ITlfNBQUAK&NGHIENCirUI
Danh gia tinh trang dinh drfcfng t r e em 6-60 thang tuoi trong benh vign bang phtfrfng phap
nhSn trac va phtfrfng phap SGA
Nguyin Dd Huy (*), Vu Minh Thuc (**)
Nghiin ctfu cd muc tiiu so sdnh gitfa ddnh gid tinh trgng dinh dudng tre em trong binh viin bang phuang phdp do cdc chi sd nhdn trdc vd bang cong cu ddnh gid SGA (phuang phdp SGA). Thiit ki nghien ctfu cat ngang md td trin 330 ddi tuang tre ttf 6 din 60 thdng tudi duoc diiu trf tgi Khoa Nhi - Bfnh viin da khoa tinh Hdi Duong ttf thdng 5-11/2009. Kit qud cho thdy: Khdu phdn nang luang cua Ire em dudi 5 tudi thdp han nhu cdu khuyin nghi ttf 10 din 30%. Ty le ddng gdp ctia khdu phdn lipit (22,4-29,3%) trong tdng nhu cdu ndng luang chua dgt theo nhu cdu. Ty le suy dinh dudng theo ddnh gid bdng cdc chi sdnhan trac (cdn ngng, chiiu cao) iheo tudi thd'p htm nhiiu so vdi ly If ndy khi ddnh gid bang phuang phdp SGA. Khdng cd stf khdc biit 6 ca ba lhi suy dinh dudng (theo phuang phdp nhdn trdc): nhf cdn, thdp coi vd gdy com (P > 0,05) nhUng cd stf khdc biit vi suy dinh dUdng theo phuong phdp SGA gitfa nhom tri dudi 24 thdng va tren 24 thdng tudi (P < 0,05).
Ttf khda: Tre em, nhdn trdc, phuang phdp SGA, tj le suy dinh dudng.
Assessment of nutritional status of hospitalised children aged 6 -60 months by
anthropometrical method and SGA tool
Nguyen Do Huy (•); Vu Minh Thuc (••)
The purpose ofthe smdy is to compare assessment of nutritional status of hospitalized children by anthropometrical method and by SGA tool. A cross-sectional study was conducted with involvement of 330 hospitalized children from 6-60 months of age in Pediatric Department of Hai Duong General Hospital fi-om May to November, 2009. The results show that: Energy iniake of hospitalized children was from 10 to 30% lower than that in the recommended guidelines. Contribution tn term of energy of lipid intake (22.4-29.3%) in total of energy requirement did not meet the recommended guidelines.
Prevalence ofmalnutrition by anthropometrical method (weight, height) try age was much lower Ihan
Tap chi Y t( C6ng rfng, 3.2013, SS 27 (27) 11
ITONeHURN&NGHIENeUUj
that of malnutrition by SGA tool. There was no significant difference in malnutrition status by anthropometrical method including underweight, stunting and wasting (P > 0.05), bul there was a significant difference in malnutrition status by SGA tool belH'een age groups (below 24 months and above 24 months of age) (P<0.05).
Key words: Children, anthropometrical method, SGA tool, malnutrition status.
1&C gia:
(*): TS.BS Nguyin D S Huy, Phd Gidm &6c Trung t3m diio tao Dmh diTdng va Thtfc pham. Vi?n Dinh du'dng QuS'c gia. Email: [email protected]
(••): Benh vi^n Tai-Mfli-Hgng Tnmg Udng,
1. D3t vSfn d l
Suy dinh du'dng (SDD) ctia benh nhan ndi chung, b§nh nhi noi rieng (trong bgnh vien) hen quan tdi tang nguy ctJ mac benh, tii" vong va keo dai thcfi gian nam vien. SDD khong chi la m6t bfinh ddn thuan m4 Hfin quan tdi nhieu van de trong benh vifin, bang chttng la nhieu bfinh nhan tie'p tiic hi SDD trong thdi gian nam vifin [3].
M0t sS*nghifin cttu trfin the'gidi da siJdung cdng cu dinh gii dinh diTdng do'i tu'dng toan difin (Subjective Global Assessment) (SGA) trong danh gia tinh trang dmh du'dng (TTDD) ciia benh nhi va cho thS'y dSy 1^ cong cu dinh gia TTDD cua benh nhi d^c hieu va tin cSy, do vay du'dc ichuyen nghi ap dting cong cu nay de hd trd. bd sung cho cac phUdng phap nhan trac trong dinh gia TTDD tre em [2],[3],[4],[5].
