Endocrinology and Nutrition Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; CIBERER, Instituto de Salud Carlos III, Madrid, Spain; ICREC Research Program, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain.
Endocrinology and Nutrition Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; CIBERER, Instituto de Salud Carlos III, Madrid, Spain; ICREC Research Program, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain.
Clin Nutr. 2019 Dec;38(6):2740-2746. doi: 10.1016/j.clnu.2018.12.001. Epub 2018 Dec 10.
BACKGROUND & AIMS: There is no consensus on the best method for nutritional screening and assessment in patients with heart failure (HF). This study aimed to determine which nutritional assessment method had the highest prognostic significance for patients with HF treated in outpatient clinics. We also aimed to identify a fast, reliable screening method for detecting malnutrition in these patients.
This prospective study included 151 subjects that attended an outpatient HF clinic at a university hospital. All patients completed three nutritional screening tools: the Malnutrition Universal Screening Tool (MUST), the MNA-short form (MNA-SF), and the Malnutrition Screening Tool (MST), and then, two nutritional assessment questionnaires: the Subjective Global Assessment (SGA) and the Mini Nutritional Assessment®(MNA). Patients were followed-up for 2 years. The primary endpoint was all-cause mortality.
Malnutrition or nutritional risk was identified in 15.9% of patients with the SGA and in 25.1% of patients with the MNA. Age, New York Heart Association (NYHA) functional class, and MNA were the only independent all-cause death predictors after adjusting for age, gender, NYHA functional class, body mass index, Barthel index, 25-hydroxyvitamin D concentrations, treatment with angiotensin converting enzyme inhibitors or angiotensin II receptor blockers, and treatment with beta-blockers. The SGA could not independently predict all-cause mortality in a multivariate analysis that included the same covariates. The MNA-SF had the best sensitivity, specificity, and kappa coefficient for screening malnutrition, based on the MNA and the SGA as references, compared to the other screening methods.
In our cohort, malnutrition assessed by MNA, but not by SGA, was an independent predictor of mortality. MNA-SF showed remarkable sensitivity and specificity; thus, it might be a valuable tool for rapidly identifying malnutrition risk in outpatients with HF.
心力衰竭（HF）患者的营养筛查和评估方法尚未达成共识。本研究旨在确定哪种营养评估方法对在门诊接受治疗的 HF 患者具有最高的预后意义。我们还旨在确定一种快速、可靠的筛查方法，以检测这些患者的营养不良。
这项前瞻性研究纳入了在一所大学医院的门诊 HF 诊所就诊的 151 例患者。所有患者均完成了三种营养筛查工具：营养不良通用筛查工具（MUST）、MNA 简化版（MNA-SF）和营养不良筛查工具（MST），然后完成了两种营养评估问卷：主观全面评估（SGA）和微型营养评估®（MNA）。对患者进行了 2 年的随访。主要终点是全因死亡率。
根据 SGA，有 15.9%的患者存在营养不良或营养风险，根据 MNA，有 25.1%的患者存在营养不良或营养风险。在校正年龄、性别、纽约心脏协会（NYHA）功能分级、体质量指数、巴氏指数、25-羟维生素 D 浓度、血管紧张素转换酶抑制剂或血管紧张素 II 受体阻滞剂治疗以及β受体阻滞剂治疗后，年龄、NYHA 功能分级和 MNA 是全因死亡的唯一独立预测因素。在包括上述相同协变量的多变量分析中，SGA 不能独立预测全因死亡率。与其他筛查方法相比，MNA-SF 在以 MNA 和 SGA 为参考的情况下，对筛查营养不良具有最佳的敏感性、特异性和kappa 系数。
在我们的队列中，MNA 评估的营养不良，而不是 SGA 评估的营养不良，是死亡率的独立预测因素。MNA-SF 显示出显著的敏感性和特异性；因此，它可能是快速识别门诊 HF 患者营养风险的有价值工具。
