10日間の入院で脳疾患の低栄養2倍

10日間の入院で、神経疾患患者（約半数が脳卒中）の低栄養の割合が約2倍になるという報告です。MNAで調査して良好、At risk、低栄養が入院時59％、34％、7％だったものが、10日後に21％、57％、22％になっています。急性期病院で栄養状態が悪化するという1つのエビデンスです。

Hafsteinsdóttir TB, Mosselman M, Schoneveld C, Riedstra YD, Kruitwagen CL. Malnutrition in hospitalised neurological patients approximately doubles in 10 days of hospitalisation. J Clin Nurs. 2010 Mar;19(5-6):639-48. doi: 10.1111/j.1365-2702.2009.03142.x.

急性期病院で栄養状態が悪化する理由として、①神経疾患・手術による侵襲、②不適切な栄養管理による飢餓が考えられます。急性期病院で低栄養になり、この状態で回復期リハ病院に転院するので、回復期でも低栄養が多いことになります。

Abstract

AIMS AND OBJECTIVES:

To measure the nutritional status of neurological patients during admission and after 10 days, with a special focus on those with malnutrition and those at risk of malnutrition, and to measure the association of clinical variables and nutritional status, which may be important for the early detection of patients at risk of malnutrition.

BACKGROUND:

Studies have shown high prevalence of malnutrition in hospitalised patients and recommend structured screening and nutritional intervention for these patients. There is a lack of information concerning the nutritional status of neurological patients.

DESIGN:

A prospective descriptive study.

METHOD:

Neurological patients (n = 196) were included from departments of neurology and neurosurgery in Dutch university hospital. Nutritional status was measured with the Mini Nutritional Assessment and functional status with the Barthel Index and the Rankin Scale at admission to the hospital and after 10 days.

RESULT:

Of the patients, 34% were at risk of malnutrition, 7% were malnourished, whereas 59% of the patients were well nourished according to the MNA. After 10 days, 57% were at risk of malnutrition, 22% were malnourished and 21% were well nourished. The total group of patients malnourished and at risk of malnutrition was 41% at admission, which had grown to 79% in 10 days. Significant association was found between various clinical variables and nutritional status.

CONCLUSIONS:

A large group of neurological patients is malnourished and at risk of malnutrition during hospital admission, and the nutritional status of most patients worsens in 10 days. Various clinical variables may be of importance in detecting malnourished patients.

RELEVANCE TO CLINICAL PRACTICE:

Nurses need to observe the symptoms of malnutrition and provide evidence-based nutritional interventions to these patients. Improved education of nurses and good collaboration between the professionals and the facilitation of hospital management is essential to improve nutritional care of neurological patients.