成人患者营养不良诊断与应用指南(2025版)  

Diagnostic and application guidelines for malnutrition in adult patients(2025 edition)

作　　者：中华医学会肠外肠内营养学分会 中国营养学会临床营养分会 中国医疗保健国际交流促进会临床营养健康学分会 陈伟[2] 江华 杨桦 韩婷[5] 贾震易[6] 李海龙[2] 李融融[2] 李增宁[7] 齐玉梅[8] 秦环龙 邵春海 王新颖 王怡[12] 许红霞 尤丕聪[14] 章黎 朱明炜[15] Chinese Society for Parenteral and Enteral Nutrition;Clinical Nutrition Branch of Chinese Nutrition Society;China International Exchange and Promotive Association for Medical and Health Care Clinical Nutrition Health Branch;Chen Wei;Jiang Hua;Yang Hua(不详;Chinese Academy of Medical Sciences,Peking Union Medical College Hospital,Department of Clinical Nutrition and Peking Union Medical College,Beijing 100730,China;Sichuan Provincial People′s Hospital,University of Electronic Science and Technology of China,Institute of Emergency Medicine and Disaster Medicine,Chengdu 610072,China;Department of General Surgery,Chongqing General Hospital,Chongqing 400037,China)

机构地区：[1]不详 [2]中国医学科学院,北京协和医学院,北京协和医院临床营养科,北京100730 [3]四川省医学科学院,四川省人民医院电子科技大学附属医院急诊医学与灾难医学研究所,成都610072 [4]重庆市人民医院普外科,重庆400037 [5]同济大学附属第十人民医院临床营养科 [6]上海市第六人民医院普外科 [7]河北医科大学第一医院河北省营养与健康重点实验室 [8]天津市第三中心医院营养科 [9]苏州市立医院普外科 [10]复旦大学附属华山医院临床营养科 [11]东部战区总医院普通外科 [12]中国医学科学院,北京协和医学院,北京协和医院病案科,北京100730 [13]陆军军医大学大坪医院临床营养科 [14]天津医院内科重症医学科 [15]北京医院普外科

出　　处：《中华医学杂志》2025年第13期953-980,共28页National Medical Journal of China

基　　金：国家自然科学基金(72074222);北京协和医院中央高水平医院临床科研专项(2022-PUMCH-B-054)。

摘　　要：营养不良是影响多种疾病预后的关键性因素,尤其是老年、手术和危重症患者。随着疾病诊断相关分组(DRGs)和按病种分值付费(DIP)在中国的实施,明确营养不良的诊断及治疗,有助于改善临床决策和患者预后。本指南由多学科领域专家通过系统检索循证医学证据,采用全球营养组织倡议的营养不良诊断(GLIM)等国际通用新标准,结合中国人群数据及特征,对证据级别进行分类并提出推荐建议。指南涵盖了成人患者营养不良的定义、流行病学、营养风险筛查和多层次营养评估以及诊断的全过程,并针对不同患者群体(如肥胖、危重症患者)提出个性化诊断策略,提出营养不良诊断的规范流程,最终形成27个问题、38条推荐意见,以期提升中国营养不良诊断的实践能力。Malnutrition is a crucial factor affecting the prognosis of various diseases,especially among elderly,surgical and critically ill patients.With the implementation of diagnosis related groups(DRGs)and diagnosis-intervention packet(DIP)in China,accurate diagnosis and treatment of malnutrition is essential for enhancing clinical decision-making and patient prognosis.These guidelines were developed by multidisciplinary experts through a systematic review of evidence-based medical literature.They adopt the new international standard for malnutrition diagnosis from the Global Leadership Initiative on Malnutrition(GLIM)proposed by the Global Nutrition Organization and categorize evidence levels,providing recommendations tailored to the Chinese population′s data and characteristics.The guidelines cover the entire process of malnutrition diagnosis in adult patients,including definition,epidemiology,nutrition risk screening,multi-level nutrition assessment,and diagnostic procedures.They also propose individualized diagnostic strategies for specific patient groups,such as obese or critically ill patients,and establish a standardized process for malnutrition diagnosis.At last,the guidelines form 27 questions,38 recommendations,in order to improve the practical capacity of malnutrition diagnosis in China.

关 键 词：营养不良 营养风险筛查 营养评估 营养诊断 肥胖 危重症 临床指南 

分 类 号：R459.3[医药卫生—治疗学]