Department of Rehabilitation, Nishi-Kobe Medical Centre, 5-7-1, Kojidai, Nishiku, Kobe, Hyogo, Japan; Department of Community Health Science, Kobe University Graduate School of Health Sciences, 7-10-2, Tomogaoka, Sumaku, Kobe, Japan.
Department of Community Health Science, Kobe University Graduate School of Health Sciences, 7-10-2, Tomogaoka, Sumaku, Kobe, Japan; Department of Rehabilitation, Kobe City Medical Centre West Hospital, 2-4, Ichiban-cho, Nagataku, Kobe, Japan.
Clin Nutr. 2019 Feb;38(1):220-226. doi: 10.1016/j.clnu.2018.01.030. Epub 2018 Feb 15.
BACKGROUND & AIMS: Several hip fracture patients are malnourished, but no study has attempted to determine the optimal nutritional screening tool for predicting functional outcomes. We investigated the association between each nutritional status assessed by four nutritional screening tools at admission and functional outcomes during the postoperative acute phase in hip fracture patients.
The Mini Nutritional Assessment-Short Form (MNA-SF), the Malnutrition Universal Screening Tool (MUST), the Nutritional Risk Score 2002 (NRS-2002) and the Geriatric Nutritional Risk Index (GNRI) were assessed at admission before surgery. We evaluated the motor domain of the functional independence measure (motor-FIM) score at discharge, efficiency on the motor-FIM (change in the motor-FIM score after postoperative rehabilitation divided by postoperative length of hospital stay), and 10-m walking speed at postoperative 14 days as functional outcomes.
Two hundred and five patients (mean patient age, 83.5 ± 7.0 years; range, 65-100 years; 82% female) were included. The MNA-SF evaluation classified 56 patients as well-nourished, 103 as at risk of malnutrition and 46 as malnourished. The MUST evaluation classified 97 patients as low risk, 42 as medium risk and 66 as high risk. The NRS-2002 evaluation classified 89 patients as well-nourished, 69 as medium risk and 47 as nutritionally at risk. The GNRI evaluation classified 44 patients as no risk, 74 as low risk and 87 as a major risk. Multiple linear regression analysis revealed that MNA-SF had a significant association with discharge motor-FIM (well-nourished vs. at risk of malnutrition, standardised β = -0.06, p = 0.04; vs. malnourished, standardised β = -0.32, p < 0.01), efficiency on the motor-FIM (well-nourished vs. malnourished, standardised β = -0.19, p = 0.02) and 10-m walking speed (well-nourished vs. malnourished, standardised β = -0.30, p < 0.01). The GNRI was significantly associated with 10-m walking speed (no risk vs. mild risk, standardised β = -0.23, p = 0.02; vs. major risk, standardised β = -0.37, p < 0.01), but not of motor-FIM and efficiency on the motor-FIM. No significant relationships were found among MUST and NRS-2002 and any functional outcomes.
The MNA-SF was found to be an optimal nutritional screening tool to associate with functional outcomes during the postoperative acute phase of elderly hip fracture patients.
一些髋部骨折患者存在营养不良，但尚无研究试图确定预测功能结局的最佳营养筛查工具。我们研究了入院时四种营养筛查工具评估的营养状况与髋部骨折患者术后急性阶段的功能结局之间的关系。
在手术前入院时评估迷你营养评估-简短表格（MNA-SF）、营养不良通用筛查工具（MUST）、营养风险评分 2002（NRS-2002）和老年营养风险指数（GNRI）。我们评估出院时功能独立性测量（motor-FIM）的运动域评分、运动-FIM 的效率（术后康复后运动-FIM 评分的变化除以术后住院时间）以及术后 14 天时 10 米步行速度作为功能结局。
共纳入 205 例患者（平均患者年龄 83.5±7.0 岁；范围 65-100 岁；82%为女性）。MNA-SF 评估将 56 例患者归类为营养良好，103 例患者归类为存在营养不良风险，46 例患者归类为营养不良。MUST 评估将 97 例患者归类为低风险，42 例患者归类为中风险，66 例患者归类为高风险。NRS-2002 评估将 89 例患者归类为营养良好，69 例患者归类为中风险，47 例患者归类为营养风险。GNRI 评估将 44 例患者归类为无风险，74 例患者归类为低风险，87 例患者归类为高风险。多元线性回归分析显示，MNA-SF 与出院时运动-FIM（营养良好与存在营养不良风险，标准化β=-0.06，p=0.04；与营养不良，标准化β=-0.32，p<0.01）、运动-FIM 的效率（营养良好与营养不良，标准化β=-0.19，p=0.02）和 10 米步行速度（营养良好与营养不良，标准化β=-0.30，p<0.01）显著相关。GNRI 与 10 米步行速度显著相关（无风险与轻度风险，标准化β=-0.23，p=0.02；与高风险，标准化β=-0.37，p<0.01），但与运动-FIM 和运动-FIM 的效率无关。MUST 和 NRS-2002 与任何功能结局之间均无显著关系。
MNA-SF 是评估老年髋部骨折患者术后急性阶段功能结局的最佳营养筛查工具。
