中上臂周径与 Powell-Tuck 和 Hennessy 方程与体重指数相关，可在胃造口喂养患者中依次使用。

Mid upper arm circumference and Powell-Tuck and Hennessy's equation correlate with body mass index and can be used sequentially in gastrostomy fed patients.

机构信息

Gastroenterology Department, Hospital Garcia de Orta, Almada, Portugal.

出版信息

Clin Nutr. 2018 Oct;37(5):1584-1588. doi: 10.1016/j.clnu.2017.08.011. Epub 2017 Aug 19.

DOI:10.1016/j.clnu.2017.08.011

Abstract

BACKGROUND & AIMS: Body Mass Index (BMI) is a simple and widespread method to assess undernutrition. However its use may be limited in bedridden patients.

AIMS

compare BMI, Mid Upper Arm Circumference (MUAC) and Powell-Tuck and Hennessy's regression equation for BMI (BMIPTH) in gastrostomy fed patients, 2) validate its correlation for sequential use and 3) select the best cut-off of MUAC and BMIPTH to predict risk of undernutrition.

METHODS

Prospective study including adult patients who underwent endoscopic gastrostomy (PEG). BMI, MUAC and BMIPTH adjusted for sex and age were determined at the day of gastrostomy (0), first (1) and third (3) months of follow up. Correlations between BMI and MUAC and BMIPTH were calculated at all time-points using Spearman's test. MUAC's Area Under ROC (AUROC) to predict risk of undernutrition (BMI ≤ 18,5 kg/m in non-elderly (<65 years) and BMI ≤ 22,5 kg/m in elderly (≥65 years)) was calculated with DeLong method and Youden Index was used to select the best cut-off for this outcome.

RESULTS

405 PEG patients were included (69,9% males, median age 62,9 ± 15,3 years). Head and neck cancer and neurological disorders were the main indications for gastrostomy. BMI correlated moderately with BMIPTH0 (ρ = 0.646-0.694), MUAC0 (ρ = 0.669) and MUAC1 (ρ = 0.699). BMI correlated strongly with BMIPTH1 (ρ = 0.764-0.794), BMIPTH3 (ρ = 0.714-0.732) and MUAC3 (ρ = 0.725). MUAC and BMIPTH's accuracy was not significantly different to predict undernutrition neither in elderly (AUROC 0.835 ± 0.033 Vs. 0.836 ± 0.033 respectively, p = 0.319) nor in non-elderly patients (AUROC 0.857 ± 0.027 Vs. 0.888 ± 0.053 respectively, p = 0.256). MUAC <26 cm (positive predictive value (PPV) 83.5%) or BMIPTH <22 kg/m (PPV 83.5%) in elderly and MUAC <25 cm (PPV 90.7%) or BMIPTH <21 kg/m (PPV 91.7%) in non-elderly can accurately predict risk of undernutrition in PEG patients.

CONCLUSIONS

MUAC and BMIPTH correlated with BMI not only at the day of PEG placement but also at the 1st and 3rd month of follow up and were equivalent to predict risk of undernutrition according to the new cut-offs defined for this population.

摘要

背景与目的

体重指数（BMI）是一种简单且广泛的方法，用于评估营养不良。然而，在卧床不起的患者中，其使用可能会受到限制。

目的

1）比较胃造口喂养患者的 BMI、上臂中部周长（MUAC）和 Powell-Tuck 和 Hennessy 的 BMI 回归方程（BMIPTH），2）验证其连续使用的相关性，3）选择 MUAC 和 BMIPTH 的最佳截断值以预测营养不良风险。

方法

这是一项包括接受内镜胃造口术（PEG）的成年患者的前瞻性研究。在胃造口术当天（0）、第 1 个月（1）和第 3 个月（3）随访时，确定 BMI、MUAC 和 BMIPTH 调整性别和年龄后的数值。使用 Spearman 检验计算所有时间点 BMI 与 MUAC 和 BMIPTH 之间的相关性。使用 DeLong 方法计算 MUAC 的 ROC 曲线下面积（AUROC）来预测营养不良风险（非老年人（<65 岁）的 BMI≤18.5kg/m，老年人（≥65 岁）的 BMI≤22.5kg/m），并使用 Youden 指数选择该结果的最佳截断值。

结果

共纳入 405 例 PEG 患者（69.9%为男性，中位年龄 62.9±15.3 岁）。头颈部癌症和神经障碍是胃造口术的主要指征。BMI 与 BMIPTH0（ρ=0.646-0.694）、MUAC0（ρ=0.669）和 MUAC1（ρ=0.699）中度相关。BMI 与 BMIPTH1（ρ=0.764-0.794）、BMIPTH3（ρ=0.714-0.732）和 MUAC3（ρ=0.725）高度相关。在老年人（AUROC 0.835±0.033 与 0.836±0.033，p=0.319）和非老年人患者（AUROC 0.857±0.027 与 0.888±0.053，p=0.256）中，MUAC 和 BMIPTH 的准确性预测营养不良的差异均无统计学意义。老年人中 MUAC<26cm（阳性预测值（PPV）83.5%）或 BMIPTH<22kg/m（PPV 83.5%），非老年人中 MUAC<25cm（PPV 90.7%）或 BMIPTH<21kg/m（PPV 91.7%）可准确预测 PEG 患者的营养不良风险。