Vl ly do tren, chdng toi tien hanh nghien cifu nay nham xic dinh thUc trang SDD tre em trong b?nh vien, so sanh diTdc ty lfi SDD cua bfinh nhi trong bfinh vifin b^ng cac phUdng phap nhan trac truyen tho'ng va phufdng phip siJdting cong cu SGA.
de luT dd hofin thifin, ip dung rgng rai cgng cu dinh gii TTDD tre em phu hdp trong benh vien.
2. PhuToTng ph^p nghidn ciJu
Thie't kfi' nghien cii'u: Nghien ctfu sti' dung phtfdng phip nghifin ctfu cat ngang, tifi'n hanh tiif thang 5-11 nam 2009 tai Khoa Nhi Benh vien Da khoa tinh Hai Difdng.
Cd mSu i/dc itfdng cho mot ty lfi [1].
ZUn. Pi^- P)
n to so taong cin diiu tra;
T (I-a/2): B$ lin c4y 95%. Z =1,96
p la ti 1$ suy dinh dUdng Irong b?nh viin Id 35 % (nghiin cifti inidc day tat Vifn Nhi Trung umg),
d Id sai so cho phip Id 5%. c^ng '^^i" 10% dif phdng, c&
mau n = 330 doi tU0ig.
Ddi tuang nghien ctfu: Chon ta't ca cic bfinh nhan nhi tCr 6 thing de'n dtfdi 60 tbing tudi mdi nh$p vien trong vdng 48 gid khdng mac cic bfinh cap linh( tieu chay ca'p. vifira dUdng hd hap cap....)
Phuang phdp nghiin ctfu vd ky thuqt thu thqp sd liiu: Cac ddi ttfdng dtfdc dinh gii TTDD khi mdi nhSp vien (trong vdng 48 gid) bang phtfdng phap nhan trac va bang cong cu SGA vdi stf trd giiip tra ldi cic thdng tin ciia ngtfdi me/ngtfdi cham sdc ciia benh nhi.
* Thu thdp, ddnh gid TTDD bang sd do nhdn trdc (can ndng, chieu cao): bang dung CIJ tifiu chuan. Can nang: can SECA difin tu" dp chinh xac 0,1 kg, can dtfdc dieu chinh, kiem tra trtfdc khi sif dung. Chilu cao: do chieu cao bang gd UNICEF vdi dp chinh xac 0,1 cm. TTDD cua tre dtfdc phSn loai theo tifiu chuan cua Td chiJc Y tfi' Thfi' gidi nam 2005. gdm SDD tha'p cdi (chieu cao/tudi), nhe can (can nang/tudi) va g^y cdm (can nang/chieu cao).
* Thu thdp, ddnh gid TTDD bang cdng cu SGA:
12 Tap chl Y te Cdng cdng, 3.2013, S6' 27 (27)
i TfiNG QUAN & NGHIEN cttu I
SGA la mdt kT thuai lam sang de danh gia SDD dtfa vao: Thay doi can nang, thay ddi khau ph^n an, cic trieu chiJng da day rupl keo dii trfin 2 man. thay doi chtfc ning vgn dgng, cac benh m^c phai va anh htfdng ciia cic stress chuyen hda, cic da'u hieu suy dinh dtfdng lam sang (mat ldp md dtfdi da, phil, cd trtfdng). TTDDdtfdc dinh gia theo 3 loai: A (tilf 11- 14 diem): dinh dtfdng binh thudng; B (6-10 diem):
SDD nhe va trung binh; C (0-5 diem): SDD nang, Phan tich thd'ng ke: Sd'lifiu dtfdc nhap vao miy tinh bang chtfdng trinh EPI DATA. Sd liej dtfdc phan tich bkng phan mem SPSS 16.0. Su^ dting cic test sang loc de danh gia tinh hdp thifc, tinh tin cay va hieu suS't ciia hai phtfdng phap, SiJ dung kiem dinh Mann-Withney U test de so sinh giiTa hai nhdm va su" diing kiem dinh khi binh phuang (Chi- Square test) dd so sinh cic ty lfi, Y nghia thdng kfi dat dtfdc vdi P value < 0.05 cho 2 phia.
