Till 2020, parenteral and enteral nutrition in China has moved from Translation 1 (T1), and then Translation 2 (T2), to Translation 3 (T3) now. The T3 transfer requires the evaluation of medical services' quality and cost-effectiveness research. After learning from international published articles, the multicenter cooperative database group of Chinese Society for Parenteral and Enteral Nutrition (CSPEN) on Nutritional risk, Undernutrition, Support, Outcome, and Cost-effectiveness ratio (NUSOC) (abbreviated to CSPEN-NUSOC Cooperative Group) has made efforts to promote health economics research in the field of parenteral and enteral nutrition in China. This paper reviewed the translational medical research of parenteral and enteral nutrition in China. At present, clinical studies toward the goal of "reasonable use to benefit patients" should be conducted in parenteral and enteral nutrition field in China, such as clinical effectiveness study of nutritional risk screening 2002 and Global Leadership Initiative on Malnutrition criteria, or health economics study on nutritional drug.

Objectives: The aim of this study is to validate the Global Leadership Initiative on Malnutrition (GLIM) criteria and determine the number of Nutritional Risk Screening 2002 (NRS2002)-positive patients who do not meet the GLIM, as well as examine whether these patients would benefit from nutritional support therapy. Methods: A reanalysis of a published prospective observational study was performed. The subjects were rediagnosed per the NRS2002 and GLIM criteria. The prevalence of malnutrition was reported, and the differ-ence in rate of infection complications and total complications between the nutritional support therapy and glucose-electrolyte cohorts was calculated. Results: Among 1831 cases in the original database, 827 cases (45.2%) were NRS2002-positive. A total of 391 cases were identified by the GLIM criteria as malnourished (21.4%) and of these, subjects in the nutritional support therapy cohort had fewer infection complications than those in the glucose-electrolyte cohort (13.0% vs. 23.0%; P = 0.010). The remaining 436 patients were NRS2002 positive but GLIM negative (23.8%). The rate of infection was also significantly lower in the support cohort than in the nonsupport cohort (8.0% vs. 15.7%; P = 0.011). Nutritional support was proven o be a protective factor for infection complications in both GLIM-positive (odds ratio: 0.407; 95% confidence interval, 0.232-0.714; P = 0.002) and NRS2002-positive/GLIM-negative patients [odds ratio: 0.314; 95% confidence interval, 0.161-0.612; P = 0.001). Conclusions: The GLIM criteria have been validated, and are useful in identifying malnourished patients who may have fewer infection complications due to nutritional support therapy. However, the criteria neglected half of the patients identified by NRS2002, among whom nutritional support therapy also decreased the rate of infection complications. (c) 2020 Elsevier Inc. All rights reserved.

《营养》(Nutrition) 2010年第26卷11 ～12期发表了揭彬等撰写的《营养支持对有营养风险患者临床结局的影响》一文.营养支持是否能改善患者的临床结局?研究表明肠外营养(parenteral nutrition,PN)可降低严重营养不良患者非感染性并发症的发生率;营养不良患者肠内营养(enteral nutrition,EN)与降低感染性并发症发生率以及缩短住院时间(length of hospital stay,LOS)有关,而营养良好患者则不然.然而,营养良好患者也可因疾病或住院期间治疗营养摄取减少,体重减轻,并因此发生营养不良.

Objective: This multicenter, prospective cohort study evaluated the effect of preoperative nutritional support in abdominal surgical patients at nutritional risk as defined by the Nutritional Risk Screening Tool 2002 (NRS-2002).Methods: A consecutive series of patients admitted for selective abdominal surgery in the Peking Union Medical College Hospital and the Beijing University Third Hospital in Beijing, China were recruited from March 2007 to July 2008. Data were collected on the nutritional risk screening (NRS-2002), the application of perioperative nutritional support, surgery, complications, and length of stay. A minimum of 7 d of parenteral nutrition or enteral nutrition before surgery was considered adequate preoperative nutritional support.Results: In total 1085 patients were recruited, and 512 of them were at nutritional risk. Of the 120 patients with an NRS score at least 5, the complication rate was significantly lower in the preoperative nutrition group compared with the control group (25.6% versus 50.6%, P = 0.008). The postoperative hospital stay was significantly shorter in the preoperative nutrition group than in the control group (13.7 +/- 7.9 versus 17.9 +/- 11.3 d, P = 0.018). Of the 392 patients with an NRS score from 3 to 4, the complication rate and the postoperative hospital stay were similar between patients with and those without preoperative nutritional support (P = 1.0 and 0.770, respectively).Conclusion: This finding suggests that preoperative nutritional support is beneficial to patients with an NRS score at least 5 by lowering the complication rate. (C) 2012 Published by Elsevier Inc.

