中国老年住院患者营养状态的多中心调查研究

Nutritional status of elderly inpatients in China:a multicenter survey

目的前瞻性调查中国老年住院患者的营养状态,评估其与临床结局的相关性.方法中华医学会肠外肠内营养学分会老年营养支持学组组织中国14个大城市30家大医院,对≥65岁的老年住院患者应用营养风险筛查(NRS2002)和微型营养评定精法(MNA-SF)等方法进行前瞻、多中心和平行的调查,了解中国老年住院患者的营养状态和营养风险,总结临床结局指标,并分析营养状态与临床结局的相关性.结果本研究共纳入符合标准老年患者10184例,年龄65~112(74.81±7.01)岁,体质指数(BMI)17.80~35.50(23.32±3.83)kg/m2,利手握力为(16.95±18.42)kg,上臂围为(25.68±3.70)cm,小腿围(32.07±3.89)cm,BMI、握力、小腿围和上臂围随增龄下降明显(F=13.74、97.47、28.31、88.68,均P<0.001);有10182例患者进行了NRS2002评估,其中10.14%(895/10182)为营养不足(BMI≤18.5 kg/m^(2)),46.42%(4726/10182)存在营养风险(NRS2002≥3分),随增龄营养不足和营养风险发生率均呈明显增加趋势(F=43.41、177.05,均P<0.001);有9755例(95.79%,9755/10182)患者完成了MNA-SF检查,14.67%(1431/9755)存在营养不良、35.04%(3418/9755)有营养不良风险、50.29%(4906/9755)营养正常,随增龄营养不良和营养不良风险发生率均明显增加(F=172.79、12.10、152.42,均P<0.05).是否存在营养风险(NRS2002≥3分)与年龄、BMI、死亡率、感染并发症、住院时间和总住院费用均相关(均P<0.05).结论中国老年住院患者营养风险和营养不良的发生率均较高,存在营养风险是导致不良临床结局的影响因素.

Objective To investigate the nutritional status of elderly inpatients in China,and to assess its relationship with clinical outcomes.Methods A prospective,multicenter,parallel investigation was organized and conducted by the Chinese Medical Association's Group of Geriatric Nutrition Support.Patients aged≥65 years from 30 major hospitals of 14 cities in China were evaluated by the Nutritional Risk Screening 2002(NRS2002)and the Mini-Nutritional Assessment-Short Form(MNA-SF),in order to understand the nutritional status and nutritional risk of elderly inpatients in China.The indicators of clinical outcomes were summarized,and the correlation between nutritional status and clinical outcomes was analyzed.Results A total of 10184 elderly patients who met the inclusion criteria were enrolled in this study,aged 65-112(74.81±7.01)years,with a body mass index(BMI)of 17.80-35.50(23.32±3.83)kg/m2.Grip strength of the dominant hand was(16.95±18.42)kg,upper arm circumference was(25.68±3.70)cm,and calf circumference was(32.07±3.89)cm.BMI,grip strength,upper arm circumference and calf circumference decreased significantly with age(F=13.74,97.47,28.31 and 88.68,all P<0.001).NRS2002 was conducted on 10182 patients.Of them,10.14%(895/10182)suffered malnutrition(BMI≤18.5 kg/m^(2)),and 46.42%(4726/10182)were at nutritional risk(NRS2002 score≥3).Nutrition deficiency and nutritional risk showed upward trends with age(F=43.41 and 177.05,both P<0.001).A total of 9755 patients(95.79%,9755/10182)completed the MNA-SF.Of them,14.67%(1431/9755)had malnutrition,35.04%(3418/9755)were at risk of malnutrition,and 50.29%(4906/9755)had normal nutritional status.The incidence of malnutrition and the risk of malnutrition significantly increased with age(F=172.79,12.10 and 152.42,all P<0.05).Nutritional risk(NRS2002 score≥3)was related to age,BMI,mortality,infectious complications,length of hospital stay and total hospital cost(all P<0.05).Conclusions The incidence of malnutrition and the risk of malnutrition are high in elderly inpatients in China.Nutritional risk is an influencing factor for adverse clinical outcomes.