2021ESPEN肿瘤患者营养实践指南解读
2021ESPEN肿瘤患者营养实践指南解读
编者按：
2021年，欧洲临床营养与代谢协会(European Society for Clinical Nutrition and Metabolism, ESPEN)在其官⽅杂志Clinical Nutrition上发布了最新版的肿瘤患者营养实践指南(ESPEN practical guideline: Clinical Nutrition in cancer)，该版本在2017年ESPEN肿瘤患者营养指南进⾏缩减，在内容没有变化的43条建议中添加了流程图，更加便于临床医师、营养师及护⼠等在临床实践中使⽤。
肿瘤特定全营养是继普通全营养、糖尿病特定全营养的的第三⼤全营养品类，受到众多的关注；ESPEN的肿瘤患者营养实践指南是业界权威指南。从明华教授和吴国豪教授分别对指南进⾏了专业的解读，⼩编在两位教授的解读上做了综合编辑，以飨读者。此外，推荐⽔平、证据⽔平以及共识⽔平强的做了标红。
⼀、肿瘤患者营养通则
1.1 筛查与评估
推荐1
To detect nutritional disturbances at an early stage, we recommend to regularly evaluate nutritional intake, weight change, and body mass index (BMI), beginning with cancer diagnosis and repeated depending on the stability of the clinical situation. (Recommendation B1-1; strength of recommendation strong – level of evidence very low – strong consensus)
为早期发现营养失衡，建议从肿瘤确诊就定期评估患者的营养摄⼊量、体重变化与⾝体质量指数(BMI)，并依据病情反复评估。(强推荐、证据⽔平很
三星智能机怎么样
低、强共识)
推荐2
提高笔记本显卡性能
In patients with abnormal screening, we recommend objective and quantitative assessment of nutritional intake, nutrition impact symptoms, muscle mass, physical performance and the degree of systemic inflammation. (Recommendation B1-2; strength of recommendation strong – level of evidence very low – consensus)
对对营养筛查有异常的患者，建议进⾏进⾏客观、定量的评估：营养摄⼊量、营养相关症状、肌⾁质量、体能及全⾝炎症程度。(强推荐、证据⽔平很低、共识)
1.2 能量与底物需求
推荐3
We recommend that the total energy expenditure (TEE) of cancer patients, if not measured individually, be assumed to be similar to healthy subjects and generally ranging between 25 and 30kcal/kg/day. (Recommendation B2-1; strength of recommendation strong – Level of evidence low – consensus)
肿瘤患者的总能量消耗(TEE)若⽆法个体化测量，推荐其与健康⼈相似，⼀般为25-30kcal/kg/d。(强推荐、证据⽔平低、共识)
推荐4
We recommend that protein intake should be above 1g/kg/day and, if possible up to 1.5g/kg/day. (Recommendation B2-2; strength of recommendation strong – Level of evidence moderate – strong consensus)
蛋⽩质摄⼊量每⽇应⼤于1g/kg ，有条件者增加⾄1.5g/kg以上。(强推荐、证据⽔平中等、强共识)
推荐5
We recommend that vitamins and minerals be supplied in amounts approximately equal to the recommended daily allowance and discourage the use of high-dose micronutrients in the absence of specific deficiencies. (Recommendation B2-4; strength of recommendation strong – Level of evidence low –strong consensus)
维⽣素与矿物质的供给量应⼤致等于每⽇营养推荐量，若没有特别缺乏不建议使⽤⾼剂量微量营养素。(强推荐、证据⽔平低、强共识)
推荐6
In weight-losing cancer patients with insulin resistance, we recommend to increase the ratio of energy from fat to energy from carbohydrates. This is intended to increase the energy density of the diet and to reduce the glycemic load. (Recommendation B2-3; strength of recommendation strong – Level of evidence low – consensus)
体重丢失且患有胰岛素抵抗的患者，推荐增加脂肪相对碳⽔化合物在能量供给中所占的⽐例，以增加饮⾷的能量密度并降低葡萄糖负荷量。(强推荐、证据⽔平低、共识)
1.3 营养
推荐7
We recommend nutritional intervention to increase oral intake in cancer patients who are able to eat but are malnourished or at risk of malnutrition. This includes dietary advice, the treatment of symptoms and derangements impairing food intake (nutrition impact symptoms), and offering oral nutritional supplements (ONS). (Recommendation B3-1; strength of recommendation strong – Level of evidence moderate – consensus)
对能经⼝进⾷的营养不良或存在营养不良风险的肿瘤患者，推荐进⾏营养⼲预来增加经⼝饮⾷，包括给予膳⾷建议、影响进⾷的相关症状和紊乱，以及提供⼝服营养补充(ONS)。(强推荐、证据⽔平中等、共识)
