握力指数在社区老年人营养不良筛查中的应用价值

The value of Handgrip strength index of the elderly as a predictor of malnutrition risk in a community

目的:通过评价社区门诊老年人的营养状况,探讨握力指数在社区老年人营养筛查中的应用价值。方法:2017年6月至8月在上海市华阳街道社区卫生服务中心,采用定点连续抽样的方法对门诊65岁以上老年人进行微型营养评估短表(mini nutrition assessment-short form,MNA-SF)的问卷调查,同时测定身高、体重、小腿围和握力。握力指数=握力(kg)/身高2(m^2)。结果:(1)共有1 276名老年人完成有效调查,其中MNA-SF≤11分(即营养不良风险) 104人,营养不良风险发生率8. 15%。与营养正常组[(9. 57±2. 43) kg/m^2]比较,营养不良风险组的握力指数明显降低[(8. 31±2. 45) kg/m^2,P=0. 000]。相关性分析显示,握力指数与年龄、BMI、小腿围和MNA-SF评分相关(r分别为-0. 337,0. 160,0. 298,0. 194,P值均为0. 000)。将自变量小腿围、BMI和握力指数与应变量MNA-SF进行多元线性回归分析,结果显示BMI和握力指数可预测MNS-SF评分,模型为MNA-SF评分=6. 895+0. 042×握力指数+0. 229×BMI。(2)选取MNA-SF> 11分的104例老人,按照性别和年龄与MNA-SF≤11分的老年人进行配对t检验,结果显示,营养不良风险组的握力指数为[(8. 31±2. 50) kg/m^2],仍然显著低于营养正常组[(9. 78±1. 89) kg/m^2,P=0. 000]结论:社区营养不良风险老年人的握力指数显著降低,握力指数可作为社区老年人营养筛查的参考指标。

Objective:To evaluate the value of handgrip strength(HS)index in malnutrition screening for the elderly in a community.Methods:From June to August 2017,at the Huayang Community Health Service Center in Shanghai,we conducted a mini nutrition assessment-short form(MNS-SF)questionnaire based survey in elderly outpatients by fixed point continuous sampling method.Meanwhile,height,weight,calf circumference,handgrip strength were measured.HS index=Handgrip Strength(kg)/height2(m2).Results:①Atotal of 1 276 elderly people completed questionnaires and 104 people had an MNA-SF score of less than 12 points.Malnutrition risk rate was 8.15%.The difference in HS index between the malnutrition risk group and the normal nutrition group was statistically significant[(8.31±2.45)kg/m2 vs(9.57±2.43)kg/m2,P=0.000].There was significant correlation between HS index and age,BMI,calf circumference and MNA-SF score(R=-0.337,0.160,0.298,0.194,P=0.000).Multivariate linear regression was performed with leg calf circumference,BMI and HS index as the independent variable and MNA-SF as the dependent variable,it was found that MNA-SF Score=6.895+0.042 X HS index+0.229 X BMI.(②One hundred and four elderly people with MNA-SF greater than 11 points were selected and the parameters were analysed by paired-test by gender and age,the results showed that there were still statistical differences betw^een the two groups in the grip strength index[the malnutrition risk group us the normal nutrition group:(8.31±2.50)kg/m2us(9.78±1.89)kg/m2,P=0.000].Conclusion:The grip strength index of the elderly with malnutrition risk were lower,grip strength index could be used as a reference indicator for nutrition screening for the elderly in the community.