3. Kd't qua nghidn cihi
Bdng 1. Ty li SDD theo SGA va nhdn trac theo
Bdng 2. Bdc diim khdu phdn dinh dUdng cua tre theo nhom tudi
« ( j l« SDD c a n nliBB hien l - , l k e l CTB + SD)
'^IZ^'"""''
S D D l h ™ S G A . n ( ' ; i S D D i h f n h c c i n n C i i l SDDI^f iri5|icAi,iii't) SDDIhj^yl:^lT:T,nl«J
N M n i l r i < 2 4 t i U u i g (nnlST)
,..:.
...
. ' i l i J M i 915.71 29(18 5) 1217,61
Nbam t r i 1 1 4 0 (hiiDe lii=ITJ)
,.=.«
9 2 4 + 9 6
89(51 41 13(7-^) 59(34.1) 1015 8)
^,.,»
ooui 0 541 0 2D3 0 374 S^ ligu irong Ifdng la trung binh d0 l?ch chudn. Gid Irj P nh4n dupc tic Chi-Square test <ho4c Fisher's exact test) cho cdc ly I?
ho$c kiem dinh Independent T- test cho hai biin djnh lupng
Bing 1 trinh bay sd'do nhan trac va ty le SDD ciia dd'i ttfdng nghien ctfu theo phtfdng phap nhan trac vl SGA. Ty Jfi SDD di/a tren cic sddo nhSn trac lan Itfpt la 6,7% (cSn/mdi), 26,7% (cao/tuoi) va 6,7% (can/cao) va khong cd stf khic bifit cd y nghia thd'ng ke khi so sinh giifa hai nhdm tudi vi cic the SDD theo cic chi sfi'nhan trac (P> 0,05). Tuy v3y, cd tdi 42,7% tre em khi nhap vien cd t J le SDD theo cdng cu danh gii SGA. stf khic bifit cd ^ nghTa thd'ng ke khi so sinh giifa hai nhdm tudi ve ty lfi SDD theo SGA (P< 0.05).
Sd'lieu trong bang la trung binh dp Ifich chuan.
Gii tri P nhan du'dc tif Chi-Square test (hoac Fisher's exact test) cho cic ty 16 hoac kiem dinh Independent T- test cho hai bie'n dinh Itfdng.
Bljc Hfm kb^D pli£n
N 5 n s luon? Uidu phan |Kc»l) T i r 6 - S i h i n e T i r 9 ^ i l ili^nE rilV<-'-Hhioz PiPieui (") Lipid (s) Glucid {£) R L r G ( « l
N h o m t r e e 24 t h d n e in=is7irrB±sn>
7 2 1 6 ± ; 3 9 1 5::i.5 £ 164 7 7 8 2 . : ± no 1 9^B : * 241 5 32 0 + 1 4 7 2 3 i + n o l ( M 4 + 7 4 : 16.6 29.5 S4.1
M i A i n t r e 2 4 - 6 0 t U i i E ( i i . l 7 3 K T B t S D )
938 1 - 2 4 1 . 5
3 9 . 2 + L l 9 24 3 + i : 6 ISO 7 1 5 5 4 16,0 22,4 61,e
Bang 2 trinh biy dac diem kh^u phan dinh dtfdng ctia dd'i ttfdng nghifin cifu theo tuoi. Nhin chung, khau ph^n cic cha't dinh dtfdng nhtf U pit, gluxit cua hai nhdm tudi khdng dat nhu cau khuye'n nghi.
Bdng 3. Mtfc gidm cdn cda tre theo nhdm tudi
Milt °iain cun
Crfl-TXjIf Gidin ars-io^
Gidm > 10^
Nh6m ae < 24 Ihdng (n:^l57) mil,Oi 46129.3) 3III9.SI
Nhom u e lir 24.60 t h i n g (11=173)
95lS4,9l ZSII6.2) 50129 01
( n - 3 3 0 i t75(53.0l 74(22.4}
Sll}4.5t P^Bke
p=a,02D
S^li^u trong bdng la n (%). Gid trj P nhiSn dUpc tit Chi-Sqmre lest (hoac Fisher's exact test) cho cdc r? 1$ hode kiem dinh Independent T- lest cho hai biin djnh lupng.