OBJECTIVE To evaluate the impact of glutamine dipeptide-supplemented parenteral nutrition (GLN-PN) on clinical outcomes in surgical patients. METHODS MEDLINE, EMBASE, Web of Science, and the Cochrane Controlled Clinical Trials Register were searched to retrieve the eligible studies. The studies were included if they were randomized controlled trials that evaluated the effect of GLN-PN and standard PN on clinical outcomes of surgical patients. Clinical outcomes of interest were postoperative morbidity of infectious complication, mortality, length of hospital stay, and cost. Statistical analysis was conducted by RevMan 4.2 software from the Cochrane Collaboration. RESULTS Fourteen randomized controlled trials (RCTs) (N = 587) were included in this meta-analysis. The results showed that glutamine dipeptide significantly reduced the length of hospital stay by around 4 days in the form of alanyl-glutamine (weighted mean difference [WMD] = -3.84; 95% confidence interval [CI] -5.40, -2.28; z = 4.82; P < .001) and about 5 days in the form of glycyl-glutamine (WMD = -5.40; 95% CI -8.46, -2.33; z = 3.45; P < .001). The overall effect indicated a significant decrease in the infectious complication rates of surgical patients receiving GLN-PN (risk ratio = 0.69; 95% CI 0.50, 0.95; z = 2.26; P = .02). CONCLUSION GLN-PN was beneficial to postoperative patients by shortening the length of hospital stay and reducing the morbidity of postoperative infectious complications.

http://pen.sagepub.com/content/34/5/521 The online version of this article can be found at: DOI: 10.1177/0148607110362587 2010 34: 521 JPEN J Parenter Enteral Nutr Yan Wang, Zhu-Ming Jiang, Marie T. Nolan, Hua Jiang, Hae-Ra Han, Kang Yu, Hai-Long Li, Bin Jie and Xiao-Kun Liang Patients: A Meta-Analysis of Randomized Clinical Trials Supplemented Parenteral Nutrition on Outcomes of Surgical − The Impact of Glutamine Dipeptide

Objective: To evaluate the impact of glutamine dipeptide–supplemented parenteral nutrition (GLN‐PN) on clinical outcomes in surgical patients. Methods: MEDLINE, EMBASE, Web of Science, and the Cochrane Controlled Clinical Trials Register were searched to retrieve the eligible studies. The studies were included if they were randomized controlled trials that evaluated the effect of GLN‐PN and standard PN on clinical outcomes of surgical patients. Clinical outcomes of interest were postoperative morbidity of infectious complication, mortality, length of hospital stay, and cost. Statistical analysis was conducted by RevMan 4.2 software from the Cochrane Collaboration. Results: Fourteen randomized controlled trials (RCTs) (N = 587) were included in this meta‐analysis. The results showed that glutamine dipeptide significantly reduced the length of hospital stay by around 4 days in the form of alanyl‐glutamine (weighted mean difference [WMD] = −3.84; 95% confidence interval [CI] −5.40, −2.28; z = 4.82; P < .001) and about 5 days in the form of glycyl‐glutamine (WMD = −5.40; 95% CI −8.46, −2.33; z = 3.45; P < .001). The overall effect indicated a significant decrease in the infectious complication rates of surgical patients receiving GLN‐PN (risk ratio = 0.69; 95% CI 0.50, 0.95; z = 2.26; P = .02). Conclusion: GLN‐PN was beneficial to postoperative patients by shortening the length of hospital stay and reducing the morbidity of postoperative infectious complications.

