Khac Minh. Dinh duong trong phong ngua....pdf

7/26/2019 Khac Minh. Dinh duong trong phong ngua....pdf

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THI KHC MINH

PH GIO S

TIN S

DC S

i hc Y Dc TP. HCM

Vit Nam


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DINH DNG TRONG

PHNG NGA V IU TR SUY MN

BNH NHN UNG TH

Thnh PhHCh Minh 19/5/2016

PGS. TS. DS. THI KHC [email protected]

ihcY DcThnh PhHCh Minh


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ihcY DcThnh phHCh Minh

ng ming

ng thng qua d dy

ng thng qua rut (Enteralduodenal/jejunal)

ng thng vi lng nh v tim truyn

Tim truyn ton phn

Cch cho ntt nht


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Tstcn n suy mn do ung th Dinh dngy hcchuyn bitcho

bnh nhn ung th Tngkt

Tng quan


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Tng quan


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Stcn thngphbin:30-80% bnhnhn ung th

Bozzetti 2008 and 2001; Bosaeus 2001Laviano A, Meguid MM. Nutrition 1996;12:358-71


8/60

Suy mn do ung th

@20%bnhnhn ung thchtdo suy mn (suydinh dngv mtc).@50% bnhnhn michnonung thc tnhtrngbingn.

30-80% bnhnhn ung th c st cn-Bnhl ung th(loi, giai on)- iutr

- Tui- Khnngnhycmcac nhn- Cng cnhgi

Nutrition; 12: 358-371, 1996


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Stcn bnh nhn ung th

Caro MM, Laviano A, Pichard, Clin Nutr 2007

Ung thGimlngthcn

Tm l cngthngaun

BingnRilonvgicKh nut

Bunnn v i maChngbngv to bn

Tiu chyv rilonhpthu

Thay ichuynha

TngnnglngChuynha cbn

Cytokin tinvim,neuropeptides,

Hormon

Carbohydrate:- Tngglucose- Khng Insulin

Chtbo:- Tngphn hychtbo- Mtcn bnggiato

v phn hylipid- Tngoxy ha lipid- Tnglipid huyt

Protein:- TngCRP

- GimProtein cbp- Cn bngNitm

Caro MM, Laviano A, Pichard, Clin Nutr 2007


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Stcn nng: gimthigian sngcn

Ann Oncol. 2011, 22(4):835-41.


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Stcn dnnktquiutrkm bnhnhn ung thngtiu ha

51% 49%cn nng bstcn

nnh

QoL score (0-100) 76 59 p


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Stcn l yuttin lngclpchossngcabnhnhn K phikhng tbo nhNSCLC

Bnhnhn K phikhng tbo nhcstcn thngkhng hon tt3tha tr

Dliucly bnhnhn giai onIII/IV NSCLC


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Cn nngnnhtrong ha trgpphnko di ssng

Dliucly bnhnhn giai onIII/IV


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Ha tr liu tiu chun v cc tr liu ung thkhc lm tng tnh trng st cn do ung th

+

CarmustineCarboplatinCisplatin5-Fluoruracil

DoxorubicinPaclitaxelSoraf inib

Everol imus

Radiat ionSurgery

Gimcn khi btuiutrung thlin quan vigimtlpngvtngctnh cathucv l mttiu ch quan trngtrong theo di tcdngphcatrliu.

US Dept Health and Human services NIH, NCI: CTCAE v4.0


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Tc dngphthnggpiutrung th

= iutrc tc dngphthnggp

iutr Stcn Mtmi Bunnn

Vimnimmc

ming

Thay ikhuv

To bn

Tl% 50% -

90%

70% -

100%

30% -

90%

40% -

100%

35% -

70%

40% -

50%

Ha tr

XTr

Phuthut

Liuphp

mindch


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Suy mn ung th (Cancer Cachexia)

Suy mn ung thcnhngha l mthichngc trngbis mt lin tc khi c

xng(c hay khng c km mtkhim) m

n skhngchiphchon ton bihtrdinh dng thng thng, din tin n suychcnng.

V mt bnh hc: cn bng nng lng vmmdo phihpca2 yutl- Gimcung cplngthcn(ngim); v- Chuynha btthng.

