Arnaud-Battandier F, Malvy D, Jeandel C, Schmitt C, Aussage P, Beaufrère B, Cynober L
Nestlé Clinical Nutrition, Noisiel, France.
Clin Nutr. 2004 Oct;23(5):1096-103. doi: 10.1016/j.clnu.2004.02.007.
BACKGROUND & AIMS: Inadequate nutritional support in elderly patients is likely to be responsible for increased morbidity and increased associated costs. Conversely prescribing oral supplements to ensure sufficient protein and energy intake should be beneficial. Even though this claim makes sense there is a lack of objective data to support the evidence. The objective of the present study was to assess the cost of malnutrition and related comorbidities among elderly patients living in the community and to determine the impact of nutritional support practice on these outcomes.
Observational, prospective, longitudinal, cohort study with a 12 months follow-up conducted with 90 general practitioners in France. Two groups of physicians were selected based on historical prescribing practice: group 1 with rare and group 2 with frequent prescription of oral nutrition supplements. The resulting study population was 378 elderly malnourished patients aged over 70, living in the community, either at home or in institutions. Nutritional status at baseline was determined using the Mini Nutritional Assessment (MNA) scale. Main outcome measures were nutritional status, malnutrition-related comorbidities and medical care consumption.
Populations in the two groups of patients were balanced for age, gender, weight and body mass index but differed significantly in terms of housing status (P < 0.005) and nutritional status (P < 0.001). After adjustment for baseline characteristics, MNA improved within both groups over time but improvement was significantly higher in group 2 than in group 1 (P < 0.01). The adjusted cost per patient of hospital care (EUR -551), nursing care (EUR -145) and other medical care was significantly reduced in group 2 as compared to group 1, with cost savings of EUR -723 per patient (90% CI: EUR -1.444 to EUR -43). Including the costs related to nutritional products, the total cost savings per patient attributable to nutrition support were EUR -195 (90% CI: EUR -929 to EUR +478).
Appropriate nutrition support can address the problem of malnutrition among elderly individuals living in the community and may contribute to reduce the costs of health care.
老年患者营养支持不足可能导致发病率增加及相关费用上升。相反，开具口服补充剂以确保充足的蛋白质和能量摄入应该是有益的。尽管这一说法有道理，但缺乏客观数据来支持这一证据。本研究的目的是评估社区老年患者营养不良及相关合并症的成本，并确定营养支持措施对这些结果的影响。
在法国对90名全科医生进行了一项为期12个月随访的观察性、前瞻性、纵向队列研究。根据既往开药习惯选择两组医生：第1组很少开具口服营养补充剂，第2组经常开具。最终的研究人群为378名70岁以上、居住在社区（在家或在机构中）的老年营养不良患者。使用微型营养评定（MNA）量表确定基线时的营养状况。主要结局指标为营养状况、与营养不良相关的合并症及医疗保健消耗。
两组患者在年龄、性别、体重和体重指数方面均衡，但在居住状况（P < 0.005）和营养状况（P < 0.001）方面存在显著差异。在对基线特征进行调整后，两组患者的MNA随时间均有改善，但第2组的改善明显高于第1组（P < 0.01）。与第1组相比，第2组患者的住院护理（-551欧元）、护理（-145欧元）及其他医疗保健的调整后人均成本显著降低，每名患者节省成本723欧元（90%置信区间：-1444欧元至-43欧元）。包括与营养产品相关的成本，营养支持使每名患者节省的总成本为195欧元（90%置信区间：-929欧元至+478欧元）。
适当的营养支持可解决社区老年个体的营养不良问题，并可能有助于降低医疗保健成本。