Bang 3 trinh biy mifc giim can cua ddi ttfdng nghifin cifu theo nhdm tudi, cdn tdi gin 25% tre em bi giam can tdi hdn 10 % cSn nang khi nhSp vifin, Cd stf khic bifit cd J nghia thdng kfi khi so sinh giifa hai nhdm tudi ve mifc giam cln (P< 0,05).
Bang 4. Thay ddi khdu phdn dn va thay ddi cdc chtfc ndng cda cathitheo nhom tuoi
«r.r
N - h „ . , - . < 2 4 a , * n , Nhnm u f l i 24.60 iSng c^@Thaj dli'i khiu phin KM„i!,liasdS,\
Ciam\
C i c cJiilcnBnt ciia Khdns lAnv dS: 1 Cidin
«iki JII26.I 116,-3.9,
lositus.
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4il26.0l 12111740)
I02IS9.0I 7114101
Ii6i26,h 244IT3 9)
21016361 I20'364i
f ^ v . l «
p=0,541
p.0,D41
Soli$u Irong bdng Id n (%). Gid trj P nhdn dupc lit Chi-Square test (hogc Fisher's exact lest) cho cdc ly 1$ hoifc kiim dmh Independent T- test ctto tuii biin d/nh lu<pig.
Bang 4 cho thay cd tdi gan 74% tre em khi mic benh cd giam khau phin an va cd tdi gan 37% ddi ttfdng nay bi mifc giam chtfc nang chung ciia cd thd tre khi mac benh. Khdng cd sif khic biet cd S nghia Tap chi Y ti Cdng cdng, 3.2013, Sd 27 (27) 13
ITfNGtUN&NGHIlNCIiUI
thdng ke khi so sanh giifa hai nhdm tudi ve mtfc giam khau phan va giam chtfc nang ciia cd the khi mac bfinh (P> 0,05).
Bdng 5. Xudi hi^n cdc trifu chtfng d^ day-ruQt vd thay ddi nhu cdu cdc chdt dinh di^ng khi mdc bfnh theo nhom tudi
T n ( a c M ^ l i t a l t 6 i & 1 Sbimui<U
• W d l n d u h d O i i t | thiiit<|iBl57|
Nban t r i 1 4 . M I T M ^ c ^ i g
•1>*^1 lB=nJ> (DzJN) T n ^ c t O b f dad^^-ni^
*>o-,S Co
* - | d ( . 4 , M.'SJ:,
llSiUQ, 4S26;.
" . ' , « L - 1 / 0 5 i ' / « , Tba} 6ii nhu ria dmh dJOoj!
t3^,ii«rd^
G^
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;/j((S5j(
60I3J7, 229(e9..<(
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Sd" bfu trong bdng B n (%). Gid tri P nh$n dupc tH Chi-Square test (ho^c Fisher's exact test) cho cdc ty If hode kiem dfnh Independent T- lest cho hai biin dinh lupng.
Bang 5 cho tha'y gan 32% tre em khi mac benh cd trifiu chiJng da day rudt va cd stf khac biet cd y nghia ihd'ng ke khi so sanh giifa hai nhdm mdi ve trieu chifng da day-rudt (P< 0.05). Gan 31% ddi ttfdng nay cd giam nhu cau dinh dtfdng. Khdng cd stf khac biet cd y nghia thdng ke khi so sanh giiTa hai nhdm tudi ve thay ddi nhu cau dinh dtfdng (P>
0.05).
Bdng 6. Tinh trqng viim loet miing vd nhu^c, yiu cOcda Ire theo nhom tudi
V I c H l a c t M i f a t a
l U i « < i i = l 5 7 l Ibsni iii=l'3i lii=.330) V.imk^m,ias
aidntloej Colati NbiKK. vft. cn
f3^!
Co iJ7(0J«>
10:6 41
113'': Ol W 2 S 0 i
UtiSill 29(I6.S,
12<k694, 33l.<0 Sl
29JfSS.2i 39-11.8,
::33-706- 9T29 4,
F-nim!
f=0.005
P-0.34S
So lifu irong bdng Id n (%) Gid trj P nhdn dupc ni* Cht-Square test (hoifc Fisher's exact test) ctio cdc ry If hogc kiem djnh Independent T- test cho fiat biin dinh lupng.