Fearon K et al. Lancet Oncol 2011; 12:489-495


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Cnpht hinsmduhiustcn!

Bnhthng

Tinsuymn

Stcn 5%BMI2% hayHC. Suy mn vst>2%

Thngnungkm/ vim tonthn

Mcsuy mn adngBnhung th: dha vkhng pngviiutrung thimchsthchtthp

Tin lngsngcn


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Tiu chunbtbuc

Stcn 5%/ tia

12 thng

(HocBMI


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Dinh dngcho bnhnhn ung th


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Can thipdinh dng

Smtrong tinsuy mn v suy mn

iutrngch(am thc):iutrung thchiu(phuthut, ha, xtr)iutrphihpnhgimau, nn

iutrdinh dng:Cithincung cpdinh dngbnhnhniuha pngchuynha lin quan vim (dngchtcbit

v thuc)Vnngcth(exercise ikhng- Resistance exercise)


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Dinh dngcho bnhnhn ung th

dinh dng

Cng thciuha chuynha

ChnPP dinhdngthch hp

Bsung DD ngming DD qua ngthng DD tnhmch(PN)

NL: 25-30kcal/ kg/ngy m: 1,2-1,5g/ kg/ ngy

(max 2g) 50% NL khng tm

Acid bo omega 3 Thuc(khng vim, ni

titt)

ESPEN Guideline 2006- 2009; ASPEN Guideline 2009


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Chnphngphp dinh dngESPEN Guideline 2006- 2009; ASPEN Guideline 2009

C chnhcan thipDD

TvnDD:

Bsung DD quangming(sip feeding)

Dinh dngquangthng(Tube feeding)

Dinh dngqua

tnhmch(Parenteralnutrition)


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Trong xhay ha x tr: Tvndinh dng tch

ccv bsung dinh dngqua ngmingtngkhuphnnv phng ngastcn do iu

trv ngnngagin oniutr(Grade A)

tsonde nui nnuung thu, mtc, thc

qun gy tc nghn hoc nu c th tin lng

cvim nim mckhu tr (Grade C)

Chnphngphp dinh dngESPEN Guideline 2006- 2009; ASPEN Guideline 2009


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Bn SDD hay iko di >1 tunv khng thdng DDqua sonde (Grade C)

Bn vim nim mchay vim rutxtrnng(Grade C)

Bsung DDTM khi tin lngkhnngnunghay DDqua sonde


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Tng quan


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Chng ta cho bnhnhn nnhthno??

Can thipbngdinh dngtheo cch thngthngtchiuqugiihn

Cc snphmdinh dngngungtiu chun

Cho nqua ngthngDinh dngtim truynton phn

Can thipbngdinh dngtheo cch thngthngkhnggiiquytccchtimncagimcn trong ung th


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Chng ta cho bnhnhn nnhthno??

Can thipbngdinh dngtheo cch thngthngkhnggiiquytccchtimn

cagimcn trong ung th


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Tngcung cpdinh dngnthunKHNG c hiuqu

2

1.5

1

0.5

0

0.5

1

1.5

2

0 1 2 3 4 5

ctvn

i chng

Chang

einWeight(kg)

Tng lng nng lng np vo khng b tr c

nhng thay i chuyn ha dn ti suy mn.

Time (months)

105 bnhnhn ung thphitbo nh, bungtrnghocung thv.Tngcalo ln 1,5-1,7 lnREE.tngdung npngk, nhng tngcn khng ngk


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70% c thay i v gic (TA) trong ha tr& cctriu chng khng gim sau ha trnhiuthng

Ung th phi 54% Nghin cu gia ngy 0 v 30 ca CTUng thtuyn ty 19%Ung thi trc trng 26%Tui: 65 nm; Nam 57%

N=197

Thay ivgic theo thigian

Zabernigg et al, Taste alterations in in Cancer

Patients receiving Chemotherapy,The Oncologist CME program 2010


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Lin quan gia thay i v gic v chtlngcucsng(QoL)

Zabernigg et al, 2010

Thay ivgic lin quan ng kvi:

