人体组成工具用于成人营养不良床边评定：研究事项与临床应用教程

　　由于人体瘦组织（其中主要成分是骨骼肌肉）在创伤和疾病应激中发挥着重要角色，因此它的维持是决定营养状态的重要因素。随着营养与饮食学会/美国肠外肠内营养学会诊断营养不良框架的最新发展，肌肉耗失成为其中一个界定准则。使用客观方法来评定每个急性和慢性患者是必要的。生物阻抗和超声技术是目前临床应用中最好的选择，然而，仍需进一步研究来调查如何最佳优化检查并使误差最小化，同时确定这些技术能否（以及哪种具体方法可以）独立评定营养不良，超越大多数主观评价方法。在本指南中，对校验床旁评定瘦组织中使用的基本概念和统计方法进行了讨论。不仅描述了在临床和科研中最普遍的人体组成评定方法，同时使用临床病例来说明临床医生如何利用生物阻抗和/或超声作为床旁评定营养状态的工具。关于营养不良的评定方法仍需进一步研究确认。

JPEN J Parenter Enteral Nutr. 2015;39(7):787-822.

Body Composition Tools for Assessment of Adult Malnutrition at the Bedside: A Tutorial on Research Considerations and Clinical Applications.

Earthman CP.

Department of Food Science and Nutrition, University of Minnesota-Twin Cities, St Paul, Minnesota.

Because of the key role played by the body's lean tissue reserves (of which skeletal muscle is a major component) in the response to injury and illness, its maintenance is of central importance to nutrition status. With the recent development of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition diagnostic framework for malnutrition, the loss of muscle mass has been recognized as one of the defining criteria. Objective methods to evaluate muscle loss in individuals with acute and chronic illness are needed. Bioimpedance and ultrasound techniques are currently the best options for the clinical setting; however, additional research is needed to investigate how best to optimize measurements and minimize error and to establish if these techniques (and which specific approaches) can uniquely contribute to the assessment of malnutrition, beyond more subjective evaluation methods. In this tutorial, key concepts and statistical methods used in the validation of bedside methods to assess lean tissue compartments are discussed. Body composition assessment methods that are most widely available for practice and research in the clinical setting are presented, and clinical cases are used to illustrate how the clinician might use bioimpedance and/or ultrasound as a tool to assess nutrition status at the bedside. Future research needs regarding malnutrition assessment are identified.

KEYWORDS: bioimpedance; body cell mass; fat-free mass; impedance ratio; intracellular water; lean body mass; malnutrition; muscle loss; muscle mass; nutrition status; phase angle; skeletal muscle; spectroscopy

PMID: 26287016

DOI: 10.1177/0148607115595227