臨床での栄養管理の意義

Malnutrition commonly occurs in the hospital setting and adds significantly to costs. Multiple surveys have shown that 40% to 50% of hospitalized patients are at risk for malnutrition, and up to 12% are severely malnourished. Unquestionably, profound malnutrition causes growth retardation and lowered resistance to infection, with marked effects on cellular immunity and increased mortality, particularly among infants, children, and the elderly. Malnutrition, in and of itself, is a cause of death and disease. Several studies demonstrated a direct cause-effect relationship between malnutrition and morbidity and mortality.
In developing countries, where famine is not a problem, malnutrition is not yet a routine concern and often not recognized in the clinical setting. However, medical research generally shifted to infection and, more recently, to prevention and control of chronic disease. Researchers are now turning their attention back to nutrition, seeing it as a key component of health and a key tool in decreasing the risk of chronic illness. Nutrition screening, follow-up assessment, and aggressive intervention are not uniformly part of routine medical care, probably because studies of nutrition support are sometimes judged to be imperfect and inconclusive.
This review presents scientific and economic justifications for routine nutrition screening and suggests when assessment and intervention might be appropriate. This information demonstrates the role of screening, assessment, and intervention as cost-effective features of health care in Japan.