- Mt cmgic thm n

- Mt mi

- Bun nn/ i ma

- Chc nngnhn thc


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Thch thc trong vic nung

Thay i v gic thng gp nhng bnh nhn ung th dobnh tt v / hoc iu tr

68 % bnh nhn ha tr liu c thay i vgic1:

- Mi v thc n gingba cacton hoc giy nhm- Qu mn

- Qu ngt- Qu chua- Qu cay ng- V kim loi

1 Wickham et al, 19992 Ijpma et al, Cancer Treat Rev 2014

T lc v kim loi dao ng 9,7- 78% ty loiung th, phngphp hatr, v giai on iutr 2

Carbohydrat: trehalose


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Ngibnh

ung th

pngmindchivikhiung th:snxutcytokine vim nhIL-1, IL-6,

TNF-, INF gama

cmgicthm n

pngproteinpha cp(CRP)

nung REE (tiu hao NLlc ngh)

Btthngchuynha ng, m,

bo

Hichngsuy mn ung th

Khiung

th

Cc yutdha

chiuu (PIF, LMF)

Phn hyc, m


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Ung th

ngha >>> DhaNgibnh:

Dha >>> ngha

Khng bingibnhung

th!Cancer cachexia


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Ngibnh

ung th

pngmindchivikhiung th:snxutcytokine vim nhIL-1, IL-6,

TNF-, INF gama

cmgicthm n

pngproteinpha cp(CRP)

nung REE (tiu hao NLlc ngh)

Btthngchuynha ng, m,

bo

Hichngsuy mn ung th

Khiung

th

Cc yutdha

chiuu (PIF, LMF)

Phn hyc, m

EPA

EPA


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Bsung EPA (-3) bo c thgip nnhcn bnhnhnung thc chnungtngcng, stcn khng ch.


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LiuEPA cho bnhnhn ung th

< 2 g EPA/ngy: KHNG HIU QU2 g EPA/ngy : LIU TI U6 g EPA/ngy : KHNG HIU QU HN 2g

Liu2g/ngy EPA l thch hp gip nnhthtrngbnhnhn, yli stcn dnnsuy mn

Khuynco cahidinh dnglm sng Hoa K(ASPEN):


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Bsung EPA: cithincn nngv hotngcth bnhnhn ung ththcqun

0

20

40

60

80

100 Active

Control

*p < 0.05

Improved Stable Worsened

ChangeinECOG

score(%o

fpat

ients)

Active Control

0.00

0.25

0.50

0.75

1.00

1.25

1.50

1.75

*p < 0.05A

Bodyweightchange(kg)

Thay i cn nng im s nh gi hot ngPerformance score

J Cachexia Sarcopenia Muscle. 2015 , 6(1):32-44


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Overall survivalTime to progression

Tngcngktquha trbngFEC 75cho bnhnhn ung thv di cn

Nghin cumcpngv an ton: 1,8 gr DHA l khng c tc dng ph v ci thin kt qu ca ha tr liu khi

dng liucao kt hp

KthpviDHA liucao (n=12) cho thytlpngiutrv kh

nngsngst cao hnso vinhm kt hpDHA liuthp(n=13)Bougn oux et al., Br J Cancer 2009

i hc Y Dc


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Suy mn do ung thv 3

Gut. 2003 52(10):1479-86.

i hc Y Dc


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Eur J Clin Nutr. 2012, 66(3):399-404

i hc Y Dc


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Khng lm gimnguy ctvong

Can thipdinh dng bnhnhn ung thsuy dinh

dng: tngquan hthngv nghin cugp

J Natl Cancer Inst. 2012;104(5):371-85

Oral nutritional interventions and

mortality meta-analysis.

i hc Y Dc


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Cithinchtlng

sngcn


Oral nutritional

intervention and global

quality of life

metaanalysis

i hc Y Dc


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Gip bnhnhn tng

cn


Oral nutritional

interventions and

weight gain meta-

analysis.

i hc Y Dc


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T st cn n suy mn do ung th

FortiCare cung cp hm lngcao protein v du c(n -3 EPA)

n -3 EPA gip gimsuy mn, gim vim vh

tr chc nng min dchNng lng v protein pngnhu cu giatng bnh nhn ung th

Hngvthch hp, khi lng nh (gip tngs

tun th)


