Geriatric Education and Research Institute, Singapore; Shanghai Center for Systems Biomedicine, Key Laboratory of Systems Biomedicine (Ministry of Education), Shanghai Jiao Tong University, Shanghai, China.
Gerontology Research Programme, Department of Psychological Medicine, National University of Singapore, Singapore.
Nutrition. 2019 Oct;66:180-186. doi: 10.1016/j.nut.2019.05.006. Epub 2019 May 29.
Older adults who are malnourished are at high risk for adverse functional and mortality outcomes. The aim of this study was to assess the long-term changes in nutritional status among community-living older adults and their associations with adverse health outcomes.
This was a population-based observational cohort study (Singapore Longitudinal Aging Study, SLAS 1), with a 4- to 5-y follow-up of 2075 community-living adults ≥60 y of age. Nutritional status (Mini Nutritional Assessment Short-Form [MNA-SF] and Nutritional Screening Initiative [NSI]), instrumental/basic activities of daily living (IADLs/ADLs) and quality of life (QoL) were assessed at both baseline and at the 4- to 5-y follow-up. The 10-y mortality was assessed from the date of 4- to 5-y follow-up to March 2017. Estimates of associations between changes in nutritional status and adverse health outcomes were analyzed using multinomial logistic regression or Cox proportional hazards regression, and indicated by odds ratios/hazard ratios (ORs/HRs) and 95% confidence intervals (CIs).
Nutritional status was dynamic from baseline to the 4- to 5-y follow-up according to both MNA-SF and NSI. Compared with persistent normal nutrition, nutritional deterioration was associated with increased incident IADL/ADL disability (MNA-SF: OR, 3.22; 95% CI, 1.13-9.16), poor QoL (MNA-SF: OR, 4.53; 95% CI 2.13-9.64), and mortality (MNA-SF: HR, 4.76; 95% CI, 2.82-8.03; NSI: HR, 1.99; 95% CI, 1.27-3.14); nutritional improvement was associated with decreased incident IADL/ADL disability (NSI: OR, 0.17; 95% CI, 0.05-0.59); persistent poor nutrition (MNA-SF at risk/malnourished or NSI moderate/high nutritional risk) was associated with elevated incidence of poor QoL (MNA-SF: OR, 1.92,; 95% CI, 1.05-3.52; NSI: OR, 2.31; 95% CI, 1.19-4.49) and mortality (MNA-SF: HR, 2.57; 95% CI, 1.59-4.15; NSI: HR 1.97; 95% CI, 1.17-3.32). Compared with persistent poor nutrition, nutritional improvement was also associated with decreased incidence of mortality (MNA-SF: HR, 0.43; 95% CI, 0.23-0.80).
Changes in nutritional status are associated with adverse health outcomes, and should be monitored with simple screening tools to identify older adults at high risk for adverse functional and mortality outcomes for selective nutritional interventions.
营养不良的老年人发生不良功能和死亡结局的风险很高。本研究旨在评估社区居住的老年人营养状况的长期变化及其与不良健康结局的关系。
这是一项基于人群的观察性队列研究（新加坡老龄化纵向研究，SLAS1），对 2075 名≥60 岁的社区居住成年人进行了 4-5 年的随访。在基线和 4-5 年随访时评估营养状况（迷你营养评估简表[MNA-SF]和营养筛查倡议[NSI]）、工具性/基本日常生活活动（IADLs/ADLs）和生活质量（QoL）。从 4-5 年随访日期到 2017 年 3 月评估 10 年死亡率。使用多项逻辑回归或 Cox 比例风险回归分析营养状况变化与不良健康结局之间的关联，并通过比值比/风险比（OR/HR）和 95%置信区间（CI）表示。
根据 MNA-SF 和 NSI，营养状况从基线到 4-5 年随访是动态变化的。与持续正常营养相比，营养恶化与新发 IADL/ADL 残疾（MNA-SF：OR，3.22；95%CI，1.13-9.16）、较差的 QoL（MNA-SF：OR，4.53；95%CI，2.13-9.64）和死亡（MNA-SF：HR，4.76；95%CI，2.82-8.03；NSI：HR，1.99；95%CI，1.27-3.14）有关；营养改善与新发 IADL/ADL 残疾减少有关（NSI：OR，0.17；95%CI，0.05-0.59）；持续营养不良（MNA-SF 风险/营养不良或 NSI 中度/高度营养风险）与较差的 QoL 发生率升高有关（MNA-SF：OR，1.92；95%CI，1.05-3.52；NSI：OR，2.31；95%CI，1.19-4.49）和死亡率（MNA-SF：HR，2.57；95%CI，1.59-4.15；NSI：HR，1.97；95%CI，1.17-3.32）。与持续营养不良相比，营养改善也与死亡率降低有关（MNA-SF：HR，0.43；95%CI，0.23-0.80）。
营养状况的变化与不良健康结局有关，应使用简单的筛查工具进行监测，以识别发生不良功能和死亡结局风险较高的老年人，以便进行有针对性的营养干预。