Bang 6 cho tha'y chi cd 1 l.S'r tre em Ichi mac bfinh cd trifiu chifng loet mieng va cd sif khac bifit cd y nghia thdng ke khi so sanh giifa hai nhdm tudi ve trifiu chifng lo6t mifing (P < 0.05). Gan 30% ddi ttfdng nay cd da'u hieu nhtfdc cd nhilbg chtfa cd sif khac biet cd y nghTa tho'ng ke khi so sinh giifa hai nhdm tudi ve bieu hien nhtfdc cd khi mac bfinh d dd'i ttfdng niy (P > 0.05).
4. Ban luan
Dinh gia nang Itfdng khau phan In vio theo phtfdng phip hdi glii 24 gid qua cho tha'y cic nhdm tre deu cd khau phan nang Itfdng an vao tha'p hdn nhu cau khuyfi'n nghi: Nhdm tre 6-8 thing tudi chi dat gan 70% nhu cau khuyfi'n nghi (756 Kcal);
Nhdm tre 9-U thing mdi dal 91.1% nhu clu khuyfi'n nghi (858 Kcal); Nhdm tre 12-<24 thang tudi chi dat 83,8% nhu cau khuye'n nghi (1.118 Kcal); Nhdm tre >24-60 thing tudi chi dat t^ 63,8 de'n 83,8% nhu cau khuye'n nghi (1,118 Kcal-1.470 Kcal) [2], Khau phan protein ctia hai nhdm ire deu cao hdn nhu cau khuye'n nghi: Nhdm tre 6-<24 thing ludi cd khau phan protein In vao 11 32g/ngly (nhu can khuyfi'n nghi 11 23g/ngay). Nhdm tre >24- 60 thang tuoi cd khau phan protein an vao la 39.2g/ngay (nhu clu khuye'n nghi la 29g/ngay) [2].
Ttfdng tlf, khau phan h pit cua hai nhdm tre thi'p hdn nhu cau khuye'n nghi: Nhdm tre 6-<24 thing mdi cd khau phan h pit an vao chi dam bao 29,2% nhu cau nang Itfdng (nhu cau khuyfi'n nghi 11 40%). Nhdm tre >24-60 thing tudi cd khau phan h pit an vao chi dam bao 22,4% nhu cau nang Itfpng (nhu clu khuyen nghi la 35 deh 40%) [2].
Cich danh gii TTDD dtfa vio cic chi so' nhan trac chl xac dinh nhtfng sd do ve can nang. chieu cao theo mdi cua ire khi mac benh ml khong tinh tdi sir thay ddi (giam can nang, giam khau phin.
giam chifc nang cua cd the...) nhtf each danh gia bang cdng cu SGA. Qua danh gii SGA, ta cd the bifi't dtfdc: Cd tdi gan 50% tre em khi nhap vien xuat hien tinh trang giam can rif >5% trgng Itfdng cd the llic binh thtfdng, ty Ifi tre giam can >5% ciia nhdm tre dtfdi 24 thing cao hdn so vdi ty le nay d nhdm tre >24 de'n 60 thing tudi. Cd tdi 3/4 sd' tre em nhap vifin cd giam khau phan an vio va cd tdi 1/3 sd'tre cd giam chifc nang ctia cd the khi nhap vien.
Ttfdng ttf, trieu chifng tifiu hda hfin quan tdi dinh dtfdng vl giam nhu clu dinh dtfdng cung xuat hifin 5 1/3 sd tre nhip vifin. Nhiing bieu hifin ISm sing niy chac chan cung gdp phan xac dinh tre cd nguy cd SDD trong thdi gian bi bfinh de tif dd cd nhiJng bifin phap phdng trinh SDD co hieu qua.
