• “Food First” –is the first treatment option for elderly people who are malnourished • Use of oral nutritional supplements is generally not recommended until a Food First approach has been trialled • Nutrition support is recommended for malnourished people who are unable to maintain body weight by food intake alone • Oral nutritional supplements are a top-up to food intake rather than a replacement – they should be given between meals, not at meal times
不仅改善老年人营养状况，而且改善老年人 的生活质量以及结局
评估
干预
监测
20
老年人营养干预（支持）
营养支持（干预）策略
三大策略 四种方法
Adapted From: Lochs H et al. Clin Nutr. 2006; 25(2):180-186.
Strategies to improve nutrition in elderly people
营养不良影响临床结局
感染率增加至3倍 住院时间延长
院 内 感 染 率 %
住 院 天 数 （天）
Schneider SM et al BMJ 2004
Pichard et al. AJCN 2004
11
营养状况与住院天数
Pirlich M, et al. Clin Nutr. 2006;25(4):563-72.
3
营养不良的概念
• Malnutrition is both a “cause and consequence of ill-health” • The term malnutrition can apply to various states – under-nutrition or malnutrition – over-nutrition – deficiencies of specific nutrients
• 干预时间：12周
Margareta P, et al. Nutritional supplementation and dietary advice in geriatric patients at risk of malnutrition. Clinical Nutrition (2007) 26, 216–22
• 住院老年患者108人, 平均年龄 85（6）岁，sMNA：Risk of malnutrition • 对照组：brief written dietary advice • 干预组 • 2次个性化干预：出院前以及出院后一周 • 3次电话干预： • using full-fat milk instead of low-fat milk • cream and creme fraiche in their cooking • eat more snacks between meals • liquid supplement：85 or 120 kcal+ 4 or 5 g protein/100ml • Follow up: 4 month
营养状况与合并症
吴国豪，等. 中华外科杂志. 2005;43(11):693-696
营养状况与合并症
孙建琴，等. 肠内与肠外营养. 2005;12(6):345-346
营养状况与生存率
Kagansky N , et al. Am J Clin Nutr. 2005;82(4):784-91.
营养状况与死亡率
营养支持（干预）策略
膳食营养 干预 肠内营养 干预
• 饮食建议-initiated by dietary device • 食品强化-increase energy and protein intake without increasing volume
• 口服营养 • 管饲营养 • 改善进餐环境 • 喂养助理 • 肠外营养-digestive tract can’t be used
老年人蛋白质推荐摄入量（RNI）（轻体力活动）(g)
年龄 18~ 50~ 60~ 70~ 80~
男 75 75 75 75 75
女 65 65 65 65 65
各种微量营养素（维生素和微量元 素）的需要不仅不低于 成年人， 甚
至比成年高更，因此容易引起隐性
缺乏或明显缺乏。
老年人普遍存在营养摄入不足
• 21个安老院筛选出41 老年人：BMI <18.5，把安老院随机 分分干预组和对照组 • 对照组: 日常饮食-19 人 • 干预组：增加能量（ 1673 kJ ）但不增加食物份量-22人
+ Double cream (50 mL) add to cereal, porridge, soup and desserts +Butter (8 g) was added to potatoes + A 250-mL malted milk made with whole milk was offered each evening
Mean Consumption vs. Dietary Reference Intake (DRI) Ages 70+ yrs
Energy Vitamin A Vitamin D Vitamin E Vitamin K Vitamin C Choline Calcium Magnesium Potassium
• 国内外临床资料表明，老年人容易罹患营养不良
– 有独立生活能力的社区老年人中：5%～10%
– 老年住院患者（急性）：10% ～ 50%
– 长期需要病护： 10 ～ 70%
– 养老院：85% 以上 – 蛋白质热量营养不良症在住院老年病人中患病率为60%, 但 被诊出率仅为36%, 获得营养支持者只有8%
其他
Dietary advice is frequently recommended as
the first means of nutritional intervention
• The first step of Nutrition support should always be to maximise an individual’s nutritional intake from regular food and drink often termed “ The Food First” • The Food First approach includes increasing the frequency of eating, maximising the nutrient and energy density of food and drink and fortifying food with the addition of fats and sugars.
Leslie WS, et al. Improving the dietary intake of under nourished older people in residential care homes using energy-enriching food approach: a cluster randomised controlled study. Journal of Human Nutrition and Dietetics, 2013, 26, 387–394
47% 58% 61% 59% 62% 19% 25% 41% 47% 81% 96% 106% 103% 80% 78%
100% of DRI (70+ yrs)
89% 88%
70% 73% 67%
females males
What We Eat In America, NHANES 2007-2008. 2010; Available from: /Services/docs.htm?docid=18349
National Institute for Health and Clinical Excellence (NICE). Nutritional support in adults. NICE, 2006. Available from: /Guidance/CG32 (Accessed Apr, 2011).
-生活中的压力
-精神/神经
老年 BEE
每日能量需要量
老年人能量推荐摄入量（RNI）（轻体力活动）(kcal)
年龄 18~ 50~ 60~ 70~ 80~
男 2400 2300 1900 1900 1900
女 2100 1900 1800 1700 1700
蛋白质-需要量不低于 成年人， 摄入质和量 难达要求
National Institute for Health and Clinical Excellence (NICE). Nutritional support in adults. NICE, 2006. Available from: /Guidance/CG32 (Accessed Apr, 2011) Watterson C，et al. Dietitians Association of Australia, 2009 Kagansky et al, 2005
老年人营养不良的干预技术与方法
中山大学公共卫生学院 朱惠莲教授
我国人口老龄化特点
老年人口基数大，数量多；人口老龄化呈现出高龄化趋势