Cereda Emanuele, Pusani Chiara, Limonta Daniela, Vanotti Alfredo
International Centre for the Assessment of Nutritional Status, University of Milan, via Botticelli 21, 20133 Milan, Italy.
Br J Nutr. 2009 Aug;102(4):563-70. doi: 10.1017/S0007114509222677. Epub 2009 Feb 10.
The Mini Nutritional Assessment (MNA) is recommended for grading nutritional status in the elderly. A new index for predicting the risk of nutrition-related complications, the Geriatric Nutritional Risk Index (GNRI), was recently proposed but little is known about its possible use in the assessment of nutritional status. Thus, we aimed to investigate its ability to assess the nutritional status and predict the outcome when compared with the MNA. Anthropometry and biochemical parameters were determined in 241 institutionalised elderly (ninety-four males and 147 females; aged 80.1 (SD 8.3) years). Nutritional risk and nutritional state were graded by the GNRI and MNA, respectively. At 6 months outcomes were: death; infections; bedsores. According to the GNRI and MNA, the prevalence of high risk (GNRI < 92)/malnutrition (MNA < 17), moderate risk (GNRI 92-98)/malnutrition at-risk (MNA 17-23.5) and no risk (GNRI > 98)/good status (MNA > 24) were 20.7/12.8%, 36.1/39% and 43.2/48.2%, respectively, with poor agreement in scoring the patient (Cohen's kappa test: kappa = 0.29; 95% CI 0.19, 0.39). GNRI categories showed a stronger association (OR) with overall outcomes than MNA classes, although no difference (P>0.05) was found between malnutrition (v. 'good status', OR 6.4; 95% CI 2.1, 71.9) and high nutritional risk (v. 'no risk', OR 9.7; 95% CI 3.0, 130). Multivariate logistic regression revealed the GNRI as an independent predictor of complications. In overall-outcome prediction, a good sensitivity was found only for GNRI < 98 (0.86 (95% CI 0.67, 0.96)). The combination of a GNRI > 98 with an MNA > 24 seemed to exclude adverse outcomes. The GNRI showed poor agreement with the MNA in nutritional assessment, but appeared to better predict outcome. In home-care resident elderly, outcome prediction should be performed by combining the suggestions from both these tools.
迷你营养评定法（MNA）被推荐用于评估老年人的营养状况。最近提出了一种新的预测营养相关并发症风险的指标——老年营养风险指数（GNRI），但对于其在营养状况评估中的潜在应用知之甚少。因此，我们旨在研究与MNA相比，GNRI评估营养状况和预测结果的能力。对241名机构养老的老年人（94名男性和147名女性；年龄80.1（标准差8.3）岁）进行了人体测量和生化参数测定。分别通过GNRI和MNA对营养风险和营养状况进行分级。6个月时的结果包括：死亡、感染、褥疮。根据GNRI和MNA，高风险（GNRI<92）/营养不良（MNA<17）、中度风险（GNRI 92 - 98）/营养不良风险（MNA 17 - 23.5）和无风险（GNRI>98）/良好状况（MNA>24）的患病率分别为20.7/12.8%、36.1/39%和43.2/48.2%，在对患者评分方面一致性较差（Cohen卡方检验：kappa = 0.29；95%置信区间0.19, 0.39）。与MNA类别相比，GNRI类别与总体结果的关联更强（比值比），尽管在营养不良（与“良好状况”相比，比值比6.4；95%置信区间2.1, 71.9）和高营养风险（与“无风险”相比，比值比9.7；95%置信区间3.0, 130）之间未发现差异（P>0.05）。多因素逻辑回归显示GNRI是并发症的独立预测因素。在总体结果预测中，仅发现GNRI<98时具有良好的敏感性（0.86（95%置信区间0.67, 0.96））。GNRI>98与MNA>24的组合似乎可排除不良结果。GNRI在营养评估中与MNA的一致性较差，但似乎能更好地预测结果。对于居家养老的老年人，应结合这两种工具的建议进行结果预测。
