Division of Bone Diseases, Department of Internal Medicine Specialties, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
Eur J Clin Nutr. 2013 Nov;67(11):1175-81. doi: 10.1038/ejcn.2013.166. Epub 2013 Oct 16.
Several guidelines recommend systematic screening for malnutrition in elderly inpatients for early dietary intakes assessment and treatment, but data demonstrating the efficacy of such interventions are scarce. The aim of this study was to evaluate a critical medical pathway for the detection and management of malnutrition in elderly inpatients.
In a 3-month prospective controlled study, 694 recently admitted inpatients were assigned to an intervention group (critical medical pathway; n=465) or a standard care control group (n=229). Nutritional status was assessed at the time of admission with a Mini Nutritional Assessment. A renutrition program tailored to the initial dietary assessment results was applied in the intervention group. The efficacy of the program was verified by measuring the evolution of serum insulin-like growth factor 1 (IGF-I) between admission and 3 weeks later.
In the intervention group at baseline, 23% were malnourished, 51% were at risk and 26% were eunourished. Serum IGF-I increased in the intervention group (from 84±45 μg/l to 95±50 μg/l, P<0.0001; mean±s.d., n=209), but remained stable in the controls (from 79±43 μg/l to 81±35 μg/l, P=0.4; n=99), with a statistically significant between group difference (P<0.01).
Early malnutrition assessment and targeted renutrition program in elderly inpatients were associated with an increase in serum IGF-I. It remains to be determined whether such variations are clinically relevant.
一些指南建议对老年住院患者进行系统的营养不良筛查，以便及早评估饮食摄入并进行治疗，但缺乏此类干预措施有效性的数据。本研究旨在评估一种针对老年住院患者营养不良的检测和管理的关键医疗路径。
在一项为期 3 个月的前瞻性对照研究中，将 694 名新入院的患者分为干预组（关键医疗路径；n=465）或标准护理对照组（n=229）。入院时采用 Mini 营养评估法评估营养状况。在干预组中，根据初始饮食评估结果制定个性化的营养补充计划。通过测量入院时和 3 周后血清胰岛素样生长因子 1（IGF-1）的变化来验证该方案的疗效。
在干预组中，入院时 23%的患者存在营养不良，51%的患者处于营养风险状态，26%的患者营养良好。干预组的血清 IGF-1 水平升高（从 84±45 μg/l 增加到 95±50 μg/l，P<0.0001；n=209），而对照组则保持稳定（从 79±43 μg/l 增加到 81±35 μg/l，P=0.4；n=99），两组间存在统计学差异（P<0.01）。
对老年住院患者进行早期营养不良评估和针对性的营养补充计划与血清 IGF-1 的增加相关。但目前尚不清楚这些变化是否具有临床意义。
