中国学者使用营养不良新定义分析住院老年患者长期死亡率
前情提要
2017年6月22日，英国《自然》旗下《科学报告》在线发表四川大学华西医院的前瞻研究事后分析报告，对2015年欧洲肠外肠内营养学会（ESPEN）新标准诊断的营养不良能否预测老年住院患者的长期死亡率进行了评价。
该前瞻研究于2012年8～12月在四川大学华西医院和成都市第五人民医院的老年急症病房进行，共入组年龄≥60岁的老年参与者437例。事后分析根据2015年ESPEN新标准（nESPEN）和微型营养评定简表（MNA-SF）分别定义营养不良，通过3年电话随访确定生存状况。
结果发现：
根据nESPEN和MNA-SF，分别有66例（15.1%）和45例（10.3%）参与者为营养不良。
根据nESPEN定义的营养不良、无营养不良参与者，3年全因死亡率有显著差异（41.7%比15.3%，P＜0.001）。
根据MNA-SF定义的营养不良、无营养不良参与者，3年全因死亡率无显著差异（26.2%比18.4%，P=0.228）。
通过多变量比例风险回归模型，校正相关混杂因素后：
根据nESPEN定义的营养不良、无营养不良参与者，3年全因死亡率有显著差异（风险比：2.98，95%置信区间：1.87～4.86，P＜0.001）。
根据MNA-SF定义的营养不良、无营养不良参与者，3年全因死亡率无显著差异（风险比：1.67，95%置信区间：0.89～2.31，P=0.073）。
因此，作者认为，新的ESPEN营养不良诊断标准与MNA-SF相比，对于预测老年住院患者3年全因死亡率较可靠。
Sci Rep. 2017 Jun 22;7(1):4067.
Predicting long-term mortality in hospitalized elderly patients using the new ESPEN definition.
Jiang J, Hu X, Chen J, Wang H, Zhang L, Dong B, Yang M.
West China Hospital, Sichuan University, Chengdu, Sichuan, China.
The European Society of Clinical Nutrition and Metabolism (ESPEN) recently published new diagnostic criteria for malnutrition. The aim of this study was to evaluate whether malnutrition by the new ESPEN diagnostic criteria can predict long-term mortality in elderly inpatients. We conducted a prospective study in the acute geriatric wards. Malnutrition was defined according to the new ESPEN criteria and the Mini Nutritional Assessment (MNA), respectively. The survival status was determined by telephone interviews at 3-years. A total of 437 elderly adults were included. According to the new ESPEN criteria, 66 participants (15.1%) were malnourished. According to the MNA, 45 participants (10.3%) were identified as malnourished. The 3-year all-cause mortality was 41.7% in participants with malnutrition defined by the ESPEN criteria and 15.3% in participants without malnutrition (p<0.001). After adjusting for relevant confounders, malnutrition defined by the ESPEN criteria was a significant predictor of 3-year all-cause mortality (hazard ratio [HR] 2.98, 95% confidence interval [CI] 1.87-4.86). However, malnutrition defined by the MNA was not a significant predictor of 3-year all-cause mortality (HR 1.67, 95% CI 0.89-2.31). In conclusion, the new ESPEN diagnostic criteria for malnutrition are reliable in predicting 3-year all-cause mortality among elderly inpatients.
PMID: 28642623
DOI: 10.1038/s41598-017-04483-1