Established the subject of tumor nutrition in China, and put forward tumor nutrition therapy, tumor metabolism regulation therapy, three-level diagnosis of malnutrition, four-dimensional analysis of malnutrition, five-step treatment of malnutrition, H-C-H graded nutrition therapy and holistic nutrition therapy.
He is currently the Chairman-designate of Parenteral Nutrition Branch of Chinese Medical Association, the Deputy Chairman of Medical Food and Nutrition Support Branch of China Nutrition Society, and the editor and editorial board of Journal of Nutritional Oncology. He published 293 papers and edited 42 monographs, including 17. There are 29 patents, including 20 invention patents. Won the honorary title of "National Excellent Scientific and Technological Worker" and "Specialist Elite Award" in the national "Glory Doctor" public welfare selection activity.
Hello, everyone, it is a great honor to have this opportunity to come to such a podium and talk about my understanding of nutrition.
I am a gastrointestinal surgeon in the Millennium Monument Hospital affiliated to Capital Medical University, and I am also responsible for clinical nutrition. The title of my report is: "Let nutrition return to first-line treatment."
You may ask, why use this topic? I hope the following lecture can answer your concerns.
Let's first look at what malnutrition is.
The first picture, as we all know, is a comparison of Mr. Nie Weiping's photos before and after his illness.
The second is Jobs, which is also a comparison of cancer patients before and after illness.
The third is our own patient.
Through these three pictures, malnutrition is well explained, and the photos tell us what malnutrition is.
So what is the incidence of malnutrition? Everyone may think that malnutrition should disappear since our whole human race is so prosperous and developing.
Is that so? Let's take a look at this big data. The first is the data of WHO in 2006, which said that 63 million people died in the world that year, of which 36 million died of malnutrition-related diseases.
In fact, malnutrition-related deaths account for 58% of all-cause deaths, which is a very large number, and more than half of them are related to malnutrition.
The second data is the report of the World Food and Agriculture Organization in 2007, which shows that there were 930 million malnourished people in the world that year, an increase of 80 million over the previous year.
The third data is the report of WHO 20 13, which said that malnutrition was the most important cause of child death in the world that year, accounting for 45% of the total deaths.
The fourth data, this is the data of 20 15 in the United States. As we all know, the United States is the most developed country at present, so there are 48 million malnourished people, including children160,000, accounting for 654.38+03% of the total population of the United States.
According to the above data, WHO pointed out that malnutrition was, is and will be the biggest health threat and the leading cause of death for all mankind. We must fully understand the harm of malnutrition.
So, what is the harm of malnutrition?
Many of us are clinicians. The first harm we can think of is that it shortens the survival time of patients, increases hospitalization expenses and increases the mortality rate, which is the concern of hospitals and doctors.
Then economists may worry that it will increase medical expenses and the cost of the whole hospital. So to what extent has the cost increased? Let's look at a few more data:
The annual cost of malnutrition in Britain is 7.3 billion pounds, accounting for 10% of the total medical expenses.
In the Netherlands, every malnourished patient spends an extra 10000 euros a year, which is compared with patients without malnutrition.
In 2009, the direct medical expenses of malnutrition in Europe reached 3 1 100 million euros.
Based on the above clinical, economic and social considerations, malnutrition is not only a medical problem, but also an economic problem. More importantly, it is a serious social problem, so we should attach great importance to the prevention and treatment of malnutrition.
So, what is the function of nutritional therapy? Let's also look at the data and speak with the data.
First, clinically speaking, nutritional therapy significantly reduces the incidence and mortality of patients with complications, and thus improves the survival rate of patients.
Secondly, from the perspective of cost, our government and various departments are very concerned about the cost of medical insurance. How to control the total cost of medical insurance, and whether nutritional treatment saves money or spends money? There is always no clear answer, and they are all controversial.
