Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands; Department of Nutrition and Health, Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands; Dutch Malnutrition Steering Group, Amsterdam, The Netherlands.
Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands; Department of Dietetics, Albert Schweitzer Ziekenhuis, Dordrecht, The Netherlands.
Clin Nutr. 2018 Oct;37(5):1518-1525. doi: 10.1016/j.clnu.2017.08.024. Epub 2017 Aug 31.
The European Society for Clinical Nutrition and Metabolism (ESPEN) has recently published consensus-based criteria for the diagnosis of malnutrition; in subjects identified at nutritional risk the diagnosis is confirmed by either BMI <18.5 kg/m or weight loss in combination with low BMI or low FFMI. Concerns have been raised whether this definition correctly classifies malnutrition in patients with normal weight or overweight and concomitant weight loss. Therefore, the aim of this research is to assess the association between weight loss and one-year mortality in hospitalized patients, stratified by BMI and FFMI subgroups.
This prospective study included 769 patients admitted to the VU University Medical Center. Critical weight loss (CWL) was defined as >5% weight loss in the previous month or >10% weight loss in the previous six months. The association between CWL and one-year mortality was analyzed with a priori stratification by BMI cut-off values (</≥20.0 kg/m for patients <70 years and </≥22.0 kg/m for patients ≥70 years) and FFMI cut-off values (derived from BIA measurements, </≥15 kg/m for females and </≥17 kg/m for males). Mortality risks were calculated (HR, 95% CI).
CWL occurred in 35% of patients and was associated with an increased one-year mortality rate vs. no-CWL (25% vs. 15%, p = 0.001), HR for mortality risk 1.76 (1.26-2.45)). CWL + low FFMI was associated with higher mortality risk (HR 1.95 (1.20-3.17), whereas CWL + normal FFMI was not (HR 1.37 (0.85-2.21)). Among patients with normal/high BMI, those with CWL had a significantly higher mortality risk compared to those without critical weight loss, however additionally adding FFMI to that model showed that a low FFMI was crucial in the observed association with mortality (CWL + normal BMI + low FFMI, HR 2.69 (1.29-5.65); CWL + normal BMI + normal FFMI, HR 1.38 (0.84-2.27)).
欧洲临床营养与代谢学会（ESPEN）最近发布了用于营养不良诊断的基于共识的标准；在确定有营养风险的患者中，通过 BMI<18.5kg/m2 或体重减轻加上低 BMI 或低 FFMI 来确认诊断。有人担心，这种定义是否能正确分类体重正常或超重且伴有体重减轻的患者的营养不良。因此，本研究的目的是评估在按 BMI 和 FFMI 亚组分层的住院患者中，体重减轻与一年死亡率之间的相关性。
这项前瞻性研究纳入了 769 名入住 VU 大学医学中心的患者。临界体重下降（CWL）定义为过去一个月体重下降>5%或过去六个月体重下降>10%。通过 BMI 临界值（对于<70 岁的患者为</≥20.0kg/m2，对于≥70 岁的患者为</≥22.0kg/m2）和 FFMI 临界值（基于 BIA 测量，女性为</≥15kg/m2，男性为</≥17kg/m2）的预先分层，分析 CWL 与一年死亡率之间的相关性。计算死亡率风险（HR，95%CI）。
35%的患者发生 CWL，与无 CWL 相比，一年死亡率增加（25%比 15%，p=0.001），死亡率风险 HR 为 1.76（1.26-2.45）。CWL+低 FFMI 与更高的死亡率风险相关（HR 1.95（1.20-3.17），而 CWL+正常 FFMI 则不相关（HR 1.37（0.85-2.21））。在 BMI 正常/高的患者中，与无临界体重下降的患者相比，有 CWL 的患者死亡率明显更高，但在该模型中额外加入 FFMI 后，发现低 FFMI 是与死亡率相关的关键因素（CWL+正常 BMI+低 FFMI，HR 2.69（1.29-5.65）；CWL+正常 BMI+正常 FFMI，HR 1.38（0.84-2.27））。
-与无临界体重下降的患者相比，有临界体重下降的患者一年死亡率更高。FFMI 似乎在这种相关性中起着至关重要的作用，因为正常体重且 FFMI 正常的患者的死亡率低于其低 FFMI 的对应者。
