes in 73 elderly patients admitted for hip fracture.  Aging Clin Exp Res. 2005;  17 343-346
• 39 Bleda M J, Bolibar I, Pares R. et al . Reliability of the mini nutritional assessment (MNA) in institutionalized elderly people.  J Nutr Health Aging. 2002;  6 134-137
• 40 Bauer J M, Vogl T, Wicklein S. et al . Comparison on the Mini Nutritional Assessment, Subjective Global Assessment, and Nutritional Risk Screening (NRS 2002) for nutritional screening and assessment in geriatric hospital patients.  Z Gerontol Geriat. 2005;  38 322-327
• 41 http://www.ake-nutrition.at/uploads/media/Prague_malnutrition_declaration.pdf http://www.european-nutrition.orgfiles/pdf_pdf_43.pdf