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前情提要
EAL推荐意见
营养不良筛查和营养评定验证工具 推荐意见 等级：强，必不可少
推荐意见 等级：强，必不可少
依据：营养不良筛查和再筛查可识别将受益于注册饮食营养师（RDN）进行营养评定和干预的患者。采用在目标人群和场所被验证的工具的重要性已在其他地方描述【16】。表1列出的7个研究【17-23】（参见：www.andjrnl.org）评估了一个营养不良筛查工具（如MST）在门诊、5个工具（如抑郁自评量表中的2个营养筛查条目、营养不良咨询小组营养筛查工具、MST、癌症患者营养不良筛查工具和营养不良通用筛查工具）在急诊采用的有效性和可信性。在门诊，MST用于识别成人肿瘤患者的营养不良风险有效且可信。在急诊，有3个工具用于识别成人肿瘤患者的营养不良风险有效且可信，即MST【17,20】、癌症患者营养不良筛查工具【20】和营养不良通用筛查工具【17】，而营养不良咨询小组营养筛查工具【18】和抑郁自评量表中的2个营养筛查条目【23】并不有效和可信。PG-SGA常用作成人肿瘤患者的筛查（确定营养不良风险）和评定工具（确定营养不良的出现）。到这次综述完成时，还无针对PG-SGA简表的验证研究，它包括由患者完成的四个病史相关问题。因此，将这个工具纳入到下面营养评定证据里，而不是作为单独的营养不良筛查工具。
表1中列出的7个研究【24-30】（参见：www.andjrnl.org）评估了营养评定工具的有效性和可信性。PG-SGA【24-29】和主观整体评定法【28】作为全面营养评定的一部分在识别门急诊成人肿瘤患者的营养不良方面有效且可信。营养评定法【30】已在门诊患者中进行了评估，对诊断门诊肿瘤患者营养不良具有敏感性，但与PG-SGA相比，在识别营养不良上只具有中度特异性。营养评定法未在急诊进行评估。 在纳入营养不良筛查和营养评定工具问卷调查的14个研究中，6个研究【18-20,24,25,27】用主观整体评定法作为参考标准，4个用PG-SGA作为参考标准，其他参考标准包括人体测量【26】和生化指标【28】、营养和食品专业人员评定【20,29】及营养风险筛查2002（NRS-2002）。【17】 EAL RECOMMENDATIONS Validated Tools for Malnutrition Screening and Nutrition Assessment Recommendation Inpatient settings: Malnutrition Screening Tool (MST), Malnutrition Screening Tool for Cancer Patients, and Malnutrition Universal Screening Tool. Ambulatory/outpatient settings: MST.
Rating: Strong; Imperative Recommendation Rating: Strong; Imperative Rationale: Malnutrition screening and rescreening identifies patients who would benefit from nutrition assessment and intervention by an RDN. The importance of using a tool validated in the population and setting in which it is intended has been described elsewhere.【16】 Seven studies,【17-23】shown in Table 1 (available online at www.andjrnl.org), evaluated the validity and reliability of one malnutrition screening tool (ie, MST) in the ambulatory setting and five tools in the acute care setting (ie, the 2-item nutrition screen from the Zung Self-Rating Depression Scale, Malnutrition Advisory Group Malnutrition Screening tool, MST, Malnutrition Screening Tool for Cancer Patients, and Malnutrition Universal Screening Tool). In the ambulatory setting, the MST【19,21】was found to be valid and reliable for identifying malnutrition risk in adult oncology patients. In acute care settings, three tools were found to be valid and reliable for identifying malnutrition risk in adult oncology patients: the MST,【17,20】the Malnutrition Screening Tool for Cancer Patients,【20】and Malnutrition Universal Screening Tool,【17】whereas the Malnutrition Advisory Group Malnutrition Screening tool18 and the 2-item nutrition screen from the Zung Self-Rating Depression Scale【23】were not found to be valid and reliable in this setting. The PG-SGA tool is often used as both a screening tool (to determine risk for malnutrition) and an assessment tool (to determine presence of malnutrition) in adult oncology patients. At the time this review was completed, there were no validation studies for the PG-SGA short form, which consists of four history related questions completed by the patient. Thus, the tool was included in the nutrition assessment evidence below, rather than as a separate malnutrition screening tool. Seven studies,【24-30】shown in Table 1 (available online at www.andjrnl.org), evaluated the validity and reliability of nutrition assessment tools. The PG-SGA【24-29】and the Subjective Global Assessment【28】were found to be valid and reliable in identifying malnutrition as part of a comprehensive nutrition assessment in adult oncology patients in both ambulatory and acute care settings. The Malnutrition Assessment【30】was evaluated in patients in ambulatory care settings, and was found to have the sensitivity to diagnose oncology patients with malnutrition in the ambulatory setting, but was only moderately specific in identifying malnutrition when compared with the PG-SGA. The Malnutrition Assessment was not evaluated in an acute care setting. Of the 14 studies included in the malnutrition screening and nutrition assessment tool questions, six studies【18-20,24,25,27】used the Subjective Global Assessment as the reference standard, whereas four21-23,30 used the PG-SGA as the reference standard. Other reference standards included anthropometric【26】and biochemical measures,【28】food and nutrition practitioner assessment,【20,29】and the Nutritional Risk Screening 2002 (NRS-2002).