46/60

Nghin cutiVitNam

Nghin cungdng lm sng, ngunhin c nhm chng

trn 60 bnhnhn

Stcn trung bnh 3,3 kg/thng trckhi vo nghin cuBnhnhn ung thitrctrng c suy dinh dng, suy mn theobngnhgi SGA tnh trngC (cn nng, chn n, teo c):

St> 5% cn nngtrong 6 thng qua,

Teo ctuhoccdenta,Mtlpmdida ctam uhocvngxngsnditiimgiavng nc

+ Tiu chun loi:Khng st cn trn hoc bng 3,3 Kg/thng hoc khng c du hiu suy mnSuy cc chc nng gan, thn, bnh ni tit chuyn ha. Thiu 1 phn c th ( ct

tay, chn ) .

a im:Khoa ngoi C Bnh vin K.Trung tm dinh dnglm sng BnhvinBchMaiKhoa ung bu v chm sc gim nh , BV HY H ni

Thi gian: thng 12/2012 6/2015


47/60

Nghin cutiVitNam

iu tr phc EPA (2g/ngy) gip bnh nhnung thitrctrng chnggimcn v suy mn:tngtrnglngtrung bnh camibnhnhn ln3 kg sau 8 tuniutr.

iutrEPA gip bnhnhn ung thitrctrng tngprotein cac th, ngnngasging ha protein cac th: Bnh nhn c tng chu vi vng cnh tay; tngnngAlbumin trong mu sau iutr(40,4 so vitrc

can thipl 29,0 g/l).Can thip dinh dng b sung EPA gp phn ci thincht lng sng cho BN UTTT: 100% BN c cm gicngon ming, bnhnhn tngtrung bnh 3 kg , tngkch

thcchu vi vng cnh tay, cithinAlbumin mu.


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Nghin cutiVitNam

Phc iutrEPA cho bnhnhn ungthitrctrngLiulng: iutrlin tc

Protein trung bnh 1,51,7g/kg/ngy

Nnglngtrung bnh 35 Kcal/kg/ngyEPA 2g/ngy

Kinngh: EPA nn cavo trong iutr

nhngBN stcn do UTTT v dphng suymn v chmsc gimnhtrong UTTT giaionmun


49/60

Hiu qu ca iu tr bng EPA trongdinh dngbngngungphthucvo s tun th ca bnh nhn. Bn

cnhvicchn n, victun thiutrcabnhnhn vidngdinh dngcaonnglng, cao protein v bsung EPAbgiihnbiv thngxuyn gpphimi vkh chu(caduc).V vy, viccn thit l ci thin thin tnh ngonming, dchucadngdinh dngbsung EPA ci thin s tun th cabnhnhn viiu trv mang lihiu

qutrliu.

i hc Y Dc


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Thc n m khngcn th khngbao gi l dinh

dng!Prof Jeya Henri

i hc Y Dc


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ihcY DcThnh phHCh MinhCC CCH CUNG CP

> 2 GRAM EPA/NGY

nlnglnmc C trch, c ng, c thu, c mi,

Vin duc

Dngsakthpgiadinhdngvi lngv alng

ihcY Dc


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c cThnh phHCh Minh

FORTICARE: CCH TINLICUNG CPDINHDNGQUAN TRNGCHO BNHNHN UNG TH

Dinh dngchuyn bitcho bnhnhn ung th:

Dinh dngiutr

Nnglngcao

Hm lngprotein cao

Hdinh dnghon chnh

ChsGI thp

Thtch nh

nhtthp

Bsung nhiuEPA

Hngvtuytvi

p ng nhu cu bnh nhn mt cch


53/60

p ng nhu cu bnh nhn mt cchthun tin

Nhu cu cth Stin liKhi lng nh

Dinh dnghon chnhCn bng

nht thp

Hng v ph hp

Nnglng caoGiu protein

Protein chtlngcaoCht dinh dngv m

Vi chtEPA (200 g c trch

2 con c trch/ ngy 2.2 gr EPA/ngytrong FortiCare

=

Cht x

ihcY Dc


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Thnh phHCh Minh

Chnh: Bnhnhn ung th, suy mn do ung th Bnhnhn suy dinh dng, nkm, chn n itngcnnhu cudinh dngcao Bnhnhn cntngcn chunbphuthut; Bnnhn huphu, kcphnc thai, sinh con Sdngccho bnhitho ng, tngng

huyt. Bnhnhn tiungcnchia nhban.

