营养状况与严重痴呆和死亡率相关：Cache 县痴呆进展研究。
Nutritional Status is Associated With Severe Dementia and Mortality: The Cache County Dementia Progression Study.
机构信息
Utah State University, Logan, UT.
The Johns Hopkins University, Baltimore, MD.
出版信息
Alzheimer Dis Assoc Disord. 2018 Oct-Dec;32(4):298-304. doi: 10.1097/WAD.0000000000000274.
PURPOSE
Studies have reported faster cognitive/functional decline in persons with dementia (PWD) with malnutrition. We investigated whether baseline nutritional status predicted severe dementia and mortality in a population-based sample.
PATIENTS
A maximum of 300 PWD were assessed annually for up to 8.6 years.
METHODS
Nutritional status was assessed using a modified Mini-Nutritional Assessment (mMNA). Severe dementia was defined as: "severe" rating on the Clinical Dementia Rating or Mini-Mental State Examination score ≤10. Using Cox proportional hazards models, we examined the association between baseline mMNA score (or its subcomponents) with each outcome. Covariates included demographics; dementia onset age, type, and duration; APOE genotype; and residency with caregiver.
RESULTS
Compared with "well-nourished," "malnourished" PWD had 3-4 times the hazard of severe dementia [hazard ratio (HR), 4.31; P=0.014] and death (HR, 3.04; P<0.001). Those "at risk for malnutrition" had twice the hazard of severe dementia (HR, 1.98; P=0.064) and 1.5 times the hazard of death (HR, 1.46; P=0.015). mMNA subcomponents of food group intake, weight loss, body mass index, mobility, health status, protein consumption, and mid-arm circumference predicted one or both outcomes.
CONCLUSIONS
Nutritional status is an important predictor of clinical outcomes in dementia and may provide an avenue for intervention.
目的
研究报告称，营养不良的痴呆症患者（PWD）认知/功能衰退更快。我们调查了在基于人群的样本中，基线营养状况是否预测严重痴呆和死亡率。
患者
最多有 300 名 PWD 每年接受评估，最长可达 8.6 年。
方法
使用改良的迷你营养评估（mMNA）评估营养状况。严重痴呆定义为：临床痴呆评定或简易精神状态检查评分≤10 的“严重”评分。使用 Cox 比例风险模型，我们检查了基线 mMNA 评分（或其亚成分）与每种结局之间的关联。协变量包括人口统计学特征；痴呆发病年龄、类型和持续时间；APOE 基因型；以及与照顾者一起居住。
结果
与“营养良好”相比，“营养不良”的 PWD 发生严重痴呆的风险增加了 3-4 倍[风险比（HR），4.31；P=0.014]和死亡（HR，3.04；P<0.001）。那些“有营养不良风险”的患者发生严重痴呆的风险增加了两倍（HR，1.98；P=0.064），死亡风险增加了 1.5 倍（HR，1.46；P=0.015）。食物摄入、体重减轻、身体质量指数、活动能力、健康状况、蛋白质摄入和上臂中部周长等 mMNA 亚成分预测了一个或两个结局。
结论
营养状况是痴呆症临床结局的重要预测因素，可能为干预提供途径。
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