Allard Johane P, Keller Heather, Jeejeebhoy Khursheed N, Laporte Manon, Duerksen Don R, Gramlich Leah, Payette Helene, Bernier Paule, Vesnaver Elisabeth, Davidson Bridget, Teterina Anastasia, Lou Wendy
Department of Medicine, University Health Network, University of Toronto, Ontario, Canada
Schlegel-UW Research Institute for Aging, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
JPEN J Parenter Enteral Nutr. 2016 May;40(4):487-97. doi: 10.1177/0148607114567902. Epub 2015 Jan 26.
In hospitals, length of stay (LOS) is a priority but it may be prolonged by malnutrition. This study seeks to determine the contributors to malnutrition at admission and evaluate its effect on LOS.
This is a prospective cohort study conducted in 18 Canadian hospitals from July 2010 to February 2013 in patients ≥ 18 years admitted for ≥ 2 days. Excluded were those admitted directly to the intensive care unit; obstetric, psychiatry, or palliative wards; or medical day units. At admission, the main nutrition evaluation was subjective global assessment (SGA). Body mass index (BMI) and handgrip strength (HGS) were also performed to assess other aspects of nutrition. Additional information was collected from patients and charts review during hospitalization.
One thousand fifteen patients were enrolled: based on SGA, 45% (95% confidence interval [CI], 42%-48%) were malnourished, and based on BMI, 32% (95% CI, 29%-35%) were obese. Independent contributors to malnutrition at admission were Charlson comorbidity index > 2, having 3 diagnostic categories, relying on adult children for grocery shopping, and living alone. The median (range) LOS was 6 (1-117) days. After controlling for demographic, socioeconomic, and disease-related factors and treatment, malnutrition at admission was independently associated with prolonged LOS (hazard ratio, 0.73; 95% CI, 0.62-0.86). Other nutrition-related factors associated with prolonged LOS were lower HGS at admission, receiving nutrition support, and food intake < 50%. Obesity was not a predictor.
Malnutrition at admission is prevalent and associated with prolonged LOS. Complex disease and age-related social factors are contributors.
在医院中，住院时间是一个重要指标，但营养不良可能会延长住院时间。本研究旨在确定入院时导致营养不良的因素，并评估其对住院时间的影响。
这是一项前瞻性队列研究，于2010年7月至2013年2月在加拿大的18家医院对年龄≥18岁、住院时间≥2天的患者进行。排除直接入住重症监护病房、产科、精神科或姑息治疗病房或日间医疗单元的患者。入院时，主要的营养评估是主观全面评定法（SGA）。还进行了体重指数（BMI）和握力（HGS）测量以评估营养的其他方面。在住院期间从患者处收集了更多信息并查阅了病历。
共纳入1015例患者：根据SGA，45%（95%置信区间[CI]，42%-48%）存在营养不良，根据BMI，32%（95%CI，29%-35%）为肥胖。入院时营养不良的独立相关因素包括查尔森合并症指数>2、有3个诊断类别、依靠成年子女购买食品杂货以及独居。中位（范围）住院时间为6（1-117）天。在控制了人口统计学、社会经济和疾病相关因素及治疗后，入院时的营养不良与住院时间延长独立相关（风险比，0.73；95%CI，0.62-0.86）。与住院时间延长相关的其他营养相关因素包括入院时较低的HGS、接受营养支持以及食物摄入量<50%。肥胖不是一个预测因素。
入院时营养不良很普遍，且与住院时间延长相关。复杂疾病和与年龄相关的社会因素是其成因。
