Račić M, Ivković N, Kusmuk S
Acta Med Croatica. 2015 Nov;69(4):347-56.
The prevalence of malnutrition in elderly is high. Malnutrition or risk of malnutrition can be detected by use of nutritional screening or assessment tools. This systematic review aimed to identify tools that would be reliable, valid, sensitive and specific for nutritional status screening in patients older than 65 at family medicine. The review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies were retrieved using MEDLINE (via Ovid), PubMed and Cochrane Library electronic databases and by manual searching of relevant articles listed in reference list of key publications. The electronic databases were searched using defined key words adapted to each database and using MESH terms. Manual revision of reviews and original articles was performed using Electronic Journals Library. Included studies involved development and validation of screening tools in the community-dwelling elderly population. The tools, subjected to validity and reliability testing for use in the community-dwelling elderly population were Mini Nutritional Assessment (MNA), Mini Nutritional Assessment-Short Form (MNA-SF), Nutrition Screening Initiative (NSI), which includes DETERMINE list, Level I and II Screen, Seniors in the Community: Risk Evaluation for Eating, and Nutrition (SCREEN I and SCREEN II), Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), and Malaysian and South African tool. MNA and MNA-SF appear to have highest reliability and validity for screening of community-dwelling elderly, while the reliability and validity of SCREEN II are good. The authors conclude that whilst several tools have been developed, most have not undergone extensive testing to demonstrate their ability to identify nutritional risk. MNA and MNA-SF have the highest reliability and validity for screening of nutritional status in the community-dwelling elderly, and the reliability and validity of SCREEN II are satisfactory. These instruments also contain all three nutritional status indicators and are practical for use in family medicine. However, the gold standard for screening cannot be set because testing of reliability and continuous validation in the study with a higher level of evidence need to be conducted in family medicine.
老年人营养不良的患病率很高。可通过使用营养筛查或评估工具来检测营养不良或营养不良风险。本系统评价旨在确定对家庭医学中65岁以上患者营养状况筛查可靠、有效、敏感且特异的工具。该评价按照系统评价和Meta分析的首选报告项目（PRISMA）声明进行。通过MEDLINE（经由Ovid）、PubMed和Cochrane图书馆电子数据库检索研究，并通过人工搜索关键出版物参考文献列表中列出的相关文章。使用适应每个数据库的定义关键词并结合医学主题词（MESH）对电子数据库进行搜索。使用电子期刊图书馆对手册中的综述和原始文章进行修订。纳入的研究涉及社区居住老年人群筛查工具的开发和验证。在社区居住老年人群中进行有效性和可靠性测试的工具包括微型营养评定法（MNA）、微型营养评定简表（MNA-SF）、营养筛查倡议（NSI），其中包括“判定”清单、一级和二级筛查、社区老年人：饮食与营养风险评估（SCREEN I和SCREEN II）、主观全面评定法（SGA）、营养风险指数（NRI）以及马来西亚和南非的工具。MNA和MNA-SF在筛查社区居住老年人方面似乎具有最高可靠性和有效性，而SCREEN II的可靠性和有效性良好。作者得出结论，虽然已开发出多种工具，但大多数尚未经过广泛测试以证明其识别营养风险的能力。MNA和MNA-SF在筛查社区居住老年人营养状况方面具有最高可靠性和有效性，SCREEN II的可靠性和有效性令人满意。这些工具还包含所有三项营养状况指标，在家庭医学中使用很实用。然而，由于需要在家庭医学中开展具有更高证据水平的研究进行可靠性测试和持续验证，因此无法设定筛查的金标准。