First of all, let's look at the elderly community population in the normal population. A report in the Netherlands found that the whole elderly population in the Netherlands was divided into two groups, one group was given oral nutritional supplements, and the other group was not given any oral nutritional supplements.
Compared with the two groups, after deducting the cost of purchasing oral nutritional supplements, the overall medical expenses of the oral nutritional supplements group did not increase, but decreased by 18.9%.
Therefore, from the perspective of middle-aged and elderly people in normal population, the economy of nutritional therapy is verified.
So, do inpatients save money or spend more money? Let's take a look at the Philippton study in the United States, which is by far the largest study in the world, with 40 million inpatients participating.
It was found that during clinical hospitalization, compared with patients who took oral nutritional supplements and those who didn't, the overall hospitalization expenses of patients who took oral nutritional supplements decreased by 265,438 0.6% compared with those who didn't.
Therefore, based on the above two data, one is the elderly in the community, and the other is the inpatients, we can easily draw the conclusion that nutritional therapy not only does not waste money, but also greatly saves medical expenses. How much did you save? Medical expenses have been reduced by nearly 20%.
Therefore, in our future medical reform, we should not cut off nutritional preparations and nutritional treatment. On the contrary, we should increase nutritional therapy to save medical expenses.
I think this study can provide a reference direction for China's medical reform.
Let's take a look at the comparison of domestic and international status quo.
In the 1980s, the United States proposed that nutritional therapy is the ultimate solution to cure chronic diseases. Moreover, in 2000, Canada also put forward that nutrition is the first-line treatment and listed it as Canada's national policy.
Unfortunately, in our country today, our nutritional treatment and diagnosis have not been included in the medical fee system. Moreover, our nutritional preparations, which are often listed as reform targets, are considered as auxiliary drugs, so they have been deleted.
Let's take a look at the current situation of cancer in China.
It can be clearly seen from the above figure that China's total population accounts for 18.8% of the world, but China's cancer patients account for 2 1.6% of the world, exceeding 1/5.
What about our tumor death toll? It accounts for 26.8% of all cancer deaths in the world, exceeding 1/4. What does this mean? High incidence and low survival rate are the current situation of cancer patients in China.
So how low is the survival rate? The above data is clear. The five-year survival rate of cancer patients in China is 30.9%, 82.5% in Canada and 66.9% in the United States. It can be seen that the survival time of cancer patients in China is less than half of five years.
Then it is easy for everyone to ask, what caused it?
There are many reasons for this situation, including various problems such as cancer screening and early diagnosis, one of which is related to our nutrition.
Let's look at this data: 78% of hospitalized cancer patients in the United States have received effective nutritional treatment, while this figure in our country is only 29%. That is to say, 7 1% patients in China did not receive proper nutritional treatment during hospitalization, so more than half of the 29% patients who received nutritional treatment were irregular.
Therefore, neglecting nutritional therapy is a very important reason for the decline of the overall five-year survival rate of cancer patients in China.
I once made a prediction that if cancer patients in China can get effective nutritional treatment during hospitalization, at least the five-year survival rate of cancer patients in our country can be improved by at least five percentage points, so we should intensify our efforts.
What should we do?
First, we must do a good job in popular science.
For example, the "intestine" mentioned today is very important, which really captures the pain point of our country.
So why pay attention to popular science? Let me talk about a data. As we all know, there are many reasons for malnutrition in cancer patients. The first reason is the high metabolic consumption of the tumor itself, and the second reason is that the adverse reactions in the process of tumor treatment have not been handled in time or are not handled well.
The above reasons exist at home and abroad, but there is another characteristic in China, that is, the most important reason for malnutrition of tumor patients in China is the misunderstanding of nutrition cognition. Therefore, it is very important for cancer patients to get out of the misunderstanding of nutrition, and the significance of scientific popularization lies in this.
Then, to popularize science, we must first update our concepts and realize that nutrition is a treatment, not a support, not an aid.