【17】 参考文献 National Cancer Institute. What is cancer? http://www./cancertopics/cancerlibrary/what-is-cancer. Updated February 9, 2015. Accessed February 15, 2016. National Cancer Institute. Cancer statistics. http://www./about-cancer/what-is-cancer/statistics. Updated March 14, 2016. Accessed June 13, 2016. American Cancer Society. Genes in cancer. http://www./cancer/cancercauses/geneticsandcancer/genesandcancer/genes-and-cancer-gene-changes. Reviewed June 25, 2014. Accessed February 15, 2016. National Cancer Institute. Nutrition in cancer care-health professional version (PDQ): Overview. http://www./cancertopics/pdq/supportivecare/nutrition/HealthProfessional. Updated January 8, 2016. Accessed February 15, 2016. Reeves, GK, Pirie, K, Beral, V, Green, J, Spencer, E, Bull, D. Cancer incidence and mortality in relation to body mass index in the Million Women Study: Cohort study. BMJ. 2007;335:1134. Lelièvre, SA, Weaver, CM. Global nutrition research: Nutrition and breast cancer prevention as a model. Nutr Rev. 2013;71:742-752. Key, TJ, Allen, NE, Spencer, EA, Travis, RC. The effect of diet on risk of cancer. Lancet. 2002;360:861-868. Key, T. Cancer prevention and treatment. World Rev Nutr Diet. 2014;111:123-129. American Society of Parenteral and Enteral Nutrition. Clinical guidelines. http://www./Guidelines_and_Clinical_Resources/Clinical_Guidelines/. Accessed February 15, 2016. Clinical Oncological Society of Australia, Cancer Council Australia. 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Ferguson M, Capra S, Bauer J, Banks M. Development of a valid and reliable malnutrition screening tool for adult acute hospital patients. Nutrition. 1999;15(6):458-464. Isenring E, Cross G, Daniels L, Kellett E, Koczwara B. Validity of the malnutrition screening tool as an effective predictor of nutritional risk in oncology outpatients receiving chemotherapy. Support Care Cancer. 2006;14(11):1152-1156. Kim JY, Wie GA, Cho YA, et al. Development and validation of a nutrition screening tool for hospitalized cancer patients. Clin Nutr; 2011:1-6. Kirsh KL, Dugan C, Theobald DE, Passik SD. A chart review, pilot study of two single-item screens to detect cancer patients at risk for cachexia. Palliat Support Care. 2003;1(4):331-335. Bauer JCS, Ferguson M. Use of the scored patient-generated subjective global assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr. 2002;56(8):779-785. Isenring E, Bauer J, Capra S. The scored patient-generated subjective global assessment (PG-SGA) and its association with quality of life in ambulatory patients receiving radiotherapy. Eur J Clin Nutr. 2003;57:305-309. Kwang AY, Kandiah M. Objective and subjective nutritional assessment of patients with cancer in palliative care. Am J Hosp Palliat Care. 2010;27(2):117-126. Laky B, Janda M, Cleghorn G, Obermair A. Comparison of different nutritional assessments and body-composition measurements in detecting malnutrition among gynecologic cancer patients. Am J Clin Nutr. 2008;87(6):1678-1685. Li R, Wu J, Ma M, et al. Comparison of PG-SGA, SGA and body-composition measurement in detecting malnutrition among newly diagnosed lung cancer patients in stage IIIB/IV and benign conditions. Med Oncol. 2011;28:689-696. Persson C, Sjödén PO, Glimelius B. The Swedish version of the patientgenerated subjective global assessment of nutritional status: Gastrointestinal vs urological cancers. Clin Nutr. 1999;18(2):71-77. 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翻译：肖慧娟（天津市第三中心医院） 
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