Rocaspana-García Mariona, Blanco-Blanco Joan, Arias-Pastor Alfonso, Gea-Sánchez Montserrat, Piñol-Ripoll Gerard
University of Lleida, Faculty of Nursing and Physiotherapy, GRECS-IRBLleida, Lleida, Spain.
GESEC Research Group, Faculty of Nursing and Physiotherapy, University of Lleida, Health Care Research Group (GRECS), Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain.
PeerJ. 2018 Jul 6;6:e5150. doi: 10.7717/peerj.5150. eCollection 2018.
Alzheimer's disease (AD) is a neurodegenerative disease that is characterized by deficits in episodic memory. It is the most common form of dementia and affects 50-70% of patients with cognitive impairments over the age of 65. Elderly people are particularly susceptible to malnutrition and that risk is even higher in patients with AD. This study assessed the nutritional status of patients with AD at different stages of AD and explored how that status correlated with cognitive, functional and behavioural variables and caregiver overburden. The characteristics of the diet and the degree of adherence to the Mediterranean diet were also analysed.
This was a cross-sectional study that was representative of the general population and it was carried out in the Unit of Cognitive Disorders, Lleida, Spain. The participants were 111 subjects with AD who were aged 65 and over and still living at home. The subjects' nutritional status was assessed using the Mini Nutritional Assessment (MNA) and Controlling Nutritional Status system. The monthly food intake was estimated using the short Food Frequency Questionnaire and adherence to the Mediterranean diet was evaluated using the Mediterranean Diet Score. The Mini Mental State Examination (MMSE), Global Deterioration Scale, Neuropsychiatric Inventory (NPI) and Zarit Burden Interview (ZBI) were also used.
We found that 68% of the subjects presented with a risk of malnutrition and 19% were malnourished according to the MNA scale. Patients ate a higher quantity of meat and dairy products than recommended and fewer products from the remaining healthier food groups. Of the 111 subjects, 73% showed low adherence to the Mediterranean diet and 27% showed moderate adherence. There was a partial correlation between nutritional status and the MMSE when the data were adjusted for age and sex ( = 0, 318; = 0.001) and inverse correlations were found for functional status ( = - 0.283; = 0.004) and the NPI ( = - 0.409; = 0.000) and ZBI scales ( = - 0.433; = 0.000) when they were adjusted using the same variables. The ZBI scale (OR 1.08, 95% CI [1.01-1.15]) showed an increase in the risk of malnutrition in the multivariate analysis.
Alterations in nutritional status were more common during the advanced stages of AD and were also associated with behavioural changes and caregiver overburden. Low adherence to traditional healthy diets in Mediterranean countries and food intake profiles should be considered when managing patients with AD. Other countries can use the results to examine diets in people with AD that are high in meat and dairy and low in healthy food groups like fruit and vegetables.
阿尔茨海默病（AD）是一种神经退行性疾病，其特征是情景记忆缺陷。它是最常见的痴呆形式，影响65岁以上认知障碍患者的50 - 70%。老年人特别容易营养不良，而AD患者的这种风险更高。本研究评估了AD不同阶段患者的营养状况，并探讨了该状况与认知、功能和行为变量以及照料者负担之间的相关性。还分析了饮食特征和对地中海饮食的依从程度。
这是一项具有一般人群代表性的横断面研究，在西班牙莱里达的认知障碍科进行。参与者为111名65岁及以上且仍居住在家中的AD患者。使用微型营养评定法（MNA）和控制营养状况系统评估受试者的营养状况。使用简短食物频率问卷估计每月食物摄入量，并使用地中海饮食评分评估对地中海饮食的依从性。还使用了简易精神状态检查表（MMSE）、总体衰退量表、神经精神科问卷（NPI）和扎里特负担访谈量表（ZBI）。
根据MNA量表，我们发现68%的受试者存在营养不良风险，19%的受试者营养不良。患者食用的肉类和奶制品数量高于推荐量，而其余更健康食物组的产品食用较少。在111名受试者中，73%对地中海饮食的依从性较低，27%的依从性中等。在对年龄和性别进行数据调整后，营养状况与MMSE之间存在部分相关性（r = 0.318；P = 0.001），在使用相同变量进行调整后，发现与功能状态（r = -0.283；P = 0.004）、NPI（r = -0.409；P = 0.000）和ZBI量表（r = -0.433；P = 0.000）呈负相关。在多变量分析中，ZBI量表（比值比1.08，95%置信区间[1.01 - 1.15]）显示营养不良风险增加。
营养状况改变在AD晚期更为常见，并且还与行为变化和照料者负担相关。在地中海国家管理AD患者时，应考虑对传统健康饮食的低依从性和食物摄入情况。其他国家可以利用这些结果来研究AD患者中肉类和奶制品含量高而水果和蔬菜等健康食物组含量低的饮食情况。