推荐8
We recommend not to use dietary provisions that restrict energy intake in patients with or at risk of malnutrition. (Recommendation B3-2; strength of recommendation strong – Level of evidence low – strong consensus)
我们建议不要在营养不良或有营养不良风险的患者中使⽤限制能量摄⼊的饮⾷规定。(强推荐、证据⽔平低、强共识)
推荐9
If a decision has been made to feed a patient, we recommend EN if oral nutrition remains inadequate despite nutritional interventions (counseling, ONS), and PN if EN is not sufficient or feasible. (Recommendation B3-3; strength of recommendation strong – Level of evidence moderate – strong consensus)如果进⾏了营养⼲预(咨询,ONS)，但⼝服营养仍然不⾜，建议EN；如果EN不充⾜或不可⾏，建议PN。(强推荐、证据⽔平中等、强共识)
推荐10
If oral food intake has been decreased severely for a prolonged period, we recommend to increase (oral, enteral or parenteral) nutrition only slowly over several days and to take additional precautions to prevent a refeeding syndrome.  (Recommendation B3-4; strength of recommendation strong – Level of evidence low – consensus)
对经⼝进⾷量长期严重下降患者，推荐营养摄⼊量(经⼝补充，肠内营养或肠外营养)在⼏天内缓慢增加，并采取额外措施以防⽌再喂养综合征。(强推荐、证据⽔平低、共识)营养师报考条件2021最新规定
推荐11
In patients with chronic insufficient dietary intake and/or uncontrollable malabsorption, we recommen
d home EN or PN in suitable patients. (Recommendation B3-5; strength of recommendation strong – Level of evidence low – strong consensus)
对长期膳⾷摄⼊不⾜和/或顽固性吸收不良患者，推荐对合适的患者进⾏家庭EN或PN。(强推荐、证据⽔平低、强共识)
1.4 运动
推荐12
We recommend maintenance or an increased level of physical activity in cancer patients to support muscle mass, physical function, and metabolic pattern.  (Recommendation B4-1; strength of recommendation strong – Level of evidence high – consensus)
推荐肿瘤患者坚持或增加体⼒活动⽔平，以维持肌⾁质量、机体功能及代谢状态。(强推荐、证据⽔平⾼、共识)
推荐13
We suggest individualized resistance exercise in addition to aerobic exercise to maintain muscle stre
ngth and muscle mass. (Recommendation B4-2; strength of recommendation weak – Level of evidence low – strong consensus)
建议在有氧运动外基础上制定个体化抗阻训练以维持肌⾁⼒量和质量。(弱推荐、证据⽔平低、强共识)
1.5 药物
推荐14
We suggest considering corticosteroids to increase the appetite of anorectic cancer patients with advanced disease for a restricted period (1-3 weeks) but to be aware of side effects (e.g. muscle wasting, insulin resistance, infections). (Recommendation B5-1;  strength of recommendation weak – Level of evidence high – consensus)
推荐短期内(1-3周)使⽤糖⽪质激素以增加晚期厌⾷性肿瘤患者的⾷欲，但需注意副作⽤(如肌⾁丢失、胰岛素抵抗及感染等)。(弱推荐、证据⽔平⾼、共识)
推荐15
We suggest considering progestins to increase the appetite of anorectic cancer patients with advanced disease but to be aware of potentially serious side effects (e.g. thromboembolism). (Recommendation B5-2; strength of recommendation weak – Level of evidence high – consensus)
对有厌⾷的晚期肿瘤患者，推荐对使⽤黄体酮以增加⾷欲，但需注意⾎栓等副作⽤。(弱推荐、证据⽔平⾼、共识)
推荐16
In patients with advanced cancer undergoing chemotherapy and at risk of weight loss or malnourishe
d, we suggest using supplementation with long-chain N-3 fatty acids or fish oil to stabilize or improve appetite, food intake, lean body mass, and body weight. (Recommendation B5-7; strength of recommendation weak – Level of evidence low – strong consensus)
对化疗或存在体重丢失及营养不良风险的晚期肿瘤患者，建议补充长链N-3脂肪酸或鱼油来保持或改善⾷欲、进⾷量、瘦体重及体重。(弱推荐、证据⽔平低、强共识)
推荐17
