第九章 住院病人营养膳食.pptx

第九章 住院病人的营养膳食;蒋建华 李秋桂;住院病人营养不良的发生率较高 Disease related malnutrition clearly exisis in a high proportion of hospitalized patients. Patients with a high likelihood of malnutrition have Prolonged hospital stays and higher mortality. 对病人进行营养评价的重要性; Nutritional assessment is essential to identify patients who are malnourished or at risk of developing malnutrition. It also provides an important base line of data on which to evaluate the adequacy of nutritional therapy. ;评 价 方 法;一、膳食调查 ; Dietary Assessment The purpose of a dietary assessment is to identify a person’s eating habits and to estimate the average daily nutrient intake. Dietary assessment should identify the patient who is at high risk of having or developing a nutritional problem, whether it is due to nutrient excess or deficiency. ;（一）膳食调查的内容及方法; 询问法：通过询问了解患者饮食摄入情况。简便易行，费用低；但准确性较差。 查帐法：通过查询食物出入帐目，了解个体的营养摄入情况。特点：适合于集体就餐的人群，所需人力少；但难以对不同个体实际摄入各种营养素量作出较准确的估算。 ; 称重法：对所消耗的全部食物在烹调前和烹调后进行称重，再根据实际就餐人数和生熟比值折算出每人实际摄入的食物重量。特点：调查结果较准确、细致；但工作量大并费时。 化学分析法：将被调查对象全天所摄入的食物进行备份，并在实验室进行化学分析。特点：需要一定的仪器设备，分析操作复杂，不适合一般的调查。;Methods of Estimating an Individual’s Dietary Intake Dietary recall. Simply, ask the patient what he or she has eaten. This is the least accurate. Food diary. This is slightly more accurate. Complete chemical analysis. This is the most expensive but the most accurate method.;（二）膳食调查结果的整理及评价; 计算所摄入三大营养素各占能量百分比；并分类计算蛋白质和脂肪来源百分比。 计算三餐或多餐的能量摄入百分比； 有针对性地计算需要了解的某种营养素来源的百分比。;2．结果评价：将调查结果与中国居民膳食营养素参考摄入量进行比较，并做出评价。 摄入食物是否种类多样，食物搭配是否合理；能量及各种营养素是否能满足被调查者的营养需要。 摄入的能量及各种营养素占同类人群营养素参考摄入量的百分比、三大营养素供能的比例、蛋白质的来源分布、脂肪的来源分布等是否合理。 ;小结;对病人进行营养评价的重要性 营养评价的方法包括有哪几种？每一种方法的优缺点简介。 简述膳食调查的几种方法 对膳食调查的资料如何进行整理及评价; 二、人体测量;Anthropometric Measurements Basic anthropometric measurements include: Height Weight Upper arm circumference: a measure of skeletal muscle mass. Skin-fold thickness: to help to assess the amount Of subcutaneous fat stores. The Wor