改善可能な低栄養の原因

高齢者の低栄養の原因の中には改善可能なものもある。その中で、最も多い原因は薬剤性のものである。その他、入れ歯などの口腔内の問題、経済問題、介護力の問題などが挙げられる。この、Meals on Wheelsはそれら、改善可能な原因を覚えるための語呂合わせである。ただし、老人ホームでの、という但し書きを忘れてはならない。在宅ではもう少し複雑で特に日本の環境では、家族の状況、介護保険上の制限などがこれらに加味される必要がある。
出典
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1: Causes of weight loss in a community nursing home.
著者: J E Morley, D Kraenzle
雑誌名: J Am Geriatr Soc. 1994 Jun;42(6):583-5.
Abstract/Text: OBJECTIVE: To determine the causes of weight loss in nursing home residents.
DESIGN: Retrospective chart review of all weights over the previous 6 months and an in-depth examination of all residents who lost 5 or more pounds over that period.
SETTING: A for-profit community nursing home in an urban area.
SUBJECTS: All residents who had been in the nursing home for 3 or more months. Their mean age was 80.1 years, and 89% were female.
RESULTS: Weight loss of 5 pounds or more occurred in 19% of subjects. Only 15% of subjects had lost 5% of body weight, and 4% had lost more than 10% of their body weight. Depression accounted for 36% of the weight loss. Other causes of anorexia included medications, psychotropic drug reduction, swallowing disorders, paranoia, dementia with apraxia, gallstones, and obsessive-compulsive disorder. Increased energy utilization as a cause of weight loss was seen in two residents who wandered incessantly, one with tardive dyskinesia and one with chronic obstructive pulmonary disease. Dehydration was the cause of weight loss in two residents, and one resident had international weight loss for obesity. Cancer was the cause of weight loss in two residents. Four of 30 residents had more than one cause of weight loss. One of 25 tube-fed residents displayed weight loss.
CONCLUSIONS: A single cause of weight loss can be identified in most nursing home residents. Depression is the most common cause of weight loss. Psychotropic drug reduction may cause weight loss. The majority of causes of weight loss in a community nursing home are potentially treatable.
J Am Geriatr Soc. 1994 Jun;42(6):583-5.

低栄養の原因となる可能性のある薬剤で高齢者がよく内服している薬剤

日本人の基礎代謝量

日本人の推定エネルギー必要量

成長に伴う組織増加分のエネルギー

栄養障害の評価アルゴリズム

炎症の有無により評価方法が異なるため栄養障害を疑った場合は炎症の有無を評価し、それぞれの定義・重症度評価に基づいて評価する。
出典
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1: Consensus statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition).
著者: Jane V White, Peggi Guenter, Gordon Jensen, Ainsley Malone, Marsha Schofield, Academy Malnutrition Work Group, A.S.P.E.N. Malnutrition Task Force, A.S.P.E.N. Board of Directors
雑誌名: JPEN J Parenter Enteral Nutr. 2012 May;36(3):275-83. doi: 10.1177/0148607112440285.
Abstract/Text: The Academy of Nutrition and Dietetics (Academy) and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) recommend that a standardized set of diagnostic characteristics be used to identify and document adult malnutrition in routine clinical practice. An etiologically based diagnostic nomenclature that incorporates a current understanding of the role of the inflammatory response on malnutrition's incidence, progression, and resolution is proposed. Universal use of a single set of diagnostic characteristics will facilitate malnutrition's recognition, contribute to more valid estimates of its prevalence and incidence, guide interventions, and influence expected outcomes. This standardized approach will also help to more accurately predict the human and financial burdens and costs associated with malnutrition's prevention and treatment and further ensure the provision of high-quality, cost-effective nutrition care.
JPEN J Parenter Enteral Nutr. 2012 May;36(3):275-83. doi: 10.1177/0148...

栄養障害の定義・重症度評価

2つ以上の重症の所見を認める場合は重症の栄養障害、2つ以上中等症以下の所見を認める場合は中等症以下の栄養障害と評価する。
 
参考文献：
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[3]:Klein S, Kinney J, Jeejeebhoy K, et al. Nutrition support in clinical practice: review of published data and recommendations for future research directions. National Institutes of Health, American Society for Parenteral and Enteral Nutrition, and American Society for Clinical Nutrition. JPEN J Parenter Enteral Nutr. 1977;21:133-156.
[4]:Rosenbaum K, Wang J, Pierson RN, Kotler DP. Time-dependent variation in weight and body composition in healthy adults. JPENJ Parenter Enteral Nutr. 2000;24:52-55.
[5]:Keys A. Chronic undernutrition and starvation with notes on protein deficiency. JAMA. 1948;138:500-511.
[6]:Sacks GS, Dearman K, Replogle WH, Cora VL, Meeks M, Canada T. Use of subjective global assessment to identify nutritionassociated complications and death in long-term care facility residents. J Am Coll Nutr. 2000;19:570-577.
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[9]:[http://www.adaevidencelibrary.com/conclusion.cfm?conclusion_statement_id=251313&highlight=prealbumin&home=1. American Dietetic Association Evidence Analysis Library. Does serum prealbumin correlate with weight loss in four models of prolonged protein-energy restriction: anorexia nervosa, non-malabsorptive gastric partitioning bariatric surgery, calorie-restricted diets or starvation. Accessed August 1, 2011.]
[10]: [http://www.adaevidencelibrary.com/conclusion.cfm?conclusion_statement_id=251315&highlight=prealbumin&home=1. American Dietetic Association Evidence Analysis Library. Does serum prealbumin correlate with nitrogen balance? Accessed August 1, 2011.]
[11]:[http://www.adaevidencelibrary.com/conclusion.cfm?conclusion_statement_id=251263&highlight=albumin&home=1. American Dietetic Association Evidence Analysis Library. Does serum albumin correlate with weight loss in four models of prolonged protein-energy restriction: anorexia nervosa, non-malabsorptive gastric partitioning bariatric surgery, calorie-restricted diets or starvation. Accessed August 1, 2011.]
[12]:[http://www.adaevidencelibrary.com/conclusion.cfm?conclusion_statement_id=251265&highlight=albumin&home=1. American Dietetic Association Evidence Analysis Library. Does serum albumin correlate with nitrogen balance? Accessed August 1, 2011.]
出典
imgimg
1: Consensus statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition).
著者: Jane V White, Peggi Guenter, Gordon Jensen, Ainsley Malone, Marsha Schofield, Academy Malnutrition Work Group, A.S.P.E.N. Malnutrition Task Force, A.S.P.E.N. Board of Directors
雑誌名: JPEN J Parenter Enteral Nutr. 2012 May;36(3):275-83. doi: 10.1177/0148607112440285.
Abstract/Text: The Academy of Nutrition and Dietetics (Academy) and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) recommend that a standardized set of diagnostic characteristics be used to identify and document adult malnutrition in routine clinical practice. An etiologically based diagnostic nomenclature that incorporates a current understanding of the role of the inflammatory response on malnutrition's incidence, progression, and resolution is proposed. Universal use of a single set of diagnostic characteristics will facilitate malnutrition's recognition, contribute to more valid estimates of its prevalence and incidence, guide interventions, and influence expected outcomes. This standardized approach will also help to more accurately predict the human and financial burdens and costs associated with malnutrition's prevention and treatment and further ensure the provision of high-quality, cost-effective nutrition care.
JPEN J Parenter Enteral Nutr. 2012 May;36(3):275-83. doi: 10.1177/0148...