Dent Elsa, Visvanathan Renuka, Piantadosi Cynthia, Chapman Ian
Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
J Nutr Gerontol Geriatr. 2012;31(2):97-145. doi: 10.1080/21551197.2012.678214.
This systematic review assessed whether nutritional screening tools (NSTs) predict mortality, functional decline, and move to higher level care in older adults residing in the community or in institutions. In total, 37 prospective studies published between 1999 and 2012 met inclusion criteria and were included in this review. The most commonly used NST in these studies was the Mini Nutritional Assessment (MNA). Comparison of NSTs was limited by variation in follow-up time, lack of uniform definition of functional decline, and biases in many studies. Results of MNA, MNA-Short Form (MNA-SF), and Geriatric Nutrition Risk Index (GNRI) assessments were significantly associated with subsequent mortality, with good negative predictive power (∼0.83), but only modest positive predictive power (PPV∼0.32). MNA-SF and MNA results had a low to moderate association with functional decline (PPV∼0.34). Move to higher level care was less strongly associated with NST scores (PPV∼0.25). Overall, there is evidence that NSTs can predict those at low risk of mortality, functional decline, and, to a lesser extent, move to higher level care in older people.
本系统评价评估了营养筛查工具（NST）能否预测居住在社区或机构中的老年人的死亡率、功能衰退以及转至更高护理级别的情况。1999年至2012年间发表的37项前瞻性研究符合纳入标准并被纳入本评价。这些研究中最常用的NST是微型营养评定法（MNA）。NST之间的比较受到随访时间差异、功能衰退缺乏统一定义以及许多研究存在偏倚的限制。MNA、MNA简表（MNA-SF）和老年营养风险指数（GNRI）评估结果与随后的死亡率显著相关，具有良好的阴性预测能力（约0.83），但阳性预测能力仅为中等水平（阳性预测值约0.32）。MNA-SF和MNA结果与功能衰退的关联程度为低到中等（阳性预测值约0.34）。转至更高护理级别与NST评分的关联较弱（阳性预测值约0.25）。总体而言，有证据表明NST能够预测老年人中死亡率、功能衰退风险较低以及（程度较轻的）转至更高护理级别风险较低的人群。
