Stratton Rebecca J, King Claire L, Stroud Mike A, Jackson Alan A, Elia Marinos
Institute of Human Nutrition, School of Medicine, University of Southampton, Level F (MP 113), Southampton General Hospital, Southampton SO16 6YD, UK.
Br J Nutr. 2006 Feb;95(2):325-30. doi: 10.1079/bjn20051622.
Malnutrition and its impact on clinical outcome may be underestimated in hospitalised elderly as many screening procedures require measurements of weight and height that cannot often be undertaken in sick elderly patients. The 'Malnutrition Universal Screening Tool' ('MUST') has been developed to screen all adults, even if weight and/or height cannot be measured, enabling more complete information on malnutrition prevalence and its impact on clinical outcome to be obtained. In the present study, 150 consecutively admitted elderly patients (age 85 (sd 5.5) years) were recruited prospectively, screened with 'MUST' and clinical outcome recorded. Although only 56 % of patients could be weighed, all (n 150) could be screened with 'MUST'; 58 % were at malnutrition risk and these individuals had greater mortality (in-hospital and post-discharge, P<0.01) and longer hospital stays (P=0.02) than those at low risk. Both 'MUST' categorisation and component scores (BMI, weight loss, acute disease) were significantly related to mortality (P<0.03). Those patients with no measured or recalled weight ('MUST' subjective criteria used) had a greater risk of malnutrition (P=0.01) and a poorer clinical outcome (P<0.002) than those who could be weighed and, within both groups, clinical outcome was worse in those at risk of malnutrition. The present study suggests that 'MUST' predicts clinical outcome in hospitalised elderly, in whom malnutrition is common (58 %). In those who cannot be weighed, a higher prevalence of malnutrition and associated poorer clinical outcome supports the importance of routine screening with a tool, like 'MUST', that can be used to screen all patients.
在住院老年人中，营养不良及其对临床结局的影响可能被低估，因为许多筛查程序需要测量体重和身高，而患病的老年患者往往无法进行这些测量。“营养不良通用筛查工具”（“MUST”）已被开发出来，用于筛查所有成年人，即使无法测量体重和/或身高，从而能够获得关于营养不良患病率及其对临床结局影响的更完整信息。在本研究中，前瞻性招募了150例连续入院的老年患者（年龄85（标准差5.5）岁），用“MUST”进行筛查并记录临床结局。尽管只有56%的患者能够称重，但所有患者（n = 150）都可以用“MUST”进行筛查；58%的患者存在营养不良风险，与低风险患者相比，这些患者的死亡率更高（住院期间和出院后，P<0.01），住院时间更长（P = 0.02）。“MUST”分类和各组成部分得分（BMI、体重减轻、急性疾病）均与死亡率显著相关（P<0.03）。那些没有测量或回忆起体重（使用“MUST”主观标准）的患者比能够称重的患者有更高的营养不良风险（P = 0.01）和更差的临床结局（P<0.002），并且在两组中，有营养不良风险的患者临床结局更差。本研究表明，“MUST”可预测住院老年患者的临床结局，在这些患者中营养不良很常见（58%）。在无法称重的患者中，更高的营养不良患病率和相关的更差临床结局支持了使用像“MUST”这样可用于筛查所有患者的工具进行常规筛查的重要性。