T> le SDD dtfa trfin cac sd'do nhan trac: Ty lfi SDD nhe can vl SDD gay cdm deu dtfdi 10%, rieng ty lfi SDD tha'p coi la ttfdng do'i cao (26,7%) khi so sanh giifa hai nhdm luoi ve cac the suy dinh dtfdng theo cac chi so nhan trac (P > 0,05). Ty lfi SDD ciia Ire em trong bfinh vien rat khac bifit giifa cic nghifin 14 Tap chi Y te Cdng cdng, 3.2013, Sd 27 (27)
I TfiNG QUAK & NGHIEN CUU I
Clfu: ty lfi n i y tir 2-37% theo Merritt va Suskind (1979), t^ le la 5 5 % (can/cao) trong nghien clfu cua Tienboon (1995). G i n d l y nhat, nghifin c&j cua C h a l e r m p o m Pojratsinkul tai Thai Lan cho thay ty lfi suy dinh dtfdng nhe c l n cua tre trong bfinh vifin II 29,5%. Ty lfi SDD theo cong cu d i n h g i i SGA 11 rat cao trong nghien cifu nay (42%). Ty le n i y ttfdng dtfdng vdi nghien cifu cua C h a l e r m p o m Pojratsirikul tai Thai Lan (35,9%), nhimg tha'p hdn ty Ifi n i y trong nghien ciJu ciia Tienboon n a m 1995 (51%) [4], [7],
T d m lai, khau phan nang Itfdng ciia tre em dtfdi 5 tudi thap hdn nhu cau khuyen nghi tif 10 de'n 30%, Chl'l Itfdng ctia khau p h i n khdng can dd'i. ly lfi ddng gdp cua khau phan H pit (22,4-29,3%) trong tdng
nhu c l u n a n g Itfdng chtfa dat t h e o nhu cau, T y lfi S D D t h e o d i n h gia b i n g c a c chi sd n h a n trac (can nang, chieu cao) theo tudi tha'p hdn nhidu so vdi ty le n a y khi danh g i i b a n g c d n g cu S G A .
ChiSng tdi di nghi ie'p tuc nghifin cifu trfin cd m a u ldn hdn, ket h d p tbu t h i p c a c chi s d ' h d a sinh dinh dtfdng d e x i c dinh phtfdng p h a p d i n h g i i T T D D phii hdp vdi tre e m trong b$nh vifin.
LoTi c a m tfn
C i c b i c sy v l dteu dtfdng cua Khoa Nhi, Benh vifin Da khoa tinh Hai Dtfdng d l lao d i l u kien cho nghifin cifu n i y dtfdc tridn khai thuan ldi va hifiu qua.
Tai li^u tham kbao
Tie'ng Vi$t
1, m Huy KhSi, L6 Thi Htfp. PhUdng phdp dich tl hgc dinh duang, Nha XuS't b^n Y hpc. 2012, 57-61.
2, L6 Thi H0p. Nbu cau dinh diTdng khuyd'n nghi cho ngtrdi Viet Nam, Nh^ XuS't ban Y hoc, 2004, 20-31.
3, Phgm Thu HUdng, NguySn Thi Lam, Nguyen Bich Ngoc, TrSn Chau Quyen. Nghifim Nguyet Thu. Pham Thing. Tinh trang dioh ditdng cda b$nh nhfin nhap vi$n khoa tifiu hiJa v^
n$i tifi't tai b$nh vi^u Bach Mai. Tap cbi dinh diTctng v^ thtfc phim, S£f 34-4, 2006. 85-91
Ti^ng Anh
4.Chaleinipom Rojratsrikul. Application of Generated
Subjective Global Assessment as a Screening tool for malnuuition in pediattic patients. J Med Assoc Thai 20D4;
876(8): 939-46.
5. Donna J. Seeker, Khursheed N. Jeejeebhoy. Subjective Global Nutntion Assessment for Children, Am J Clio Butr 2007;85: 1083-9.
6. Fiaccadori E. et al. Prevalence and chnical outcome associated with preexisting malnutrition in acute renal failure: a prospective cohort study, J Am Soc Nephrol, 1999 Mar; 10(3):581-93.
7. Prasong Tienboon. Nutntion problems of hospitalized children in a developing country: Thai land. Asia Pacific I Clin Nuu-(2002) ll(4):258-262.
8. Rosalind S. Gibson. Principles of Nutrition Assessment.
Oxford University Press, 1990.
T a p chl Y td Cdng cdng, 3.2013, S d 27 (27) 15
