微型营养评估简表在老年慢性病住院患者营养筛查中的应用

Application of mini nutritional assessment-short form in nutrition screening inelderly inpatients with chronic diseases

目的评价新版微型营养评定简表(MNA-SF)在老年慢性病住院患者营养状况评估中的应用价值。方法选取2016年3月至2018年5月在成都市老年康疗院住院、年龄≥65岁的老年患者2 861例,在入院后48 h内用新版MNA-SF进行营养筛查。采用克朗巴赫系数α评价MNA-SF的信度;采用Kaiser-Meyer-Olkin(KMO)和巴特利特球形检验分析评价MNA-SF的效度。根据MNA-SF评分将患者分为营养正常组(n=319)、营养不良风险组(n=1 046)及营养不良组(n=1 496),比较3组患者营养相关指标差异。用受试者工作特征(ROC)曲线分析量表对营养状况的预测。采用SPSS 22.0软件进行分析,组间比较采用方差分析、LSD-t检验、秩和检验或χ2检验。结果老年慢性病住院患者营养不良发生率为52. 3%(1 496/2 861)。MNA-SF量表的克隆巴赫系数为0.711,表明MNA-SF量表的信度较好。KMO值为0.827,可以进行因子分析;巴特利特球形检验χ2=27. 616(P<0.05),得出球形假设被拒绝,适合进行因子分析。MNA-SF量表中7个因子[饮食变化、近3个月的体质量减轻情况、活动能力、应激或急性疾病情况、神经精神疾病、体质量指数(BMI)、小腿围(CC)]的特征值均大于1,且累计方差贡献率达到83. 14%,表明该量表效度合理。营养正常组、营养不良风险组及营养不良组患者的年龄呈趋势性增加,BMI、CC、血清白蛋白、前白蛋白、转铁蛋白及血红蛋白呈趋势性降低,差异均有统计学意义(P<0.05)。ROC曲线显示,预测老年慢性病住院患者营养状况的最佳截断点为10分,其灵敏度为78.93%,特异度为83.59%,曲线下面积为0.797(95%CI 0. 781～0. 811,P<0.05)。结论新版MNA-SF适用于老年慢性病住院患者的营养评估,老年慢性病住院患者营养不良发生率较高,应当尽早进行营养干预。

Objective To evaluate the new mini nutritional assessment-short form(MNA-SF)in the assessment of nutritional status in the elderly inpatients with chronic diseases.Methods A total of 2 861 elderly patients aged 65 or older were selected in this study,who were hospitalized in Chengdu Elderly Care Hospital from March 2016 to May 2018.All the patients were assessed with the MNA-SF within 48 h after admission.Cronbach coefficientαwas used to evaluate reliability of MNA-SF,and Kaiser-Meyer-Olkin(KMO)and Bartlett spherical test to evaluate its validity.According to MNA-SF score,the patients were divided into normal nutrition group(n=319),malnutrition risk group(n=1 046),and malnutrition group(n=1 496).The three groups were compared in nutrition-related indicators,and the nutritional status was predicted with the receiver operating characteristic(ROC)curve.SPSS statistics 22.0 was used for analysis.ANOVA,LSD-t test,rank sum test orχ^2 test was used for comparison.Results The incidence of malnutrition was 52.3%(1 496/2 861)in the inpatients with chronic diseases.Cronbach′s alpha of the MNA-SF was 0.711,showing a good reliability.KMO value was 0.827,indicating that factor analysis could be performed.Bartlett′s spherical testχ^2 was 27.616(P<0.05),and the spherical hypothesis was rejected,indicating that factor analysis was possible.The eigenvalues of seven MNA items[dietary change,weight loss in recent three months,activity ability,stress or acute disease,neuropsychiatric disease,body mass index(BMI),calf circumference(CC)]were all greater than 1,and the cumulative variance contribution rate was 83.14%,indicating a reasonable validity of MNA-SF.The age of normal nutrition group,malnutrition risk group and malnutrition group tended to increase,while BMI,CC,albumin,prealbumin,transferrin and hemoglobin tended to decrease,with statistical significance(P<0.05).ROC curve showed that the best cut-off point for predicting nutritional status of the elderly inpatients with chronic diseases was 10 points,with a sensitivity of 78.93%,a specificity of 83.59%,and an area under curve of 0.797(95%CI 0.781-0.811,P<0.05).Conclusion MNA-SF is applicable for nutritional assessment of the elderly inpatients with chronic diseases.With a high incidence of malnutrition,nutrition intervention in the elderly patients with chronic diseases should be implemented as soon as possible.