Secondly, we should correct many wrong ideas. One is taboo, and the other is partial eclipse in order to starve tumors. No study has proved that nutritional therapy can promote tumor growth. On the contrary, nutritional therapy can effectively inhibit the growth of tumor, and malnutrition will make the life span of tumor patients shorter and the condition more serious.
Finally, one of the functions of popular science is to face up to hot issues, and there should be a unified official voice. For example, some time ago, some people said that red meat was carcinogenic, and some media said that milk was carcinogenic.
There must be a scientific and unified voice on these issues. It can't be said that expert A said it was carcinogenic, expert B said it wasn't carcinogenic, expert C said it didn't know, and expert D said it was possible. It's up to you. We should have an official and clear attitude towards these issues and tell our general public.
Second, we should strengthen discipline construction.
This is for us professionals.
First of all, we should unify nouns. Our country is very interesting, and the terms of nutrition are constantly changing: how many generations have we weighed, and now the individual quality has come out; We have been calling it the body mass index for many years, and now it is called the body mass index, the body mass index; We have been calling albumin for generations, and now we have an albumin.
Just like us, we called a name yesterday, today, tomorrow and the day after tomorrow. I don't know who this man is. Therefore, to unify nouns, there must be a very standardized noun, which cannot be changed frequently.
Second, pay attention to the collection of basic data. Collect data such as grip strength, steps, girth and body composition analysis. Unfortunately, there is no data from our country, all of which are from westerners. But westerners' bodies are totally different from those of us in China, so we should have our own data.
One of the important tasks of Parenteral and Enteral Nutrition Society of Chinese Medical Association in the next three years is to investigate the basic nutritional data of China people to diagnose our own malnutrition. It can't be said that it is wrong to use the standards of people in other countries to cover our diseases.
Third, standardize the treatment behavior. Graded diagnosis, step-by-step treatment and standardized treatment behavior are very important.
We all know that you are familiar with nutrition screening and nutrition evaluation now, but don't forget the third step-comprehensive evaluation.
We found risks in nutrition screening and malnutrition in nutrition evaluation, but we don't know what malnutrition has brought to the body and what harm it has caused. Therefore, the third step-comprehensive evaluation, also called three-level diagnosis, is needed.
Nutritional screening is a first-level diagnosis, nutritional evaluation is a second-level diagnosis, and comprehensive evaluation is a third-level diagnosis. This is a diagnostic problem.
Regarding treatment, we must follow the principle of gradual progress when implementing nutritional therapy in clinic. As we all know, antibiotics have a ladder, analgesic drugs have a ladder, and nutritional treatment should also follow the ladder treatment.
Our Society of Parenteral and Enteral Nutrition of Chinese Medical Association put forward five-step therapy:
The first step is nutrition education, which is a very effective and economical method;
The second step is oral nutrition supplement;
The third step is total enteral nutrition;
The fourth step is enteral nutrition+supplementary parenteral nutrition or partial parenteral nutrition;
The fifth step is total parenteral nutrition.
This ladder principle has been written into our national nutrition plan for 2030.
Fourthly, simplify the current methods of clinical nutrition assessment. For example, there is no way to evaluate appetite. Some people say yes, others say no, and they don't know how bad or good it is.
We learned to invent a numerical value: 0 means no appetite at all, 10 means the best appetite. Let the patient tick himself. Then, you should also evaluate your food intake and your satiety. 0 means completely hungry, 10 means very full. Let the patient tick.
Another evaluation is to examine the changes in food intake, which is particularly important for evaluating whether patients eat too much or eat less in the future.
We learned to design a table, and turn complex and vague problems into simple and quantitative things to deal with. Only in this way can we better solve the clinical application problems.
Third, it is personnel training.
There are two ways to train talents, one is school education and the other is continuing education.
With regard to school education, at present, clinical nutrition staff come from two directions, one is graduated from public health college or food college, and the other is graduated from medical college.
School of public health and food specialty are nutritionists, and these people can't write prescriptions without a license. Medical college graduates are called nutritionists. He has a doctor's license and can write prescriptions.
