Nishioka Shinta, Okamoto Takatsugu, Takayama Masako, Urushihara Maki, Watanabe Misuzu, Kiriya Yumiko, Shintani Keiko, Nakagomi Hiromi, Kageyama Noriko
Kaifukuki Rehabilitation Ward Association, Kikuya Bldg. 5F, 1-28-19, Higashi-ueno, Taito, Tokyo, Japan; Department of Clinical Nutrition and Food Services, Nagasaki Rehabilitation Hospital, 4-11, Gin-ya Machi, Nagasaki 850-0854, Japan.
Kaifukuki Rehabilitation Ward Association, Kikuya Bldg. 5F, 1-28-19, Higashi-ueno, Taito, Tokyo, Japan; Department of Rehabilitation Medicine, Nishi-Hiroshima Rehabilitation Hospital, 6-265, Miyake, Saeki-ku, Hiroshima, Japan.
Clin Nutr. 2017 Aug;36(4):1089-1096. doi: 10.1016/j.clnu.2016.06.028. Epub 2016 Jul 6.
BACKGROUND & AIMS: Whether malnutrition risk correlates with recovery of swallowing function of convalescent stroke patients is unknown. This study was conducted to clarify whether malnutrition risks predict achievement of full oral intake in convalescent stroke patients undergoing enteral nutrition.
We conducted a secondary analysis of 466 convalescent stroke patients, aged 65 years or over, who were undergoing enteral nutrition. Patients were extracted from the "Algorithm for Post-stroke Patients to improve oral intake Level; APPLE" study database compiled at the Kaifukuki (convalescent) rehabilitation wards. Malnutrition risk was determined by the Geriatric Nutritional Risk Index as follows: severe (<82), moderate (82 to <92), mild (92 to <98), and no malnutrition risks (≥98). Swallowing function was assessed by Fujishima's swallowing grade (FSG) on admission and discharge. The primary outcome was achievement of full oral intake, indicated by FSG ≥ 7. Binary logistic regression analysis was performed to identify predictive factors, including malnutrition risk, for achieving full oral intake. Estimated hazard risk was computed by Cox's hazard model.
Of the 466 individuals, 264 were ultimately included in this study. Participants with severe malnutrition risk showed a significantly lower proportion of achievement of full oral intake than lower severity groups (P = 0.001). After adjusting for potential confounders, binary logistic regression analysis showed that patients with severe malnutrition risk were less likely to achieve full oral intake (adjusted odds ratio: 0.232, 95% confidence interval [95% CI]: 0.047-1.141). Cox's proportional hazard model revealed that severe malnutrition risk was an independent predictor of full oral intake (adjusted hazard ratio: 0.374, 95% CI: 0.166-0.842). Compared to patients who did not achieve full oral intake, patients who achieved full oral intake had significantly higher energy intake, but there was no difference in protein intake and weight change.
Severe malnutrition risk independently predicts the achievement of full oral intake in convalescent stroke patients undergoing enteral nutrition.
尚不清楚营养不良风险是否与中风康复期患者吞咽功能的恢复相关。本研究旨在明确营养不良风险是否能预测接受肠内营养的中风康复期患者实现完全经口进食的情况。
我们对466名65岁及以上接受肠内营养的中风康复期患者进行了二次分析。患者从在Kaifukuki（康复）康复病房编制的“中风患者提高经口摄入水平算法；APPLE”研究数据库中提取。营养不良风险通过老年营养风险指数确定如下：严重（<82）、中度（82至<92）、轻度（92至<98）和无营养不良风险（≥98）。入院时和出院时通过藤岛吞咽分级（FSG）评估吞咽功能。主要结局是实现完全经口进食，以FSG≥7表示。进行二元逻辑回归分析以确定实现完全经口进食的预测因素，包括营养不良风险。通过Cox风险模型计算估计风险。
在466名个体中，最终264名被纳入本研究。严重营养不良风险的参与者实现完全经口进食的比例明显低于低严重程度组（P = 0.001）。在调整潜在混杂因素后，二元逻辑回归分析显示，严重营养不良风险的患者实现完全经口进食的可能性较小（调整后的优势比：0.232，95%置信区间[95%CI]：0.047 - 1.141）。Cox比例风险模型显示，严重营养不良风险是完全经口进食的独立预测因素（调整后的风险比：0.374，95%CI：0.166 - 0.842）。与未实现完全经口进食的患者相比，实现完全经口进食的患者能量摄入量明显更高，但蛋白质摄入量和体重变化无差异。
严重营养不良风险独立预测接受肠内营养的中风康复期患者实现完全经口进食的情况。
