The Gilad Geriatric Center, Ramat-Gan, Israel.
J Nutr Health Aging. 2013 Feb;17(2):162-5. doi: 10.1007/s12603-012-0075-3.
To study differences in nutritional status and body composition, by feeding modality, among disabled nursing home residents.
A retrospective chart-review study.
A nursing wing of a public urban geriatric center.
Three groups of patients: non-dysphagic, orally-fed dysphagic and percutaneous endoscopic gastrostomy -fed dysphagic patients.
Standard nursing care.
Basal metabolic rate, total energy expenditure and nitrogen balance under oral or percutaneous endoscopic gastrostomy feeding. Dietary intake was assessed during a 3-days period by daily-food intake protocols and a 24-hours urinary creatinine excretion to detect nitrogen balance and calculate body composition parameters.
Data of 117 patients (55.5% females), mean age 84.6±7.5 (range 66-98 years) was analyzed. Dysphagic patients (60) differed from non-dysphagic patients (57) by lower body mass index (p=0.020), fat mass index (p=0.017), daily protein intake (p<0.0001), daily energy intake (p<0.001), protein related energy intake (p<0.001) and a negative nitrogen balance (p<0.001). In regression analyses, dysphagia was associated with increased risk of having a body mass index lower than 22.0kg/m2 (OR=2.60, 95% CI 1.135-5.943), a negative nitrogen balance (OR=2.33, 95% CI 1.063-4.669), a low fat mass index (OR=2.53, 95% CI 1.066-6.007), and low daily protein and energy intakes per body weight (OR=2.87, 95% CI 1.316-6.268 and OR=2.99, 95% CI 1.297-6.880). Compared with orally-fed dysphagic patients (21pts.), percutaneous endoscopic gastrostomy -fed patients (39pts.) received an additional mean energy intake of 30.5% kcal per day and mean protein intake of 26.0%. This additional intake was not associated with improved body composition parameters (such as fat free mass, skeletal mass or body mass index).
Dysphagic nursing home residents are characterized by worse nutritional, metabolic and body composition parameters, compared with non-dysphagic residents. Body composition parameters did not differ between orally-fed and percutaneous endoscopic gastrostomy-fed dysphagic patients, despite significantly better nutritional and metabolic parameters in PEG-fed patients. Other approaches (perhaps physical training, pharmacological etc.) should be sought to improve body composition of such patients.
通过喂养方式研究残疾养老院居民的营养状况和身体成分的差异。
回顾性图表审查研究。
公共城市老年中心的一个护理翼楼。
三组患者：非吞咽困难、经口喂养的吞咽困难和经皮内镜下胃造口术喂养的吞咽困难患者。
标准护理。
经口或经皮内镜下胃造口喂养的基础代谢率、总能量消耗和氮平衡。通过每日食物摄入量方案和 24 小时尿肌酐排泄来评估 3 天期间的膳食摄入量，以检测氮平衡并计算身体成分参数。
分析了 117 名患者（55.5%为女性）的数据，平均年龄 84.6±7.5（66-98 岁）。与非吞咽困难患者（57 名）相比，吞咽困难患者（60 名）的身体质量指数（p=0.020）、脂肪质量指数（p=0.017）、每日蛋白质摄入量（p<0.0001）、每日能量摄入量（p<0.001）、蛋白质相关能量摄入量（p<0.001）和负氮平衡（p<0.001）较低。在回归分析中，吞咽困难与身体质量指数低于 22.0kg/m2 的风险增加（OR=2.60，95%CI 1.135-5.943）、负氮平衡（OR=2.33，95%CI 1.063-4.669）、低脂肪质量指数（OR=2.53，95%CI 1.066-6.007）以及低每日蛋白质和能量摄入量/体重（OR=2.87，95%CI 1.316-6.268 和 OR=2.99，95%CI 1.297-6.880）相关。与经口喂养的吞咽困难患者（21 名）相比，经皮内镜下胃造口术喂养的患者（39 名）每天额外摄入 30.5%的能量和 26.0%的蛋白质。这种额外的摄入量与改善身体成分参数（如无脂肪质量、骨骼质量或身体质量指数）无关。
与非吞咽困难的居民相比，吞咽困难的养老院居民的营养、代谢和身体成分参数更差。尽管经皮内镜下胃造口术喂养的患者的营养和代谢参数明显更好，但经口喂养和经皮内镜下胃造口术喂养的吞咽困难患者的身体成分参数没有差异。应该寻求其他方法（也许是身体训练、药理学等）来改善此类患者的身体成分。
