( NT 2013 : Nutrition Assessment )

( - White JV, et al. Consensus Statement : J Acad Nutr Diet 2012, 112(5):730-738)

/ / HN................................... ........

/ : OPD / IPD

............. cm. IBW , .. , C .. .. , Weight loss / kg. , BMI

( IBW : Ideal body weight : ; UBW : Usual body weight : ; CBW : Current body weight : )

( Patient performance status score ) ECOG 0 1 2 3 4

Karnofsky 100 90 80 70 60 50 40 30 20 10

1. -

= =

- -

[ ] [ ] [ ] TF [ ] PN [ ] Standard IV

[ ] Combination

TF : tube feeding , PN : Parenteral nutrition

< 7

[ ]

[ ]

> 14

[ ]

[ ] < 10 % ( NPO , [1] [2] [2] [3] [3] [4]

[ ] 10 - 25 % [0] [1] [1] [2] [2] [3]

[ ] 25 - 50 % [ ] [0] [1] [1] [2]

[ ] 50 - 75 % [0] [0] [1]

[ ] 75 -100 % [0] [0] [0]

2. [ ] [ ] = 0

[ ] %

%

[ ] [ ] [ ]

[ ] < 1 % 1 2 % > %

[ ] - < 2 % 2 3 % > 3 %

[ ] < 4 % 4 5 % > 5 %

[ ] < 7 % 7 8 % > 8 %

[ ] > < 10 % 10 % > 10 %

modified from Kovacevich DS. , et tal. N. risk classification in PN Handbook. A.S.P.E.N.2009 or CBW < IBW ~ 20 % : severe (EN Handbook. ASPEN.2009, p.5)

or CBW < previous 1 year BW ~ 20 % : severe (PN Handbook. ASPEN.2014, p.9)

7. ( > 3

= = = =

Stage I = 0 , II = 1 , III = 2 , IV = 3 )

= 2 , HD/PD = 3)

(Hepatic Encephalopathy = 3)

HIV + < 10% = 1-2, >10% + wasting = 3)

eg.Short bowel, .. )

= 2, = 3)

- = 2, = 3)

...................

3

8.

= = = = Stress : severity of hypermetabolism / catabolism

- Burn

Non neurological trauma , 1 2 3

Head injury , Acute spine injury ( GCS 15 = 0, 14-13 = 1, 12-8 = 2, 7-3 = 3 ) 1 2 3

Burn (minor : < 15 %; mod. : > 5 %; major : > 20 % / > 10 %) 1 2 3

Sepsis (sepsis = 1, severe sepsis = 2, septic shock = 3) 1 2 3

Recent major operation ( 1 - 2 wk. ) 1 2 3

Acut 1 2 3

Disease / Other condition (eg. MI , GI bleed , shock , severe diarrhea , EC-fistula

1 2 3

3

9. ( + 8 = 9 ) [ n ]

[ ] NT - 1 ( : 0 - 4 : - [ ] NT - 2 ( : - : - [ ] NT - 3 : 8 - 10 : - [ ] NT - 4 : > 10 :

3. ( Fluid accumulation )

- -

- 2 - - - - 2 0

; 1+-2+2 4 1

- ; 2+- 3+ 2

3+- 4+6 8 3

6 0 = 4-5 (strong) 1= 2-3 2 = 1 3 = 0 (no strength)

(Body fat loss) 0 = 1 = , 2 = , 3 =

5 (Muscle loss) 0 = , 1 = , 2 = , 3 =

[ ] [ ] [ ] [ ]

ECOG ( Eastern Cooperative Oncology Group ) Performance Status Karnofsky Performance Status Score Description Score Description

0 Fully active, able to carry on all pre-disease performance without restriction.

100 Normal, no complaints, no evidence of disease. 90 a\Able to carry on normal activity, minor signs or symptoms of disease.

1 Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light housework, office work.

80 Normal activity with effort, some signs or symptoms of disease. 70 Cares for self, unable to carry on normal activity or do active work.

2 Ambulatory and capable of all selfcare but unable to carry out any work activities. Up and about more than 50% of waking hours.

60 Requires occasional assistance, but is able to care for most of his/her needs. 50 Requires considerable assistance and frequent medical care.

3 Capable of only limited selfcare, confined to bed or chair more than 50% of waking hours.

40 Disabled, requires special care and assistance. 30 Severely disabled, hospitalization indicated. Death not imminent.

4 Completely disabled. Cannot carry on any selfcare. Totally confined to a bed or chair.

20 Very sick, hospitalization indicated. Death not imminent. 10 Moribund, fatal processes progressing rapidly.

*

* periorbital fat temporal area* M. biceps M. triceps

* subpectoral , -

(The Medical Research Council grading of muscle power)

Grade 0 3 Grade 1 horizontal 2Grade 2 vertical 1

Grade 3 vertical 1Grade 4 0Grade 5 0

: M. - M.

(Ideal body weight) = - 100 , = - (105-110)

*

M : IBW (kg) = 50 + (0.91 x (ht. in cm. - 152.4) F : IBW (kg) = 45.5 + (0.91 x (ht. in cm. - 152.4) (from : ARDS Network. NEJM. May 2000, 342 (18) : 1301- 08)

: -

: -

*

* *