Department of Clinical Medicine, Sapienza University, viale dell'Università 37, 00185 Rome, Italy.
Clin Nutr. 2013 Aug;32(4):527-32. doi: 10.1016/j.clnu.2012.11.011. Epub 2012 Nov 20.
BACKGROUND & AIMS: In hospitalized patients, lack of appetite, i.e., disease-associated anorexia, is the main factor determining insufficient food intake and weight loss, which in turn increase morbidity and mortality. Controversies exist on which tool should be preferred when diagnosing anorexia. Aim of the study was to evaluate in hospitalized medical patients, the performance of 4 different tools [i.e., self-assessment of appetite, FAACT-ESPEN score, visual analog scale (VAS), and the Anorexia Questionnaire (AQ)] in assessing disease-associated anorexia and predicting nutritional and clinical variables.
Hospitalized patients consecutively admitted to the Internal Medicine ward at our institution were considered. After informed consent was obtained, patients were asked to self-assess their appetite vs the previous month. The VAS, the FAACT-ESPEN score and the Anorexia Questionnaire were also submitted. Food intake immediately following the interview was recorded. Nutritional (i.e., body weight, height), functional (i.e., handgrip strength) and clinical variables (i.e., length of stay) were registered upon admission and before discharge.
We studied 105 patients (74M:31F; 66.2 ± 16.3 yrs). The prevalence of anorexia as assessed by patients' self assessment, FAACT-ESPEN score, and the Anorexia Questionnaire was 23%, 10% and 48%, respectively. VAS did not show any correlation with food intake. Anorexic patients as identified by the self assessment of appetite showed reduced food intake and weaker handgrip strength than non-anorexic. The FAACT-ESPEN score correlated with body weight, food intake and handgrip strength, but was not related with length of stay. Anorexic patients as identified by the Anorexia Questionnaire showed reduced food intake, lower body weight, weaker handgrip strength and longer hospital stay than non-anorexic patients.
The prevalence of anorexia significantly varies according to the diagnostic tool used. Except for VAS, all the tested tools identify patients with impaired nutritional and functional variables. However, only the Anorexia Questionnaire identifies patients with longer hospital stay. Our results suggest that in clinical practice, modification of appetite reflects different underlying mechanisms whose impacts on clinical outcome measures may differ. Therefore, an ideal anorexia assessment tool does not appear to exist, but it should be chosen according to the outcome measures to be assessed (i.e., Anorexia Questionnaire to predict length of stay).
在住院患者中，食欲不振即疾病相关性厌食是导致食物摄入不足和体重减轻的主要因素，而这反过来又会增加发病率和死亡率。在诊断厌食症时，哪种工具应该优先使用存在争议。本研究的目的是评估在住院内科患者中，4 种不同工具[即自我评估食欲、FAACT-ESPEN 评分、视觉模拟评分（VAS）和厌食症问卷（AQ）]在评估疾病相关性厌食症和预测营养及临床变量方面的表现。
连续纳入我院内科病房收治的住院患者。获得知情同意后，患者被要求自我评估与前一个月相比的食欲。还提交了 VAS、FAACT-ESPEN 评分和厌食症问卷。访谈后立即记录食物摄入量。入院时和出院前记录营养（即体重、身高）、功能（即握力）和临床变量（即住院时间）。
我们研究了 105 名患者（74 名男性：31 名女性；66.2±16.3 岁）。根据患者自我评估、FAACT-ESPEN 评分和厌食症问卷评估，厌食症的患病率分别为 23%、10%和 48%。VAS 与食物摄入量之间没有相关性。通过自我评估食欲确定的厌食症患者的食物摄入量和握力均低于非厌食症患者。FAACT-ESPEN 评分与体重、食物摄入量和握力相关，但与住院时间无关。通过厌食症问卷确定的厌食症患者的食物摄入量、体重较低、握力较弱且住院时间较长。
根据使用的诊断工具，厌食症的患病率存在显著差异。除了 VAS，所有测试工具均确定了营养和功能变量受损的患者。然而，只有厌食症问卷可以确定住院时间较长的患者。我们的结果表明，在临床实践中，食欲的改变反映了不同的潜在机制，这些机制对临床结局指标的影响可能不同。因此，一种理想的厌食症评估工具似乎并不存在，但应根据要评估的结局指标来选择（即，使用厌食症问卷来预测住院时间）。
