Ng Tze Pin, Nyunt Ma Shwe Zin, Gao Qi, Wee Shiou Liang, Yap Philip, Yap Keng Bee
Gerontology Research Programme, Department of Psychological Medicine, National University of Singapore, Singapore; Geriatric Education and Research Institute, Alexandra Health Services, Singapore.
Gerontology Research Programme, Department of Psychological Medicine, National University of Singapore, Singapore.
Clin Nutr ESPEN. 2017 Dec;22:54-63. doi: 10.1016/j.clnesp.2017.08.012. Epub 2017 Sep 18.
Few nutritional measurement tools have been validated that predict long-term mortality risks in community-living older persons.
To develop and validate a new nutritional prognostic index (ENIGMA) for use in geriatric outpatient or primary care.
We developed the ENIGMA (four questions: unable to shop, cook or feed one's self, difficulty eating due to oral problem, eat few fruits or vegetables, 3 or more drugs a day, and four blood indicators: low albumin, hemoglobin, total cholesterol and lymphocyte count), and evaluated its predictive validity for 10 years mortality outcome in a development cohort (N = 1550) of community-living older persons, in comparison with the Geriatric Nutritional Risk Index (GNRI), Mini Nutritional Assessment (MNA) and ESPEN Malnutrition (ESPEN-M), and calibrated it externally in a validation cohort (N = 924).
In the development cohort, ENIGMA component indicators and summary risk score (0-10) were independently associated with significantly increased mortality hazard ratio (HR), adjusted for age, sex, chronic diseases, comorbidity and inflammatory status. Increasing risk categories predicted increasing adjusted HRs (95% CI); low (0-1): reference, moderate (2-3): 1.48 (1.10-2.00), high (4-5): 2.32 (1.52-3.55), very high (6+): 4.97 (2.52-9.77). ENIGMA showed better discriminatory accuracy (C = 0.67, 95% CI = 0.63-0.71) than MNA (C = 0.59, 95% CI = 0.55-0.63), GNRI (C = 0.57, 95% CI = 0.52-0.61), and ESPEN-M (C = 0.52, 95% CI = 0.48-0.56). The predictive accuracy and utility of ENIGMA was supported in the validation cohort (C = 0.68, 95% CI = 0.62-0.74); calibration-at-large, a = 0.00007, p = 0.187; calibration slope = 0.997, 95% CI, 0.997-0.998).
The ENIGMA is a validated nutritional prognostic tool that strongly predicts long-term mortality risks and is recommended for use in geriatric outpatient and primary care settings.
很少有营养测量工具经过验证可用于预测社区居住老年人的长期死亡风险。
开发并验证一种用于老年门诊或初级保健的新型营养预后指数（ENIGMA）。
我们开发了ENIGMA（四个问题：无法购物、做饭或自理饮食，因口腔问题进食困难，很少吃水果或蔬菜，每天服用3种或更多药物，以及四项血液指标：低白蛋白、血红蛋白、总胆固醇和淋巴细胞计数），并在一个社区居住老年人的开发队列（N = 1550）中评估其对10年死亡结局的预测有效性，与老年营养风险指数（GNRI）、微型营养评定（MNA）和欧洲临床营养和代谢学会营养不良标准（ESPEN-M）进行比较，并在一个验证队列（N = 924）中进行外部校准。
在开发队列中，经年龄、性别、慢性病、合并症和炎症状态校正后，ENIGMA的组成指标和综合风险评分（0 - 10）与死亡风险比（HR）显著增加独立相关。风险类别增加预示着校正后的HR增加（95%可信区间）；低（0 - 1）：参照组，中度（2 - 3）：1.48（1.10 - 2.00），高（4 - 5）：2.32（1.52 - 3.55），非常高（6及以上）：4.97（2.52 - 9.77）。ENIGMA显示出比MNA（C = 0.59，95%可信区间 = 0.55 - 0.63）、GNRI（C = 0.57，95%可信区间 = 0.52 - 0.61）和ESPEN-M（C = 0.52，95%可信区间 = 0.48 - 0.56）更好的鉴别准确性（C = 0.67，95%可信区间 = 0.63 - 0.71）。ENIGMA的预测准确性和实用性在验证队列中得到支持（C = 0.68，95%可信区间 = 0.62 - 0.74）；整体校准，a = 0.00007，p = 0.187；校准斜率 = 0.997，95%可信区间，0.997 - 0.998）。
ENIGMA是一种经过验证的营养预后工具，能有力地预测长期死亡风险，推荐用于老年门诊和初级保健环境。
