Hsu Min-Fang, Ho Shu-Chuan, Kuo Han-Pin, Wang Jiun-Yi, Tsai Alan C
1Department of Healthcare Administration, Asia University , Wufeng, Taichung , Taiwan.
COPD. 2014 Jun;11(3):325-32. doi: 10.3109/15412555.2013.863274. Epub 2014 Jan 29.
Malnutrition is prevalent in patients with chronic obstructive pulmonary disease (COPD) but is often neglected in clinical practice. This study examined the usefulness of the Mini Nutritional Assessment (MNA) for assessing the nutritional status of patients with COPD. We recruited 83 patients with COPD in stable condition from the pulmonary rehabilitation unit of a medical center in northern Taiwan. Each patient was interviewed with a structured questionnaire to elicit personal and health-related data, and measured for anthropometric and blood biochemical indicators. Nutritional status was rated with two Taiwanese-specific versions of the MNA, MNA-T1 and MNA-T2. Fat-free mass was measured with bioelectrical impedance analysis (BIA), and exercise capacity indicators with the 6-Minute Walk Test. The two MNA versions showed high agreement (kappa = 0.949) in predicting the nutritional risk, and both versions predicted the FFMI well (area under the curve of the Receiver Operating Characteristics = 0.804, p < 0.001 for MNA-T1; and 0.813, p < 0.001 for MNA-T2). MNA scores decreased with increasing disease severity and were highly correlated with FFMI, BMI, mid-arm circumference, calf circumference, and oxygen saturation at rest and during exercise (all p < 0.01). The MNA score was positively correlated with FEV1, FVC and 6-minute walking distance, and negatively correlated with GOLD stages (all p < 0.05). However, the MNA score was not significantly correlated with blood biochemical indicators, perhaps due to inflammatory status associated with COPD. The MNA appears appropriate for rating the nutritional risk of patients with COPD. Routine use of the MNA may help reduce the risk of malnutrition in patients with COPD.
营养不良在慢性阻塞性肺疾病(COPD)患者中普遍存在,但在临床实践中常被忽视。本研究探讨了微型营养评定法(MNA)在评估COPD患者营养状况方面的实用性。我们从台湾北部一家医疗中心的肺康复科招募了83例病情稳定的COPD患者。对每位患者进行结构化问卷调查以获取个人及健康相关数据,并测量人体测量指标和血液生化指标。使用两种台湾地区特有的MNA版本,即MNA-T1和MNA-T2对营养状况进行评分。采用生物电阻抗分析(BIA)测量去脂体重,通过6分钟步行试验测量运动能力指标。两种MNA版本在预测营养风险方面具有高度一致性(kappa = 0.949),且两种版本对去脂体重指数(FFMI)的预测效果均良好(MNA-T1的受试者工作特征曲线下面积 = 0.804,p < 0.001;MNA-T2的受试者工作特征曲线下面积 = 0.813,p < 0.001)。MNA评分随疾病严重程度增加而降低,且与FFMI、体重指数(BMI)、上臂围、小腿围以及静息和运动时的血氧饱和度均高度相关(均p < 0.01)。MNA评分与第1秒用力呼气容积(FEV1)、用力肺活量(FVC)和6分钟步行距离呈正相关,与慢性阻塞性肺疾病全球倡议(GOLD)分级呈负相关(均p < 0.05)。然而,MNA评分与血液生化指标无显著相关性,这可能是由于COPD相关的炎症状态所致。MNA似乎适用于评估COPD患者的营养风险。常规使用MNA可能有助于降低COPD患者的营养不良风险。