Sánchez-Rodríguez Dolores, Marco Ester, Annweiler Cédric, Ronquillo-Moreno Natalia, Tortosa Andrea, Vázquez-Ibar Olga, Escalada Ferran, Duran Xavier, Muniesa Josep M
Geriatrics Department, Parc de Salut Mar (Centre Fòrum - Hospital del Mar), Barcelona, Spain; Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; School of Medicine, Universitat Autònoma de Barcelona, Spain; School of Medicine, Universitat Pompeu Fabra, Barcelona, Spain.
Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), 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; Universitat Internacional de Catalunya, Barcelona, Spain.
Arch Gerontol Geriatr. 2017 Nov;73:169-176. doi: 10.1016/j.archger.2017.07.010. Epub 2017 Aug 2.
To determine the relationships between malnutrition and nutrition-related conditions according to the European Society of Clinical Nutrition and Metabolism (ESPEN) consensus and guidelines and clinical outcomes in postacute rehabilitation.
Of 102 eligible inpatients, 95 (84.5 years old, 63.2% women) fulfilled inclusion criteria: aged ≥70 years, body mass index <30kg/m, admission for rehabilitation. Mini-Nutritional Assessment-Short Form (MNA-SF≤11) identified patients "at risk" and ESPEN basic and etiology based definitions were applied. Nutrition-related conditions (sarcopenia, frailty, overweight/obesity, micronutrient abnormalities) were determined. We assessed the relationship between these conditions and the clinical and rehabilitation outcomes (relative functional gain, rehabilitation efficiency) during hospitalization.
All patients were "at risk" by MNA-SF criteria and 31 reported unintentional weight loss >5% in the last year or 2-3kg in the last 6 months. Nineteen fulfilled the ESPEN basic definition, of which 10 had disease-related malnutrition with inflammation and 9 without inflammation, and 20 had cachexia. Sarcopenia (n=44), frailty (n=94), overweight/obesity (n=59), and micronutrient abnormalities (n=70) were frequent. Unintentional weight loss impaired all functional outcomes and increased length of stay [OR=6.04 (2.87-9.22); p<0.001]. In multivariate analysis, relationships between rehabilitation impact indices and the ESPEN basic and etiology-based definitions observed in univariate analysis persisted only (and marginally) for relative functional gain [OR=13.24 (0.96-181.95); p=0.005]. Infrequent in-hospital mortality prevented meaningful analysis of this outcome.
ESPEN basic and etiology-based definitions and nutrition related disorders were determined in postacute care. Malnutrition was associated with poor rehabilitation outcomes, mainly due to unintentional weight loss.
根据欧洲临床营养与代谢学会（ESPEN）的共识和指南，确定急性后期康复中营养不良与营养相关状况之间的关系以及临床结局。
在102名符合条件的住院患者中，95名（平均年龄84.5岁，63.2%为女性）符合纳入标准：年龄≥70岁，体重指数<30kg/m²，因康复入院。采用简易营养评估简表（MNA-SF≤11）确定“有风险”的患者，并应用ESPEN基于基本情况和病因的定义。确定营养相关状况（肌肉减少症、衰弱、超重/肥胖、微量营养素异常）。我们评估了这些状况与住院期间临床和康复结局（相对功能改善、康复效率）之间的关系。
根据MNA-SF标准，所有患者均“有风险”，31名患者报告在过去一年中体重意外减轻>5%或在过去6个月中减轻2-3kg。19名患者符合ESPEN基本定义，其中10名患有与疾病相关的伴有炎症的营养不良，9名不伴有炎症，20名患有恶病质。肌肉减少症（n=44）、衰弱（n=94）、超重/肥胖（n=59）和微量营养素异常（n=70）很常见。体重意外减轻损害了所有功能结局并延长了住院时间[比值比=6.04（2.87-9.22）；p<0.001]。在多变量分析中，单变量分析中观察到的康复影响指数与ESPEN基于基本情况和病因的定义之间的关系仅（且勉强）在相对功能改善方面持续存在[比值比=13.24（0.96-181.95）；p=0.005]。住院期间死亡率较低，无法对该结局进行有意义的分析。
在急性后期护理中确定了ESPEN基于基本情况和病因的定义以及营养相关疾病。营养不良与康复结局不佳相关，主要原因是体重意外减轻。
