Erfassung von Mangelernährung bei geriatrischen Traumapatienten

Epidemiology, Controversies, and Dilemmas of Perioperative Nutritional Risk/Malnutrition: A Narrative Literature Review

Current perioperative nutrition management is discouraging due to the under-recognition of clinical nutrition and the lagging development of clinical nutriology. This review aimed to identify and explore epidemiology, related adverse outcomes, controversies, and dilemmas of perioperative nutritional risk/malnutrition to call for further development of perioperative nutritional medicine. Databases including PubMed, Embase, Cochrane Library, Wanfang Database, China National Knowledge Infrastructure, China Biology Medicine disc, and Chongqing VIP Database were searched for articles published between January 1, 2014 and August 31, 2024 using the following MeSH terms: ("nutritional risk"[Title/Abstract] OR "malnutrition"[Title/Abstract] OR "undernutrition"[Title/Abstract]) AND ("surgery"[Title/Abstract] OR "surgical"[Title/Abstract] OR "operative"[Title/Abstract] OR "operation"[Title/Abstract]). The incidence of nutritional risk was in the 20% range in patients undergoing elective surgery, 54% in older adults, 44-70% in patients with tumors or major elective surgeries, and 50-55% in children. The incidence of malnutrition ranged from 11-77% in surgical patients. Nutrition-related perioperative adverse events included mainly infection, wound healing disorders, reoperation and unplanned readmission, prolonged hospital stay, mortality, perioperative neurocognitive dysfunction, and venous thrombosis. Current controversies and dilemmas in this field include the low rates of nutrition screening and medical nutrition therapy, numerous nutrition screening tools and malnutrition diagnostic criteria, no consensus on optimal assessment method, low level of evidence-based clinical nutrition research and lack of in-depth mechanistic studies, inconsistent timing of nutrition assessment, lack of reports for community hospitals, small hospitals, and low/middle-income countries or regions, and under-recognition of micronutrient malnutrition. It is, therefore, necessary for perioperative patients to undergo nutritional screening at the first outpatient visit before surgery and/or on admission. Perioperative nutritional management needs urgent attention and requires a multidisciplinary team, including anesthesia, nursing, nutrition, and surgery.

Nutritional Assessment in Older Adults : MNA® 25 years of a Screening Tool and a Reference Standard for Care and Research; What Next?

A tool to assess nutritional status in older persons was really needed. It took 5 years to design the MNA® (Mini Nutrition Assessment) tool, complete the first validations studies both in Europe and in the U.S. and to publish it. After the full MNA®, the MNA® short form and the self-MNA® have been validated. As well as Chinese and other national MNA® forms. Now more than 2000 clinical research have used the MNA® all over the world from community care to hospital. At least 22 Expert groups included the MNA® in new clinical practice guidelines, national or international registries. The MNA® is presently included in almost all geriatric and nutrition textbook and part of the teaching program for medicine and other health care professional worldwide. The urgent need is to target the frail older adults more likely to have weight loss and poor appetite and to prevent frailty and weight loss in the robust. We present in this paper the review of 25 years of clinical research and practice using the MNA® worldwide.