Department of Nutrition, CHRU de Lille, Lille, France; University of Lille, U995 - LIRIC - Lille Inflammation Research International Center, Lille, France.
Department of Public Health, EA 2694, University of Lille, Lille, France.
Clin Nutr. 2020 Jun;39(6):1900-1907. doi: 10.1016/j.clnu.2019.08.005. Epub 2019 Aug 17.
BACKGROUND & AIMS: Malnutrition affects 5-10% of elderly people living in the community. A few studies suggest that nutritional intervention may reduce health care costs. The present study included malnourished elderly patients living at home. It aimed to compare health care costs between patients that were prescribed ONS by their general practitioner and those who were not, and to assess the effect of ONS prescription on the risk of hospitalisation.
This prospective multicentre observational study included malnourished patients ≥70 years old who lived at home. Patients were defined as malnourished if they presented with one or more of the following criteria: weight loss ≥5% in 1 month, weight loss ≥10% in 6 months, BMI <21 kg/m, albuminemia <35 g/L or Short-Form MNA ≤ 7. Their general practitioners prescribed an ONS, or not, according to their usual practice. Health care costs were recorded during a 6-month period. Other collected data were diseases, disability, self-perception of current health status, quality of life (QoL), nutritional status, appetite and compliance to ONS. A propensity score method was used to compare costs and risk of hospitalisation to adjust for potential confounding factors and control for selection bias.
We analysed 191 patients. At baseline, the 133 patients (70%) who were prescribed ONS were more disabled (p < 0.001) and had poorer perception of their health (p = 0.02), lower QoL (p = 0.04) and lower appetite (p < 0.001) than the 58 patients (30%) who were not prescribed ONS. At 6 months, appetite had improved more in the ONS prescription group (p = 0.001). Weight change was not different between groups. Patients prescribed ONS were more frequently hospitalised (OR 2.518, 95% CI: [1.088; 5.829] hosp; p = 0.03). Analyses of adjusted populations revealed no differences in health care costs between groups. In the ONS prescription group, we identified that health care costs were lower (p = 0.042) in patients with an energy intake from ONS ≥ 500 kcal/d (1389 ± 264 €) vs. < 500 kcal/d (3502 ± 839 €). The risk of hospitalisation was reduced 3 and 5 times when the intake from ONS was ≥30 g of protein/day or ≥500 kcal/d, respectively.
ONS prescription in malnourished elderly patients generated no extra heath care cost. High energy and protein intake from ONS was associated with a reduced risk of hospitalisation and health care costs.
营养不良影响着 5-10%居住在社区中的老年人。一些研究表明，营养干预可能会降低医疗保健费用。本研究纳入了居家的营养不良老年患者，旨在比较经全科医生开具口服营养补充剂（ONS）与未开具 ONS 的患者的医疗保健费用，并评估 ONS 处方对住院风险的影响。
这是一项前瞻性多中心观察性研究，纳入了≥70 岁且居家的营养不良患者。患者如果出现以下一个或多个标准，即被定义为营养不良：1 个月内体重减轻≥5%，6 个月内体重减轻≥10%，BMI＜21kg/m²，白蛋白血症＜35g/L 或简易营养评估量表（MNA）得分≤7。他们的全科医生根据其常规做法开具或不开具 ONS。在 6 个月的时间内记录医疗保健费用。收集的其他数据包括疾病、残疾、对当前健康状况的自我感知、生活质量（QoL）、营养状况、食欲和对 ONS 的依从性。使用倾向评分法比较成本和住院风险，以调整潜在混杂因素并控制选择偏差。
我们分析了 191 名患者。基线时，133 名（70%）开具 ONS 的患者残疾程度更高（p＜0.001），健康感知更差（p=0.02），生活质量（p=0.04）和食欲（p＜0.001）更低，而 58 名（30%）未开具 ONS 的患者则相反。6 个月时，ONS 处方组的食欲改善更明显（p=0.001）。两组间体重变化无差异。服用 ONS 的患者更常住院（OR 2.518，95%CI：[1.088；5.829]，p=0.03）。在调整后的人群分析中，两组间的医疗保健费用无差异。在 ONS 处方组中，我们发现当 ONS 摄入的能量≥500kcal/d（1389±264 欧元）时，医疗保健费用更低（p=0.042），而当摄入能量＜500kcal/d（3502±839 欧元）时，医疗保健费用更高。ONS 摄入的蛋白质每天≥30g 或≥500kcal/d 时，住院风险分别降低 3 倍和 5 倍。
ONS 处方开具给营养不良的老年患者不会增加额外的医疗保健费用。ONS 摄入高能量和高蛋白与降低住院风险和医疗保健费用相关。
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