上海三家长照机构600例老年人膳食摄入和营养状况研究

Dietary Intake and Nutritional Status of 600 Elderly in 3 Long-term Care Institutions in Shanghai

目的了解上海地区长期照护结构(长照机构)老年人的营养状况及膳食摄入情况,为改善老年人的营养状况提供科学的依据。方法在上海市3家老年长照机构中采用整群抽样的方法对600例65岁及以上老人,采用微型营养评定法简版(MNA-SF)进行营养状况评估和日常生活活动能力(ADL)量表进行生活自理能力评估;采用3 d 24 h膳食回顾和称重法相结合的方法调查3 d饮食摄入情况,分析评估膳食结构、能量和营养素的摄入量;空腹静脉采血检测血红蛋白、白蛋白、前白蛋白。结果 (1)受调查的老年人营养不良发生率为10.67%,营养不良风险43.67%;并且发现生活自理能力越差,营养不良的发生率越高。(2)膳食结构:长照机构老年人的膳食结构不尽合理,其中禽畜肉类95 g/d,蛋类的摄入量52 g/d,均达到推荐摄入量;谷类242 g/d接近推荐摄入量;大豆及坚果21 g/d、蔬菜类221 g/d均低于推荐摄入量;鱼虾类21 g/d、水果37 g/d、奶类65 g/d均远低于推荐摄入量。(3)能量和营养素摄入情况:能量(男性1 652.9 kcal/d,女性1 498.8 kcal/d)、蛋白质(男性56.9 g/d,女性52.9 g/d)、钙、铁、硒、锌、维生素A、维生素E、维生素B1、维生素B2、维生素C均低于推荐摄入量,其中钙、膳食纤维的摄入严重不足。(4)本次调查贫血发生率为61.3%,低白蛋白血症发生率为26.5%;低前白蛋白发生率为36.3%。结论长照机构老年人膳食结构不尽合理,能量、蛋白质和多种微量营养素摄入不足,营养不良及营养风险发生率高,应引起重视。

Objective To investigate the dietary intake and nutritional status in elderly people in 3 long-term care （LTC） institutions in Shanghai so as to provide scientific basis for improving the nutritional status of the elderly. Methods Mini nutritional assessment （MNA-SF） and daily living activity （ADL） scale were applied to 600 elderly people over 65 years old in 3 LTC institutions in Shanghai to assess their nutritional status and self-care ability; 24-hour dietary recall method for 3 consecutive days combined with weighing method was used in the investigation of dietary intake of the 3 days and the die-tary patterns, energy and nutrient intake were analyzed; fasting venous blood was collected for the detection of hemoglobin, albumin and pre-albumin. Results （1） The incidence o f malnutrition among the elderly surveyed was 10.67% while the risk of malnutrition was 43.67%; the poorer the self-care ability was, the higher the incidence of malnutrition went. （2） The dietary pattern of the elderly people in LTC institutions was not quite reasonable; the daily intake of 95 g livestock meat and 52 g eggs reached the recommended levels; the daily cereal intake was 242 g, close to the recommended intake; the daily intake of soybean and nuts was 21 g and the daily intake of vegetables was 221 g, which were lower than the recommended levels while the daily intakes of fish and shrimp was 21 g, that of vegetables was 37 g and that of milk was 65 g, which were much lower than the recommended amount. （3） Energy intake was 1 652.9 kcal/d in male and 1 498.8 9 kcal/d in female and protein intake was 56.9 g/d and 52.9 g/d in male and in female respectively; the intakes of calcium, iron, zinc, selenium, vitamin A, vitamin E, vitamin Bl, vitamin B2 and vitamin C were all lower than the recommended levels, the intakes of calcium and dietary fiber were significantly insufficient. （4） The incidence of anemia was 61.3%, hypo-albuminemia 26.5 %, and low pre-albumin 36.3%. Conclusions The dietary pattern of the elderly in LTC institutions is not rational, the daily intakes of energy, protein and most of the micronutrients are lower than the recommended levels, malnutrition incidence and nutritional risk are high, which should be given more attention.