OBJECTIVE:To evaluate the impact of nutritional support on clinical outcomes in patients at nutritional risk defined by the Nutritional Risk Screening 2002.METHODS:In this prospective cohort study, hospitalized patients from three departments in Johns Hopkins Hospital in Baltimore and two teaching hospitals in Beijing were recruited from March 2007 to May 2008. Data were collected on the nutritional risk screening, application of parenteral nutrition and enteral nutrition, surgery, complications, and length of stay.RESULTS:There were 1831 patients recruited, with 45.2% of them at nutritional risk. Of the "at-risk" patients, the complication rate was significantly lower in the nutritional-support group than in the no-support group (20.3% versus 28.1%, P = 0.009), mainly because of the lower rate of infectious complications (10.5% versus 18.9%, P < 0.001). Subgroup analysis showed the complication rate was significantly lower in the enteral nutrition group (P < 0.001) but not in the parenteral nutrition group (P = 0.29) when compared with the no-support group. Of the patients without nutritional risk, the complication rate was not different between the nutritional-support group and the no-support group (P = 0.10). Multivariate analysis showed nutritional support was a protective factor for complications in at-risk patients when adjusted for confounders (odds ratio 0.54, P < 0.001). No difference in length of stay was found.CONCLUSION:The findings suggested that nutritional support was beneficial to the patients at nutritional risk according to Nutritional Risk Screening 2002 by a lower complication rate.

研究表明,肠外营养(parenteral nutrition,PN)可降低有明显营养不良(不足)患者的非感染性并发症,对营养不足的患者应用肠内营养(enteral nutrition,EN)可以减少感染性并发症并缩短住院时间,对营养状况基本正常患者的结局则无明显改善。

>任何概念都存在区别于其他概念的特征和规则,而概念分析是明确特定概念内在结构和功能的过程,目的是找出该概念普遍适用的规则及这些规则如何呈现。概念分析对澄清概念含义、发展新理论、发展新研究工具、评价已有工具均具有重要意义。概念分析有几种固定模式,目前常用的概念分析方法包括下列过程:(1)选择概念;(2)明确分

Objective To summarize the methodology used in research in the influences of nutritional intervention and nutritional risk on clinical outcomes. Methods A computerized literature search was performed using the National Library of Medicine's Entrez PubMed. The articles about Nutritional Risk Screening 2002(NRS2002) and clinical outcome were retrieved for detailed evaluation of the study findings and study methodology. Results Totally 20 studies on the NRS2002 were found in the PubMed,among them 8 studies were on NRS2002 and clinical outcomes. The clinical outcomes included complications,length of hospital stay,mortality,and hospital cost,among which the operational definitions of complication and the length of hospital stay varied in different studies. The study findings revealed the nutritionally at-risk patients had more complications,higher mortality,longer lengths of stay,and more cost than not at-risk patients. One study showed that among patients with complications,the intervention group that received nutritional intervention had a significantly lower length of hospital stay than the control patients. Conclusions Several different operational definitions of complications and length of stay are used in evaluating clinical outcomes. More clinical trials are needed to validate the effect of nutritional support on clinical outcome among nutritionally at-risk patients. The non-randomized study design is applicable when it combines with multivariate analysis to exclude confounding factors.

Objective To investigate the prevalence of nutritional risks,undernutrition,and overweight/obesity,and nutritional support in major hospitals in Beijing. Methods Adult patients in 6 departments from 3 major hospitals in Beijing were consecutively enrolled from March 2005 to April 2006. Patients with Nutritional Risk Screening 2002 (NRS2002) score≥3 were defined as under nutritional risk. Patients with body mass index (BMI)18.5 kg/m2 were defined as undernutrition. NRS2002 was performed on first morning and nutritional support evaluation on the 14th day of admission or on the discharge day. The relationship between nutritional risk and nutritional support was analyzed. Results A total of 1 127 patients were enrolled,and 971 patients(86.2%) underwent NRS2002. Overall prevalence of undernutrition was 8.5% and nutritional risk was 22.9%. If the patients without accurate BMI were excluded from analysis,the prevalence of undernutrition was 7.6% and nutritional risk was 20.1%. Totally 93 patients (36.0%) receiving nutritional support had a NRS2002≥3. And 122 patients(14.0%) receiving nutritional support when NRS20023. The average PN∶EN ratio was 5.6∶1. Conclusions A large proportion of inpatients were at nutritional risk or undernutrition in major hospitals in Beijing. The application of PN and EN is inappropriate in these hospitals. Evidence-based guideline is needed to improve this situation.

Nutritional risk refers to the risk of clinical complications related with nutritional factors rather than the risk of malnutrition.The identification of nutritional risk will be helpful to predict the clinical outcome and monitor the efficacy of nutritional support.