测量小腿围度在评估住院老年人营养状况中的作用

Usefulness of calf circumference measurement in assessing the nutritional state of hospitalized elderly people.

作者信息

Bonnefoy M, Jauffret M, Kostka T, Jusot J F

机构信息

Service de Médecine Gériatrique, Centre Hospitalier Lyon-Sud, F-69495 Pierre-Bénite, France.

出版信息

Gerontology. 2002 May-Jun;48(3):162-9. doi: 10.1159/000052836.

DOI:10.1159/000052836

PMID:11961370

Abstract

BACKGROUND

Malnutrition is a widespread but largely unrecognized problem in aged patients, more so as it is a contributing factor to the increased morbidity and mortality in this age group. Since direct measurements of body composition are not possible in a large number of patients, good anthropometric reference data are fundamental in assessing the nutritional state of elderly people.

OBJECTIVE

To examine the efficacy of calf circumference (CC) measurement for assessing the nutritional state of the elderly.

METHODS

The nutritional state was assessed by anthropometric and biological measurements in 911 elderly patients consecutively admitted to a geriatric unit. In the first instance, univariate analysis was performed for CC and other nutritional parameters. Linear and multiple stepwise regressions were performed to study the association between anthropometric or biological parameters and CC. At a later stage, the specificity, sensitivity and the optimal cutoff CC were established for 2 groups of patients: malnourished and controls. Finally, patients were classified according to this cutoff in order to verify the efficacy of CC in assessing their nutritional state.

RESULTS

The results of univariate analysis showed significant correlations between CC and other nutritional anthropometric markers (r = 0.706, p < 0.0001 with body mass index (BMI) and r = 0.661, p < 0.0001 with fat free mass) and biological markers (r = 0.219, p < 0.0001 with albumin and r = 0.162, p < 0.0001 with transthyretin). Multiple regression confirmed associations between CC and tricipital skinfold thickness (p < 0.0001), fat free mass (p < 0.0001), BMI (p < 0.0001), and serum albumin (p < 0.0001; r(2) = 0.561). The optimal cutoff for CC was found to be 30.5 cm for both men (sensitivity 73.2%, specificity 72.8%) and women (sensitivity 78.8%, specificity 61.1%). The classification of patients according to this discriminating factor was confirmed for the optimal cutoff value.

CONCLUSION

Calf circumference is a pertinent marker of nutritional state. The cutoff of 30.5 cm provides a good diagnostic capacity.

摘要

背景

营养不良在老年患者中普遍存在，但很大程度上未被认识到，因为它是该年龄组发病率和死亡率增加的一个促成因素。由于大量患者无法直接测量身体成分，良好的人体测量参考数据对于评估老年人的营养状况至关重要。

目的

探讨测量小腿围（CC）评估老年人营养状况的有效性。

方法

对连续入住老年病房的911例老年患者进行人体测量和生物学测量以评估营养状况。首先，对CC和其他营养参数进行单因素分析。进行线性和多元逐步回归以研究人体测量或生物学参数与CC之间的关联。在后期，为营养不良组和对照组两组患者确定特异性、敏感性和最佳CC截断值。最后，根据该截断值对患者进行分类，以验证CC评估其营养状况的有效性。

结果

单因素分析结果显示，CC与其他营养人体测量指标（与体重指数（BMI）的r = 0.706，p < 0.0001；与去脂体重的r = 0.661，p < 0.0001）以及生物学指标（与白蛋白的r = 0.219，p < 0.0001；与转甲状腺素蛋白的r = 0.162，p < 0.0001）之间存在显著相关性。多元回归证实CC与三头肌皮褶厚度（p < 0.0001）、去脂体重（p < 0.0001）、BMI（p < 0.0001）和血清白蛋白（p < 0.0001；r² = 0.561）之间存在关联。发现男性和女性的CC最佳截断值均为30.5 cm（男性敏感性73.2%，特异性72.8%；女性敏感性78.8%，特异性61.1%）。根据该区分因素对患者进行的分类得到了最佳截断值的证实。