In patients complaining about early satiety, after diagnosing and treating constipation, we suggest to consider prokinetic agents, but to be aware of potential adverse effects of metoclopramide on the central nervous system and domperidone on cardiac rhythm. (Recommendation B5-8; strength of recommendation weak – Level of evidence moderate – consensus)
对主诉早饱的患者，在诊断并便秘后，推荐使⽤促动⼒药，但需注意胃复安对中枢神经系统的副作⽤以及多潘⽴酮对⼼率的影响。(弱推荐、证据⽔平中、共识)
justonelastdance中文歌词
推荐18
There are insufficient consistent clinical data to recommend the supplementation with branched-chai
蓝的眼泪n or other amino acids or metabolites to improve fat-free mass. (Recommendation B5-5; strength of recommendation none – Level of evidence low – strong consensus)
没有⾜够⼀致的临床数据⽀持推荐补充⽀链氨基酸或其他氨基酸或代谢产物来改善去脂组织质量。(推荐强度⽆、证据⽔平低、强共识)
推荐19
There are insufficient consistent clinical data to recommend non-steroidal anti-inflammatory drugs to improve body weight in weight-losing cancer patients. (Recommendation B5-6; strength of recommendation none – Level of evidence low – strong consensus)
没有⾜够⼀致的临床数据⽀持推荐⾮甾体类抗炎药来改善体重丢失肿瘤患者的体重。(推荐强度⽆、证据⽔平低、强共识)
推荐20
There are insufficient consistent clinical data to recommend cannabinoids to improve taste disorders or anorexia in cancer patients. (Recommendation
B5-3; strength of recommendation none – Level of evidence low – consensus)
没有⾜够⼀致的临床数据⽀持推荐使⽤⼤⿇类制剂来改善肿瘤患者的味觉障碍或厌⾷症。(推荐强度⽆、证据⽔平低、共识)
推荐21
There are insufficient consistent clinical data to recommend currently approved androgenic steroids to increase muscle mass. (Recommendation B5-4; strength of recommendation none – Level of evidence low – consensus)
没有⾜够⼀致的临床数据⽀持推荐使⽤⽬前批准的雄激素类固醇来增加肌⾁质量。(推荐强度⽆、证据⽔平低、共识)
⼆、特殊类型肿瘤患者的营养
2.1 ⼿术
推荐22
For all cancer patients undergoing either curative or palliative surgery, we recommend management within an enhanced recovery after surgery (ERAS) program; within this program, every patient should be screened for malnutrition and if deemed at risk, given additional nutritional support. (Recommendation C1-1; strength of recommendation strong – Level of evidence high – consensus)
对于所有接受根治性⼿术还是姑息性⼿术的患者，均推荐按照加速术后康复(ERAS)原则进⾏围⼿术期管理：每个患者都应进⾏营养筛查；若存在营养不良风险，则给予额外的营养。(强推荐、证据⽔平⾼、共识)
推荐23
For a patient undergoing repeated surgery as part of a multimodal oncological pathway, we recommend the management of each surgical episode within an ERAS program. (Recommendation C1-2; strength of recommendation strong – Level of evidence low – consensus)
对需要多次⼿术作为肿瘤多模式⼀部分的患者，推荐每次⼿术的围⼿术期管理均遵循ERAS原则。(强推荐、证据⽔平低、共识)
推荐24
In surgical cancer patients at risk of malnutrition or who are already malnourished, we recommend appropriate nutritional support both during hospital care and following discharge from the hospital. (recommendation C1-3; strength of recommendation strong – Level of evidence moderate – consensus) 对存在营养不良风险或已经营养不良的外科肿瘤患者，推荐住院期间与出院后都给予适当的营养。(强推荐、证据⽔平中、共识)
推荐25
In upper GI cancer patients undergoing surgical resection in the context of traditional perioperative care, we recommend oral/enteral immunonutrition (arginine, n-3 fatty acids, nucleotides). (Recommendation C1-4; strength of recommendation strong – Level of evidence high – strong consensus)
自然数指的是什么对采⽤传统围术期管理的上消化道肿瘤⼿术患者，推荐使⽤⼝服或肠内免疫营养(如精氨酸、n-3脂肪酸、核苷酸)。(强推荐、证据⽔平⾼、共识强)

版权声明：本站内容均来自互联网，仅供演示用，请勿用于商业和其他非法用途。如果侵犯了您的权益请与我们联系QQ:729038198，我们将在24小时内删除。