Geriatrics Department, Parc de Salut Mar (Centre Fòrum-Hospital del Mar), Barcelona, Spain; Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain; School of Medicine, Universitat Autònoma de Barcelona, Spain.
Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança), Barcelona, Spain; Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain; School of Medicine, Universitat Internacional de Catalunya, Spain.
Clin Nutr. 2017 Oct;36(5):1339-1344. doi: 10.1016/j.clnu.2016.08.024. Epub 2016 Sep 9.
BACKGROUNDS & AIMS: The European Society of Clinical Nutrition and Metabolism (ESPEN) consensus definition of malnutrition has been applied in hospitalized older diabetics and middle-aged patients, geriatric outpatients, and healthy elderly and young individuals. In a post-acute care setting, our aim was to assess malnutrition (ESPEN definition) and determine its relationship with sarcopenia in older in-patients deconditioned due to an acute process.
Eighty-eight in-patients aged ≥70 years with body mass index (BMI) <30 kg/m were included (84.1 years old; 62% women) and screened for malnutrition risk using biochemical markers and Mini-Nutritional Assessment-Short Form (MNA-SF). The ESPEN definition was applied: 1) BMI <18.5 kg/m or 2) unintentional weight loss plus a) low BMI or b) low fat-free mass index (FFMI). European Working Group on Sarcopenia in Older People (EWGSOP) criteria were also applied.
Unintentional weight loss occurred in 27 (30.7%) of 88 in-patients considered "at risk" by MNA-SF. Malnutrition prevalence was 4.5%, 7.9%, and 17% using ESPEN definitions 1, 2a, and 2b, respectively; 19.3% were malnourished. Prevalence of sarcopenia was 37.5%, of which 90.9% fulfilled ESPEN malnutrition criteria, a significant association (p = 0.02). No differences in biochemical markers were observed between patients with or without malnutrition or sarcopenia.
ESPEN criteria constitute an appropriate tool to establish a malnutrition diagnosis in post-acute care. Sarcopenia, as defined by EWGSOP, was present in 37.5% of patients, of which 90.9% fulfilled ESPEN criteria; therefore, malnutrition was significantly related to sarcopenia. Additional work is needed to determine further implications of the ESPEN consensus definition.
欧洲临床营养与代谢学会（ESPEN）的营养不良共识定义已应用于住院老年糖尿病患者和中年患者、老年门诊患者以及健康的老年和年轻个体。在急性后护理环境中，我们的目的是评估因急性疾病而身体虚弱的住院老年人的营养不良（ESPEN 定义）并确定其与肌肉减少症的关系。
纳入 88 名年龄≥70 岁且 BMI<30kg/m2 的住院患者（84.1 岁；62%为女性），使用生化标志物和迷你营养评估-简短表格（MNA-SF）筛查营养不良风险。应用 ESPEN 定义：1）BMI<18.5kg/m2 或 2）非有意体重减轻加上 a）低 BMI 或 b）低去脂体重指数（FFMI）。还应用了欧洲老年人肌肉减少症工作组（EWGSOP）标准。
88 名被 MNA-SF 认为“有风险”的住院患者中有 27 名（30.7%）发生非有意体重减轻。ESPEN 定义 1、2a 和 2b 分别显示营养不良的患病率为 4.5%、7.9%和 17%；19.3%的患者存在营养不良。肌肉减少症的患病率为 37.5%，其中 90.9%符合 ESPEN 营养不良标准，存在显著相关性（p=0.02）。有或无营养不良或肌肉减少症的患者之间的生化标志物无差异。
ESPEN 标准是在急性后护理中建立营养不良诊断的合适工具。根据 EWGSOP 定义的肌肉减少症在 37.5%的患者中存在，其中 90.9%符合 ESPEN 标准；因此，营养不良与肌肉减少症显著相关。需要进一步研究以确定 ESPEN 共识定义的进一步影响。
