Lambert Christine, Nüssler Andreas, Biesalski Hans Konrad, Freude Thomas, Bahrs Christian, Ochs Gunnar, Flesch Ingo, Stöckle Ulrich, Ihle Christoph
Institute of Biological Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany.
Siegfried Weller Institute for Trauma Research, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany.
Nutrition. 2017 May;37:60-67. doi: 10.1016/j.nut.2016.12.013. Epub 2017 Jan 4.
The aim of this study was to investigate the prevalence of risk of malnutrition (RoM) in an orthopedic and traumatology patient cohort with a broad range of ages. In addition to the classical indicators for risk assessment (low body mass index, weight loss, and comorbidity), this study aimed to analyze the effects of lifestyle factors (eating pattern, smoking, physical activity) on RoM.
The prospective cohort study included 1053 patients in a level 1 trauma center in Germany. RoM was assessed by Nutritional Risk Screening (NRS) 2002 and for the elderly additionally by Mini Nutritional Assessment (MNA). Age-dependent risk factors identified in univariate statistical analysis were used for multivariate logistic regression models.
The prevalence of patients at RoM (NRS ≥3) was 22%. In the three age categories (<50 y, 50-69 y, and ≥70 y), loss of appetite, weight loss, number of comorbidities, drugs and gastrointestinal symptoms significantly increased RoM in univariate statistical analysis. In patients ages ≥70 y, several disease- and lifestyle-related factors (not living at home, less frequent consumption of vegetables and whole meal bread, low physical activity, and smoking) were associated with RoM. Multivariate logistic regression model for the total study population identified weight loss (odds ratio [OR], 6.09; 95% confidence interval [CI], 4.14-8.83), loss of appetite (OR, 3.81; 95% CI, 2.52-5.78), age-specific low BMI (OR, 1.87; 95% CI, 1.18-2.97), number of drugs taken (OR, 1.19; 95% CI, 1.12-1.26), age (OR, 1.03; 95% CI, 1.02-1.04), and days per week with vegetable consumption (OR, 0.938; 95% CI, 0.89-0.99) as risk factors.
Malnutrition in trauma and orthopedic patients is not only a problem related to age. Lifestyle-related factors also contribute significantly to malnutrition in geriatric patients.
本研究旨在调查不同年龄段的骨科和创伤科患者队列中营养不良风险（RoM）的患病率。除了风险评估的经典指标（低体重指数、体重减轻和合并症）外，本研究还旨在分析生活方式因素（饮食模式、吸烟、身体活动）对RoM的影响。
这项前瞻性队列研究纳入了德国一家一级创伤中心的1053名患者。采用2002年营养风险筛查（NRS）评估RoM，对于老年人还额外采用微型营养评定法（MNA）进行评估。单变量统计分析中确定的年龄依赖性风险因素用于多变量逻辑回归模型。
RoM（NRS≥3）患者的患病率为22%。在三个年龄组（<50岁、50 - 69岁和≥70岁）中，单变量统计分析显示，食欲不振、体重减轻、合并症数量、药物使用和胃肠道症状显著增加了RoM。在≥70岁的患者中，一些与疾病和生活方式相关的因素（不住在家中、蔬菜和全麦面包食用频率较低、身体活动量少和吸烟）与RoM相关。针对整个研究人群的多变量逻辑回归模型确定体重减轻（比值比[OR]，6.09；95%置信区间[CI]，4.14 - 8.83）、食欲不振（OR，3.81；95% CI，2.52 - 5.78）、特定年龄的低体重指数（OR，1.87；95% CI，1.18 - 2.97）、用药数量（OR，1.19；95% CI, 1.12 - 1.26）、年龄（OR，1.03；95% CI，1.02 - 1.04）以及每周食用蔬菜的天数（OR，0.938；95% CI，0.89 - 0.99）为风险因素。
创伤和骨科患者的营养不良不仅是一个与年龄相关的问题。与生活方式相关的因素也对老年患者的营养不良有显著影响。