So far, no school in China is training clinical nutritionists. In America, clinical dietitians are set up as an independent major, so this is worth learning.
There is another very important thing about school education. In all medical colleges and universities, clinical nutrition should be offered as a regular course, and clinical nutrition should be chosen as a compulsory course.
Now many schools take it as an elective course, and some even don't offer it at all, so this is a very regrettable thing.
As for continuing education, it should be multi-form and multi-dimensional, with standardized teaching materials and assessment. China has made great progress in this respect in recent years.
Fourth, medical management.
Medical management must first fully understand the therapeutic effect of nutrition. From the national level, we should realize that nutrition is treatment, and it is another treatment and the basic treatment method, just like surgery, radiotherapy and chemotherapy. All treatments are inseparable from nutritional therapy, and we should have a clear understanding of this.
First, realize that it is an independent treatment, it is the basic treatment and the cornerstone of treatment.
Second, the diagnosis and treatment of nutrition should be included in the hospital's charging system, preferably covered by medical insurance.
Third, promote the construction of "hunger-free hospitals". What is "freedom from hunger" is to eliminate malnutrition in hospitals.
As we all know, hospitalized patients are light or heavy, more or less have the problem of insufficient intake, and they are all malnourished, or at risk of malnutrition.
Then, through the construction of "hunger-free hospital", patients can get good treatment, thus reducing the complications of the disease and improving the treatment effect, thus prolonging the survival time of patients and saving medical expenses. This is the purpose of building a hunger-free hospital.
Another is to promote the construction of standardized wards, and promote or encourage qualified hospitals to set up clinical nutrition wards. Our Millennium Monument Hospital is the third hospital in China with a nutrition ward.
Finally, it is necessary to lower the entry threshold of special medical food or enteral nutrition, and bring it into the hospital's charging system, which will be charged by the hospital.
Fifth, it is business.
There is absolutely no need for us to avoid this problem. Without business, we wouldn't have a happy life now. All our products and drugs are developed by entrepreneurs or scientists, and products are made by entrepreneurs.
For nutritional products, we hope that entrepreneurs can produce more and better products for clinical service, expand their sales channels, and encourage entrepreneurs to participate in the promotion of nutrition.
Therefore, I think we should do a good job in China's nutrition through the above five aspects.
Finally, make a summary.
We now call for expanding our existing nutritional therapy system from four dimensions: time, space, connotation and extension.
First, in terms of time, our traditional nutritional therapy only pays attention to hospitalization, staying at home and recuperation. Nobody cares about this problem. Therefore, we now advocate the concept of three-hour lifelong nutrition therapy, which should cover the hospital, after discharge and recovery period.
Secondly, in terms of space, we call for the establishment of the H-C-H model. What is HCH? Hospital, community, family, this graded medical system. Nutrition therapy should focus on the community. In the family, we should also participate in nutritional therapy, not just pay attention to the hospital.
Thirdly, from the connotation, traditional nutritional therapy only pays attention to people's physiological changes, regardless of whether you gain weight or not, which is far from enough. Because the harm of malnutrition is various, not only physical, but also psychological and behavioral, the effect evaluation of nutritional therapy should also include physical, psychological and behavioral aspects, so as to establish PPSS.
What is PPSS? The first physiology, the second psychology, the third society and the fourth reason are the concepts of holistic nutrition therapy.
The last one is expansion. Our traditional nutritional therapy only focuses on the treatment of diseases. Now we call for nutritional therapy to be extended to the tertiary prevention of diseases.
Primary prevention-prevention of diseases; Secondary prevention and treatment of diseases; Tertiary prevention-disease rehabilitation.
That is, nutritional therapy should go into the whole process of disease prevention, disease treatment and disease rehabilitation, so as to establish the concept of holistic nutritional therapy.
Finally, I once again call for changing the backward concept and returning nutrition to first-line treatment.
Thank you!