Dehesa-López Edgar, Martínez-Felix Jesús Israel, Ruiz-Ramos Arturo, Atilano-Carsi Ximena
Department of Nephrology, Hospital Civil de Culiacán, Mexico; Research and Teaching Center in Health Sciences (CIDOCS), Mexico; Autonomous University of Sinaloa, Mexico.
Research and Teaching Center in Health Sciences (CIDOCS), Mexico; Autonomous University of Sinaloa, Mexico.
Clin Nutr ESPEN. 2017 Apr;18:44-48. doi: 10.1016/j.clnesp.2017.01.006. Epub 2017 Feb 8.
BACKGROUND & AIMS: No universally accepted diagnostic criteria for malnutrition are available to date. The aim was to assess the concordance for the diagnosis of hospital malnutrition between the bioelectrical impedance vector analysis (BIVA) and the new definition of malnutrition proposed by the European Society for Clinical Nutrition and Metabolism (ESPEN).
A total of 140 adult hospitalized patients were included. The malnutrition risk was assessed by the Nutritional Risk Screening. The ESPEN malnutrition criteria (body mass index (BMI) <18.5 kg/m, weight loss (WL) + low BMI, and WL + low fat free mass index (FFMI) were applied to each patient. The bioelectrical impedance of each patient was measured, and malnutrition was diagnosed using the BIVA method. Diagnostic concordance between the BIVA and the new ESPEN definition was assessed with the Kappa coefficient.
The malnutrition prevalence was higher with the BIVA vs ESPEN definition (22.1% vs 13.6%) in the global population and was similar (12.8% vs 12.1%) in the population at risk of malnutrition. The diagnostic performance of the BIVA was acceptable, with higher sensitivity in patients with fluid overload (FO) and more specificity in euvolemic patients. Diagnostic concordance between the BIVA and the ESPEN definition was poor for the global population (kappa = 0.56) and the population at risk of malnutrition (kappa = 0.67) but was acceptable in patients with FO (kappa = 0.78). However, the discordant BIVA+/ESPEN- patients classified as false positives for BIVA showed clinical and body composition data (low FFMI, low phase angle) consistent with malnutrition.
According to the clinical and bioelectrical characteristics of the discordant BIVA+/ESPEN- patients, the BIVA could perform better that the new ESPEN definition for the diagnosis of hospital malnutrition, which should be confirmed with other studies.
目前尚无被普遍接受的营养不良诊断标准。本研究旨在评估生物电阻抗矢量分析（BIVA）与欧洲临床营养与代谢学会（ESPEN）提出的营养不良新定义在诊断医院内营养不良方面的一致性。
共纳入140例成年住院患者。通过营养风险筛查评估营养不良风险。将ESPEN营养不良标准（体重指数（BMI）<18.5 kg/m²、体重减轻（WL）+低BMI以及WL+低去脂体重指数（FFMI））应用于每位患者。测量每位患者的生物电阻抗，并使用BIVA方法诊断营养不良。用Kappa系数评估BIVA与ESPEN新定义之间的诊断一致性。
在总体人群中，BIVA定义的营养不良患病率高于ESPEN定义（22.1%对13.6%），而在有营养不良风险的人群中两者相似（12.8%对12.1%）。BIVA的诊断性能尚可，在液体过载（FO）患者中敏感性较高，在血容量正常的患者中特异性较高。BIVA与ESPEN定义在总体人群（kappa = 0.56）和有营养不良风险的人群（kappa = 0.67）中的诊断一致性较差，但在FO患者中可接受（kappa = 0.78）。然而，被BIVA分类为假阳性的BIVA+/ESPEN-不一致患者显示出与营养不良一致的临床和身体成分数据（低FFMI、低相位角）。
根据BIVA+/ESPEN-不一致患者的临床和生物电特征，BIVA在诊断医院内营养不良方面可能比ESPEN新定义表现更好，这一点有待其他研究证实。
