Monacelli F, Sartini M, Bassoli V, Becchetti D, Biagini A L, Nencioni A, Cea M, Borghi R, Torre F, Odetti P
Dr. Fiammetta Monacelli, MD, PhD, Researcher Assistant in Geriatrics, Dept of Internal Medicine and Medical Specialties (DIMI), Viale Benedetto XV, 6, 16132 Genoa, Italy, Phone/fax+390103537545, e-mail
J Nutr Health Aging. 2017;21(6):614-621. doi: 10.1007/s12603-016-0814-y.
The aim of the present study was to validate the photographic indirect method as an accurate and specific tool to assess nutritional intake in a cohort of elderly hospitalized patients.
this is a prospective observational study.
hospital (geriatric acute ward and transitional care of IRCCSS AUO San Martino Hospital, Genoa, Italy).
255 consecutive elderly hospitalized patients.
assessment of malnutrition by: Mini nutritional assessment (MNA) and abbreviated Comprehensive geriatric assessment (CIRS; Barthel index, SPMSE). The direct method (Gold standard): food dish weight (before lunch) and residual (after lunch) food dish weight and estimation of the percentage of eaten food and of residual food for each dish. The percentages of food intake and residual food were calculated according to the following formula: intake %= initial weight of the dishes- residual food weight)/ initial weight dish x100. The unit of variable was the percentage. The indirect photographic method with extrapolation of the lunch food intake by photographic method confronting initial meal and residual meal (25% quartile food dish estimation).
The results showed a significant correlation between the direct method (weighing residual food) and the indirect photographic method(n=255; r=0.9735; p<0.001) as well as a significant positive correlation between the indirect photographic method and the food caloric estimation calculated by the direct method (n=255; r= 0.6489, p<0.001). Intraclass coefficient (ICC), showed a highly significant degree of agreement between the gold standard and the indirect photographic method (ICC: 0.69; p<0.0001). Additionally, the results showed a good inter rater agreement of the indirect photographic method (kappa-statistic measure of interrater agreement: (Z=13.04; p<0.001); agreement 70.29% e Kappa=0.5965) and a good specificity of the indirect method as it was independent on the single food item.
The study originally provided the validation of the indirect photographic method for the assessment of nutritional intake in a vast cohort of hospitalized elderly subjects. The present results moved a step forward in the appropriate assessment of nutrition intake in frail elderly, providing an easy to use tool that may be incorporate in routine clinical practice for early and targeted therapeutic interventions.
本研究的目的是验证摄影间接法作为一种准确且特异的工具，用于评估一组老年住院患者的营养摄入量。
这是一项前瞻性观察性研究。
医院（意大利热那亚IRCCSS AUO圣马蒂诺医院的老年急性病房和过渡护理病房）。
255名连续的老年住院患者。
通过以下方法评估营养不良：微型营养评定法（MNA）和简化综合老年评定法（CIRS；巴氏指数、简易精神状态检查表）。直接法（金标准）：午餐前餐盘重量和午餐后餐盘剩余重量，并估算每道菜的进食食物百分比和剩余食物百分比。食物摄入量和剩余食物百分比根据以下公式计算：摄入量% =（餐盘初始重量 - 剩余食物重量）/餐盘初始重量×100。变量单位为百分比。间接摄影法，通过对比初始餐食和剩余餐食的照片（25%四分位数餐盘估计）外推午餐食物摄入量。
结果显示直接法（称量剩余食物）与间接摄影法之间存在显著相关性（n = 255；r = 0.9735；p < 0.001），并且间接摄影法与直接法计算的食物热量估计值之间存在显著正相关（n = 255；r = 0.6489，p < 0.001）。组内相关系数（ICC）显示金标准与间接摄影法之间具有高度显著的一致性程度（ICC：0.69；p < 0.0001）。此外，结果显示间接摄影法具有良好的评分者间一致性（评分者间一致性的kappa统计量测量：（Z = 13.04；p < 0.001）；一致性为70.29%，Kappa = 0.5965），并且间接法具有良好的特异性，因为它不依赖于单一食物项目。
本研究首次验证了摄影间接法可用于评估大量住院老年受试者的营养摄入量。目前的结果在虚弱老年人营养摄入量的恰当评估方面向前迈进了一步，提供了一种易于使用的工具，可纳入常规临床实践以进行早期和有针对性的治疗干预。
