Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.
Medical University Vienna, Vienna, Austria.
Clin Nutr. 2017 Oct;36(5):1360-1371. doi: 10.1016/j.clnu.2016.09.005. Epub 2016 Sep 17.
BACKGROUND & AIMS: Oral nutritional supplements (ONS) can be helpful for nursing home (NH) residents to prevent or treat malnutrition. Presently little is known about the use of ONS in NHs and the factors associated with its use. Thus, the aim of this analysis was to describe the use of ONS in NHs participating in the nutritionDay project and to determine characteristics of NH residents receiving ONS.
Data from nutritionDay (nD), a cross-sectional multicenter study with standardized questionnaires on resident and NH level were analyzed. NH residents participating between 2007 and 2014 aged 65 years or older were included. Unit characteristics (2 variables), general residents' characteristics (18), residents' nutritional status (3) and residents' nutrition (4) were of interest as potential predictors of the use of ONS (no vs yes). Univariate binary logistic regression (LR) analyses were performed for all variables, and significant predictors (p < 0.05) subsequently included in a multivariate analysis (backwards LR).
13.9% of 23,689 NH residents received ONS. Univariate analysis identified all variables as predictors. After multivariate analysis 19 variables remained in the model (Nagelkerke's R = 0.319). Odds ratios (OR [95% Confidence Interval]) of receiving ONS were highest in residents receiving supplementary parenteral nutrition (29.05 [14.85-56.81]; however only 1.1% of all participants) and fortified diet (11.91 [8.52-16.64]; 5.7%). The odds ratio of receiving ONS was 3.26 ([2.86-3.71]; 18.3%) for residents being classified as at risk of malnutrition and 4.56 ([3.86-5.40]; 10.0%) for malnourished residents according to NH staff. Low BMI and weight loss in the last year increased the odds of receiving ONS by 2.34 ([1.93-2.84]; 16.0%) and 1.38 ([1.23-1.54]; 32.8%), respectively. Furthermore, increasing age, cognitive and functional impairment, low food intake on nD, neurological disease and cancer were associated with an increased likelihood of the use of ONS. In NH units with a nutritional expert (67.1%) and units performing a nutritional assessment at least once a month (71.6%), the odds of receiving ONS were also significantly increased (1.89 [1.71-2.10] and 1.17 [1.06-1.29]).
In NHs who participated in the nutritionDay, ONS are used for residents with poor nutritional and functional status and often in combination with other nutritional interventions. Future studies need to clarify the role of NH staff in the prescription and distribution of ONS and focus on the reasons for and adequacy of the use of ONS in NHs.
口服营养补充剂（ONS）有助于养老院（NH）居民预防或治疗营养不良。目前，人们对 NH 中 ONS 的使用情况以及与其使用相关的因素知之甚少。因此，本分析的目的是描述参与营养日（nD）项目的 NH 中 ONS 的使用情况，并确定接受 ONS 的 NH 居民的特征。
分析了 nD 的数据，这是一项横断面多中心研究，使用了标准化的居民和 NH 水平问卷。纳入 2007 年至 2014 年间年龄在 65 岁或以上的 NH 居民。感兴趣的单位特征（2 个变量）、一般居民特征（18 个）、居民营养状况（3 个）和居民营养（4 个）是 ONS 使用的潜在预测因素（无 vs 有）。对所有变量进行单变量二项逻辑回归（LR）分析，有意义的预测因子（p<0.05）随后被纳入多变量分析（向后 LR）。
23689 名 NH 居民中，13.9%接受了 ONS。单变量分析确定了所有变量都是预测因子。多变量分析后，19 个变量仍保留在模型中（Nagelkerke 的 R=0.319）。接受 ONS 的可能性最高的是接受补充肠外营养（29.05[14.85-56.81]；然而，所有参与者中只有 1.1%）和强化饮食（11.91[8.52-16.64]；5.7%）的居民。根据 NH 工作人员的分类，处于营养不良风险中的居民接受 ONS 的可能性为 3.26[2.86-3.71]；18.3%），营养不良居民的可能性为 4.56[3.86-5.40]；10.0%）。NH 工作人员认为 BMI 低和去年体重减轻会使接受 ONS 的可能性增加 2.34[1.93-2.84]；16.0%）和 1.38[1.23-1.54]；32.8%）。此外，年龄增长、认知和功能障碍、nD 时食物摄入量减少、神经疾病和癌症与接受 ONS 的可能性增加有关。在有营养专家的 NH 单位（67.1%）和每月至少进行一次营养评估的单位（71.6%）中，接受 ONS 的可能性也显著增加（1.89[1.71-2.10]和 1.17[1.06-1.29]）。
在参加营养日的 NH 中，ONS 用于营养和功能状况较差的居民，通常与其他营养干预措施联合使用。未来的研究需要阐明 NH 工作人员在 ONS 的开具和分发中的作用，并关注 NH 中 ONS 使用的原因和适当性。
