入院时营养不良的促使因素及其对住院时间的影响
在医院里，住院时间至关重要，但是可能被营养不良延长。为了明确入院时营养不良促使因素及其对住院时间的影响，多伦多大学、滑铁卢大学、坎贝尔顿地区医院、曼尼托巴大学、阿尔伯塔大学、舍布鲁克大学、麦吉尔大学、圭尔夫大学、加拿大营养学会、多伦多大学医疗网络对18个加拿大医院2010年7月～2013年2月、年龄≥18岁、入院≥2天的1015例住院患者开展了前瞻队列研究。排除直接收入重症监护病房、产科、精神病科、姑息治疗科、体检科的患者。入院时，主要营养评价采用主观全面评定（SGA）。同时体重指数和握力也被用于评价营养其他方面。其他信息来自患者和住院病历回顾获得。
结果发现，根据SGA有45%（95%置信区间：42%～48%）存在营养不良，根据体重指数有32%（95%置信区间：29%～35%）为肥胖。入院时营养不良的独立促使因素包括：查尔森合并症指数＞2、存在3种诊断类别、依赖成年子女购买食品、独居。中位住院时间为6（范围：1～117）天。排除人口统计学、社会经济学、疾病相关因素以及治疗等因素后，入院时营养不良是住院时间延长的独立相关因素（风险比：0.73，95%置信区间：0.62～0.86）。其他与住院时间延长有关的营养相关因素包括：入院时握力较低、接受营养支持、食物摄入量＜50%。肥胖不能成为预测因素。
因此，入院时营养不良普遍，并与住院时间延长有相关性，复杂疾病和年龄相关性社会因素也是促使因素。
JPEN J Parenter Enteral Nutr. 2016;40(4):487-97.
Malnutrition at Hospital Admission-Contributors and Effect on Length of Stay: A Prospective Cohort Study From the Canadian Malnutrition Task Force.
Allard JP, Keller H, Jeejeebhoy KN, Laporte M, Duerksen DR, Gramlich L, Payette H, Bernier P, Vesnaver E, Davidson B, Teterina A, Lou W.
University of Toronto, Toronto, Ontario, Canada; University of Waterloo, Waterloo, Ontario, Canada; Campbellton Regional Hospital, New Brunswick, Canada; University of Manitoba, Winnipeg, Manitoba, Canada; University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada; Université de Sherbrooke, Sherbrooke, Québec, Canada; McGill University, Montréal, Québec, Canada; University of Guelph, Guelph, Ontario, Canada; Canadian Nutrition Society, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada.
BACKGROUND: In hospitals, length of stay (LOS) is a priority but it may be prolonged by malnutrition. This study seeks to determine the contributors to malnutrition at admission and evaluate its effect on LOS.
MATERIALS AND METHODS: This is a prospective cohort study conducted in 18 Canadian hospitals from July 2010 to February 2013 in patients ≥ 18 years admitted for ≥ 2 days. Excluded were those admitted directly to the intensive care unit; obstetric, psychiatry, or palliative wards; or medical day units. At admission, the main nutrition evaluation was subjective global assessment (SGA). Body mass index (BMI) and handgrip strength (HGS) were also performed to assess other aspects of nutrition. Additional information was collected from patients and charts review during hospitalization.
RESULTS: One thousand fifteen patients were enrolled: based on SGA, 45% (95% confidence interval [CI], 42%-48%) were malnourished, and based on BMI, 32% (95% CI, 29%-35%) were obese. Independent contributors to malnutrition at admission were Charlson comorbidity index > 2, having 3 diagnostic categories, relying on adult children for grocery shopping, and living alone. The median (range) LOS was 6 (1-117) days. After controlling for demographic, socioeconomic, and disease-related factors and treatment, malnutrition at admission was independently associated with prolonged LOS (hazard ratio, 0.73; 95% CI, 0.62-0.86). Other nutrition-related factors associated with prolonged LOS were lower HGS at admission, receiving nutrition support, and food intake < 50%. Obesity was not a predictor.
CONCLUSION: Malnutrition at admission is prevalent and associated with prolonged LOS. Complex disease and age-related social factors are contributors.
PMID: 25623481
DOI: 10.1177/0148607114567902
