Asiimwe Stephen B
Department of Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda; Department of Epidemiology and Biostatistics, University of California San Francisco, CA, USA.
Nutrition. 2016 Jan;32(1):95-100. doi: 10.1016/j.nut.2015.07.017. Epub 2015 Sep 3.
Measuring malnutrition in hospitalized patients is difficult in all settings. I evaluated associations of items in the mini nutritional assessment short-form (MNA-sf), a nutritional-risk screening tool previously validated in the elderly, with malnutrition among hospitalized patients in Uganda. I used results to construct two simplifications of this tool that may be applicable to young and middle-aged adults.
I assessed the association of each MNA-sf item with the mid-upper arm circumference (MUAC), a specific measure of malnutrition at appropriate cut-offs. I incorporated only malnutrition-specific items into the proposed simplifications scoring each item according to its association with malnutrition. I assessed numbers classified to different score-levels by the simplifications and, via proportional hazards regression, how the simplifications predicted in-hospital mortality.
I analyzed 318 patients (median age 37, interquartile range 27 to 56). Variables making it into the simplifications were: reduced food intake, weight loss, mobility, and either BMI in kg/m(2) (categorized as <16, 16 to 16.9, and ≥17) or MUAC in centimeters (categorized as <16 or <17, 16 to 18.9 or 17 to 19.9, and ≥19 or ≥20 for females and males respectively). Compared to the traditional MNA-sf, the simplifications classified fewer patients as malnourished, yet remained strongly predictive of in-hospital mortality. In the MUAC-incorporating simplification, malnourished patients had 3.8-fold (95% CI 1.9 to 7.8) higher risk of in-hospital death than those not malnourished; adjusting for age, sex, and HIV status.
The MNA-sf simplifications described may provide an improved measure of malnutrition in hospitalized young and middle-aged adults.
在所有环境中，测量住院患者的营养不良情况都很困难。我评估了简易营养评估简表（MNA-sf）中的各项指标与营养不良之间的关联，MNA-sf是一种先前在老年人中验证过的营养风险筛查工具，此次评估其在乌干达住院患者中的情况。我利用评估结果构建了该工具的两种简化版本，它们可能适用于中青年成年人。
我评估了MNA-sf各项指标与上臂中部周长（MUAC）之间的关联，MUAC是在适当临界值下营养不良的一项具体衡量指标。我仅将特定于营养不良的指标纳入拟议的简化版本中，并根据其与营养不良的关联对每个指标进行评分。我评估了简化版本将患者分类到不同分数水平的情况，并通过比例风险回归分析简化版本如何预测住院死亡率。
我分析了318名患者（中位年龄37岁，四分位间距27至56岁）。纳入简化版本的变量有：食物摄入量减少、体重减轻、活动能力，以及以千克每平方米为单位的体重指数（BMI，分类为<16、16至16.9以及≥17）或以厘米为单位的MUAC（女性分类为<16或<17、16至18.9或17至19.9以及≥19或≥20，男性分类为<16或<17、16至18.9或17至19.9以及≥19或≥20）。与传统的MNA-sf相比，简化版本将较少患者分类为营养不良，但对住院死亡率仍具有很强的预测能力。在纳入MUAC的简化版本中，营养不良患者的住院死亡风险比未营养不良患者高3.8倍（95%置信区间1.9至7.8）；对年龄、性别和艾滋病毒感染状况进行了调整。
所描述的MNA-sf简化版本可能为住院中青年成年人的营养不良情况提供一种改进的测量方法。
