Centre for Dietetics Research, School of Human Movement and Nutritional Sciences, The University of Queensland, St Lucia, QLD 4072, Australia; Master of Nutrition and Dietetic Practice Program, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4229, Australia; Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia.
Centre for Dietetics Research, School of Human Movement and Nutritional Sciences, The University of Queensland, St Lucia, QLD 4072, Australia; Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia.
Clin Nutr. 2019 Apr;38(2):759-766. doi: 10.1016/j.clnu.2018.02.033. Epub 2018 Mar 10.
BACKGROUND & AIMS: Obesity, defined as a BMI ≥ 30 kg/m, has demonstrated protective associations with mortality in some diseases. However, recent evidence demonstrates that poor nutritional status in critically ill obese patients confounds this relationship. The purpose of this paper is to evaluate if poor nutritional status, poor food intake and adverse health-related outcomes have a demonstrated association in non-critically ill obese acute care hospital patients.
This is a secondary analysis of the Australasian Nutrition Care Day Survey dataset (N = 3122), a prospective cohort study conducted in hospitals from Australia and New Zealand in 2010. At baseline, hospital dietitians recorded participants' BMI, evaluated nutritional status using Subjective Global Assessment (SGA), and recorded 24-h food intake (as 0%, 25%, 50%, 75%, and 100% of the offered food). Post-three months, participants' length of stay (LOS), readmissions, and in-hospital mortality data were collected. Bivariate and regression analyses were conducted to investigate if there were an association between BMI, nutritional status, poor food intake, and health-related outcomes.
Of the 3122 participants, 2889 (93%) had eligible data. Obesity was prevalent in 26% of the cohort (n = 750; 75% females; 61 ± 15 years; 37 ± 7 kg/m). Fourteen percent (n = 105) of the obese patients were malnourished. Over a quarter of the malnourished obese patients (N = 30/105, 28%) consumed ≤25% of the offered meals. Most malnourished obese patients (74/105, 70%) received standard diets without additional nutritional support. After controlling for confounders (age, disease type and severity), malnutrition and intake ≤25% of the offered meals independently trebled the odds of in-hospital mortality within 90 days of hospital admission in obese patients.
Although malnourished obese experienced significantly adverse health-related outcomes they were least likely to receive additional nutritional support. This study demonstrates that BMI alone cannot be used as a surrogate measure for nutritional status and warrants routine nutritional screening for all hospital patients, and subsequent nutritional assessment and support for malnourished patients.
肥胖定义为 BMI≥30kg/m²，在某些疾病中与死亡率呈保护相关。然而，最近的证据表明，危重病肥胖患者的营养状况不佳会使这种关系复杂化。本文旨在评估非危重病肥胖急性护理住院患者的营养状况不佳、食物摄入不良和不良健康相关结局之间是否存在关联。
这是对澳大利亚和新西兰医院 2010 年进行的前瞻性队列研究——营养护理日调查数据集（N=3122）的二次分析。在基线时，医院营养师记录了参与者的 BMI，使用主观全面评估（SGA）评估营养状况，并记录了 24 小时食物摄入量（作为提供食物的 0%、25%、50%、75%和 100%）。三个月后，收集了参与者的住院时间（LOS）、再入院和院内死亡率数据。进行了单变量和回归分析，以调查 BMI、营养状况、食物摄入不良和健康相关结局之间是否存在关联。
在 3122 名参与者中，有 2889 名（93%）符合条件。该队列中肥胖的患病率为 26%（n=750；女性占 75%；61±15 岁；37±7kg/m²）。14%（n=105）的肥胖患者存在营养不良。四分之一以上的营养不良肥胖患者（n=30/105，28%）摄入的膳食量≤25%。大多数营养不良肥胖患者（n=74/105，70%）接受标准饮食，没有额外的营养支持。在控制了混杂因素（年龄、疾病类型和严重程度）后，营养不良和摄入≤提供膳食量的 25%使肥胖患者在入院后 90 天内院内死亡率增加两倍。
尽管营养不良的肥胖患者经历了显著的不良健康相关结局，但他们最不可能获得额外的营养支持。本研究表明，BMI 不能单独作为营养状况的替代指标，需要对所有住院患者进行常规营养筛查，并对营养不良患者进行后续的营养评估和支持。
