Olde Rikkert Marcel G M, Verhey Frans R, Sijben John W C, Bouwman Femke H, Dautzenberg Paul L J, Lansink Mirian, Sipers Walther M W, van Asselt Dieneke Z B, van Hees Anneke M J, Stevens Martijn, Vellas Bruno, Scheltens Philip
Radboud Alzheimer Center, Department of Geriatric Medicine, Radboud University Hospital, Nijmegen, The Netherlands.
Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, The Netherlands.
J Alzheimers Dis. 2014;41(1):261-71. doi: 10.3233/JAD-131892.
Studies on the systemic availability of nutrients and nutritional status in Alzheimer's disease (AD) are widely available, but the majority included patients in a moderate stage of AD.
This study compares the nutritional status between mild AD outpatients and healthy controls.
A subgroup of Dutch drug-naïve patients with mild AD (Mini-Mental State Examination (MMSE) ≥20) from the Souvenir II randomized controlled study (NTR1975) and a group of Dutch healthy controls were included. Nutritional status was assessed by measuring levels of several nutrients, conducting the Mini Nutritional Assessment (MNA®) questionnaire and through anthropometric measures.
In total, data of 93 healthy cognitively intact controls (MMSE 29.0 [23.0-30.0]) and 79 very mild AD patients (MMSE = 25.0 [20.0-30.0]) were included. Plasma selenium (p < 0.001) and uridine (p = 0.046) levels were significantly lower in AD patients, with a similar trend for plasma vitamin D (p = 0.094) levels. In addition, the fatty acid profile in erythrocyte membranes was different between groups for several fatty acids. Mean MNA screening score was significantly lower in AD patients (p = 0.008), but not indicative of malnutrition risk. No significant differences were observed for other micronutrient or anthropometric parameters.
In non-malnourished patients with very mild AD, lower levels of some micronutrients, a different fatty acid profile in erythrocyte membranes and a slightly but significantly lower MNA screening score were observed. This suggests that subtle differences in nutrient status are present already in a very early stage of AD and in the absence of protein/energy malnutrition.
关于阿尔茨海默病（AD）患者营养素的全身可用性和营养状况的研究广泛存在，但大多数研究纳入的是中度AD患者。
本研究比较轻度AD门诊患者与健康对照者的营养状况。
纳入来自Souvenir II随机对照研究（NTR1975）的一组未服用过药物的荷兰轻度AD患者（简易精神状态检查表（MMSE）≥20）和一组荷兰健康对照者。通过测量几种营养素水平、进行微型营养评定（MNA®）问卷以及人体测量来评估营养状况。
总共纳入了93名认知功能正常的健康对照者（MMSE为29.0[23.0 - 30.0]）和79名极轻度AD患者（MMSE = 25.0[20.0 - 30.0]）的数据。AD患者的血浆硒水平（p < 0.001）和尿苷水平（p = 0.046）显著较低，血浆维生素D水平也有类似趋势（p = 0.094）。此外，两组之间红细胞膜中的脂肪酸谱在几种脂肪酸上存在差异。AD患者的平均MNA筛查得分显著较低（p = 0.008），但未表明存在营养不良风险。其他微量营养素或人体测量参数未观察到显著差异。
在非营养不良的极轻度AD患者中，观察到某些微量营养素水平较低、红细胞膜中的脂肪酸谱不同以及MNA筛查得分略低但显著降低。这表明在AD的极早期且不存在蛋白质/能量营养不良的情况下，营养状况就已存在细微差异。
