To prevent coronavirus disease 2019 (COVID-19) and enhance the nutrition management for patients, the Beijing Quality Control and Improvement Center for Clinical Nutrition Therapy organized relevant experts to formulate Nutrition Management of Patients with Coronavirus Disease 2019 in the Hospital: An Expert Opinion (2020). It clearly stated that food safety, food hygiene, and nutrition management should be incorporated into the whole process of prevention, control, treatment, and rehabilitation of COVID-19. The reasonable and standardized pathway of nutrition management, which includes nutrition-risk screening, malnutrition diagnosis, nutritional support therapy and nutrition monitoring, should be established to improve the immune status, clinical outcome, and quality of life of patients with COVID-19.

食欲下降是肿瘤患者常见症状,癌性厌食/恶液质综合征在晚期肿瘤患者中发病率较高.肿瘤患者因营养摄入不足,会出现全血细胞减少、体重下降、脂肪组织和骨骼肌减少,导致患者免疫力降低,治疗耐受性下降,治疗机会减少,并发症增加,不利于抗肿瘤治疗措施的实施.准确评估癌性厌食的过程,无论对研究还是临床救治都极为重要,科学的食欲评价方法和技术不仅是营养工作者客观评价食欲的工具,也是进一步认识和预测营养不良的基础,对改善肿瘤患者营养不良具有积极意义.本共识根据国内外现有研究证据,对该领域的研究结果进行系统总结.从肿瘤、营养与食欲的关系出发,分析癌性厌食的发生发展机制,总结不同情况下肿瘤患者的食欲评价方法,并给出专家推荐意见.结合我国膳食现状和特点,从临床、营养、护理、中医的角度提出调节食欲的方法,科学规范癌性厌食管理策略,以便临床医师、临床营养专业人员、护士等医疗保健人员应用,更好地为肿瘤患者服务.

目的 通过对6家三甲医院老年肿瘤患者临床资料进行分析,了解营养风险、营养不良及营养治疗应用情况.方法 对2012年3月～2012年5月,6家三甲医院住院的老年肿瘤患者资料进行分析.在患者人院后24小时内应用营养风险筛查工具NRS 2002进行营养风险筛查,调查营养风险和营养不良发生率以及住院期间营养治疗应用状况.结果 共纳入老年肿瘤患者1,472例,营养风险发生率62.8％,营养不良发生率25.3％.将肿瘤患者分为非手术患者及手术患者两个群体分别研究.其中非手术患者906例,营养风险发生率61.9％;手术患者566例,营养风险发生率64.1％.两组患者营养不良的发生率有显著差异(27.7％vs18.9％,P=0.004).营养风险发生率、营养风险≥5分及营养不良的发生率均随年龄增长而升高.按病种分层,消化道肿瘤的手术患者营养风险发生率最高,其中胃癌手术组最高(77.7％);营养不良的发生率均在25％以上,其中胰腺癌非手术组最高(37.5％).有营养风险给予营养治疗的患者458例(52.4％),其中肠外营养325例(71.0％),肠内营养23例(5.0％),肠外与肠内营养联合应用110例(24.0％).无营养风险给予营养治疗患者186例(36.1％),其中肠外营养131例(70.5％),肠内营养9例(4.84％),肠外肠内营养联合应用46例(24.7％),139例为手术患者(74.7％).结论 老年肿瘤患者营养风险及营养不良发生率较高.应用肠外营养比例高,营养治疗指征尚不规范.

Abstract: Malnutrition is frequently found in hospital settings with alarming high prevalence rate. Of note, hospitalized patients have highest malnutrition incidence rate among population groups. 20%~60% patients have malnutrition at the time of admission, 30%~80% patients have in-hospital weight loss, indicating patients have nosocomial malnutrition (NM) or hospital acquired malnutrition (HAM) during hospital stay, all of which exacerbates DRM. Hungry-free hospital (HFH) is a nutrition care delivery program, with its focus on providing high-quality patient care, to ensure patients get easy access to safe, affordable, nourishing meals during hospital tasty, to reduce hunger or hidden hunger, to efficiently prevent HAM, to ensure inpatients receive proper nutrition therapy, and to effectively treat DRM. HFH is a comprehensive program, comprising with improving recognition of the adverse effects of malnutrition, develop a simple and easy-to-use clinical diagnostic tool, reinforce multimodal strategies for nutrition screening at admission, achieve higher completion rate of nutrition assessment, setting up NST and NSC, implementing nutritional nutrition consultation costing system, provide RUSF and RUTF, optimizing clinical examination and treatment time, develop a HFH evaluation system, and implementing continuous quality improvement (CQI) in hospital. In this article, HFH program consisted of four key approaches related to HFH efficient implementation: firstly, from nutrition science point of view, standardise key terms in clinical nutrition; secondly, address and apply standard clinical nutrition care process; thirdly, improve hospital administration management. Finally, reinforce hospital catering services. HFH is a multi-level approach involving professionals in clinical setting, staffs in catering system, patients and family members into HFH. Ultimately, promotion of a multi-level approach to hospital malnutrition at society level to raise awareness of the public as a whole, maximising hospital service quality and improving patient satisfaction.

Malnutrition and dyscrasia are very common in cancer patients. Malnutrition is associated with poor treatment tolerance, reduced opportunities for treatment, increased complications, increased morbidity and mortality, prolonged hospital stay, and lower survival rate. Malnutrition not only has an impact on the effect of treatment and quality of life, but also cause huge economic losses and waste of social medical resources. Nutrition therapy as a basic methods of clinical treatment and rehabilitation, has been proved by a large number of evidence-based medicine at home and abroad. The evidence shows that the reasonable and effective nutritional support will not increase the rate of tumor recurrence or metastasis rate and lower survival rate, but can significantly improve the postoperative cancer patients nutrition and immune status, reduce the incidence of complications and postoperative infection, improve the cure rate of patients, reduce the mortality rate, reduce drug and medical expenditure, has a positive for most malnourished cancer patients. In order to apply the medical nutrition therapy on patients with cancer to clinical practice, the consensus based on existing research on the relationship between cancer and nutrition at home and abroad, and combined with the status and characteristics of China's diet. Systematically summarize and analyze the influence of dietary nutritional factors on cancer patients and standardize the principles and steps of oncology nutrition treatment. Apply to clinician, clinical nutrition professionals, nurse, and other health care workers.

1背景<br>　　2013年中国肿瘤登记年报显示，全国新发肿瘤病例312万，死亡肿瘤病例270万，相当于每小时有356人被诊断为肿瘤、308人死于肿瘤；2015年中国肿瘤登记年报显示，全国共有新发肿瘤病例429万，死亡肿瘤病例281万，相当于每小时有490人被诊断为肿瘤、321人死于肿瘤[1]。比较2013、2015年报数据发现，我国肿瘤发病率及死亡率均在升高。WHO预计未来20年，全世界新发肿瘤病例会增加70%，有近一半出现在亚洲，其中大部分在中国，中国新增肿瘤病例高居全球第一位，全世界24%的肿瘤死亡患者在中国。肿瘤已经成为我国名副其实的常见疾病，并成为我国居民第一死亡原因。