[Protein-energy-malnutrition]。

Deutsche medizinische Wochenschrift (1946) Pub Date : 2025-03-01 Epub Date: 2025-02-21 DOI:10.1055/a-2358-3187
Rainer Wirth, Maryam Pourhassan, Dorothee Volkert
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引用次数: 0

摘要

食欲不振是所谓“疾病行为”的一部分,是对许多疾病的统一反应,主要由炎症信号触发。虽然这种模式在很久以前可能是一种进化优势,但如今,食欲不振和连续营养不良更多地代表了许多急性和慢性疾病的附带损害。蛋白质-能量营养不良应根据最近全球认可的“营养不良全球领导倡议”(GLIM)标准进行诊断。这些标准包括3个表型标准和3个病因标准。每组满足一项标准即可进行诊断。除了与疾病有关的食欲不振外,还有许多潜在的营养不良原因。整个范围可以从恶性肿瘤到功能受损的老年受试者的支持不足。通常,有几个因素可能起作用。DoMAP模型总结了营养不良的潜在和常见原因的非常复杂的范围。营养不良可能导致严重后果,如肌肉萎缩和肌肉减少症,导致跌倒和骨折,免疫系统功能受损,感染增加,伤口愈合受损,所有这些都与发病率和死亡率增加有关。许多荟萃分析和指南已经证明了营养治疗对营养不良患者的有效性。有充分的证据表明,根据每个病人的情况和疾病,可以单独或联合使用各种方法。特别值得一提的是,一项大型前瞻性随机对照试验——努力研究(EFFORT-study)已经证明,一种结构化但个性化的方法可能是最有效的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Protein-energy-malnutrition].

Loss of appetite is part of the so-called "sickness behavior", which is a uniform reaction to many diseases, mainly triggered by inflammatory signals. Whereas this pattern may have been an evolutionary advantage long time ago, loss of appetite with consecutive malnutrition nowadays represents more a collateral damage of many acute and chronic diseases.Protein-energy-malnutrition should be diagnosed with the recently globally consented criteria of the "Global Leadership Initiative on Malnutrition" (GLIM). These criteria comprise 3 phenotypic and 3 etiologic criteria. If one criterium of each group is fulfilled, the diagnosis can be made.Besides the disease related loss of appetite, there are many potential causes of malnutrition. The entire spectrum may reach from malignancies to insufficient support in functionally impaired older subjects. Frequently, several factors may play a role. The very complex spectrum of potential and frequent causes of malnutrition has been summarized in the DoMAP model.Malnutrition may lead to severe consequences such as muscle atrophy and sarcopenia, leading to falls and fractures, impaired function of the immune system with an increase of infections and impaired wound healing, all of which are connected with increased morbidity and mortality.Many meta-analyses and guidelines have demonstrated the effectiveness of nutritional therapy in malnourished patients. There is good evidence for various approaches, that may be utilized alone or in combination, depending on the situation and disease of each individual patient. Particularly, the EFFORT-study, a large prospective randomized controlled trial, has demonstrated, that a structured, but individualized approach may be most effective.

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