Liudng: ty theo nhu cubnhnhn Bsung dinh dng: 1-3 chai/ngy. Bnhnhn ung th: tithiu3 chai/ngy

Chngchnh: Trem di3 tui, dngthnh phn

ihcY DcH TR DINH DNG VI


55/60

Thnh phHCh Minh

EPA PH HP CHO BNHNHN UNG TH

Ti sao: ci thin kt qu ca iu tr ung th v nng

cao cht lng cuc sng cho bnh nhn.

Khi no: Kim sot tnh trng dinh dng ca mi ln chn on ung thv la chn can thip tt c cc giai on ung th.

Nh th no: H tr dinh dng chuyn su vi cc cht dinh dng ph hp

v iu ha chuyn ha mt cch nhanh chng tin li v ngonming (kch thch v gic).

Th so snh gi tr


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Thso snh gi tr

=

=

+ +

(BS. LmcHongBnhvinUng buTPHCM)
http://www.google.com/url?url=http://websosanh.vn/loa-the-nho-hinh-bao-thuoc-marlboro/1067122918/so-sanh.htm&rct=j&frm=1&q=&esrc=s&sa=U&ei=d3egVe2GCc2JuATJopeoDg&ved=0CB4Q9QEwBDgU&sig2=2Q9ONbxzUvAqJW3oXIR2rg&usg=AFQjCNFuQthaFMrGYUsPGH7BHL-vto6OPghttp://www.google.com/url?url=http://donavi.com.vn/hai-san/dau-ca-hoi-tuoi-1414.html&rct=j&frm=1&q=&esrc=s&sa=U&ei=OXigVY2QOpGTuASWtrO4AQ&ved=0CBYQ9QEwAA&sig2=BomPxWpF-mB1VbUNo5EGdw&usg=AFQjCNFSzdUxFpaxzC3CimV5ggqTP-tsIQhttp://www.google.com/url?url=http://websosanh.vn/loa-the-nho-hinh-bao-thuoc-marlboro/1067122918/so-sanh.htm&rct=j&frm=1&q=&esrc=s&sa=U&ei=d3egVe2GCc2JuATJopeoDg&ved=0CB4Q9QEwBDgU&sig2=2Q9ONbxzUvAqJW3oXIR2rg&usg=AFQjCNFuQthaFMrGYUsPGH7BHL-vto6OPghttp://www.google.com/url?url=http://www.hamruou.net/bia-nhap-khau/chi-tiet/Heineken-ha-lan_355.html&rct=j&frm=1&q=&esrc=s&sa=U&ei=qnSgVZnQIs62uQTUxLnIAg&ved=0CB4Q9QEwBA&sig2=-SMg5rP_MTXuDcQtR7V45w&usg=AFQjCNGCVvrGO-E-h2fu9NU6h4OqVIKC4Q


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Tng quan

Tng kt: Dinh dng cho


58/60

Tngkt: Dinh dngchobnhnhn ung th

Cnpht hinsmduhiustcn, suy mn do ung thttccc giai on.

Suy mn ung thnhhngnktquiutr(pngkmiutr),tnggiihn liuc, liu lngiutr t hn, gin

oniutr Dinh dngthng thngkhng giiquytccchtimn

gy suy mn trong ung th

Dinh dng giu nng lng, giu m v b sung EPA liu2g/ngy.

Mi vv stun thiutrdinh dngbsung Tngnghuytl phbincc bnhnhn ung thv cn

sdngmtsnphmph hpviGl thp

ihcY Dc


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Thnh phHCh MinhHy thucl thcphmv thcphml thuccacon ngi.

Hippocrates of Cos, Greece

460-377 B.C.

ihcY Dc


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Thnh phHCh Minh

CM N S CH LNGNGHE CA QU V!

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Khac Minh. Dinh duong trong phong ngua....pdf