欧洲老年医学学院参会者关于营养评估和诊断方法的报告：一项国际调查。
European Academy for medicine of ageing session participants' report on malnutrition assessment and diagnostic methods; an international survey.
机构信息
Geriatrics Department. Parc de Salut Mar, Spain; Rehabilitation Research Group. Hospital Del Mar Medical Research Institute (IMIM), Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, CHU - Sart Tilman. Quartier Hôpital, Avenue Hippocrate 13 (Bât. B23), 4000, Liège, Belgium.
Department of Neurosciences and Aging, Division of Geriatric Medicine, Angers University Hospital, Angers University Memory Clinic, Research Center on Autonomy and Longevity, University of Angers, UNAM, Angers, France; Robarts Research Institute, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
出版信息
Clin Nutr ESPEN. 2020 Feb;35:75-80. doi: 10.1016/j.clnesp.2019.11.007. Epub 2019 Dec 13.
INTRODUCTION
Malnutrition and nutrition-related diseases are associated with hospital admissions, disability, institutionalization, and mortality in older people. Specialists in Geriatric Medicine and nutrition evaluate nutritional status as part of the comprehensive geriatric assessment; however, malnutrition still remains under-recognized and under-managed. Our survey explored nutrition assessment approaches used in daily clinical practice by geriatricians across Europe.
METHODS
A 19-item survey on methods and instruments for malnutrition assessment in geriatric settings, and details of any national guidelines, was sent to 40 postgraduate fellows of the European Academy of Medicine of Aging (EAMA, 2017-2019 class).
RESULTS
Thirty-six of the 40 eligible EAMA participants, representing 14 European countries, responded. In clinical practice, MNA and MNA-SF were most frequently used for screening (44.1%, 52.9%, respectively) and diagnosing (45.7%, 40.0%) malnutrition. Weight loss (n = 36, 100%), body mass index (n = 30, 85.7%), and low energy/food intake (n = 27, 77.1%) were the most frequent clinical variables considered. The absolute and relative amount of weight loss, and over what time period, varied widely. These routinely considered clinical factors contribute to validated GLIM, ASPEN-AND and ESPEN criteria for diagnosis of malnutrition, but these criteria were seldom used (GLIM = 0%, ASPEN = 0%; n = 9, ESPEN = 25.7%). National guidelines were available in 9 of the 14 countries, and generally recommended MNA and MNA-SF for community-dwelling and hospitalized older patients. Albumin was often suggested as a nutritional marker.
CONCLUSIONS
Nutritional assessment is systematically performed in geriatrics; but differs widely among geriatricians and countries. Harmonizing guidelines with the new international consensus might provide best-evidence care for older people across Europe.
简介
营养不良和与营养相关的疾病与老年人的住院、残疾、住院和死亡有关。老年医学和营养专家将营养状况评估作为综合老年评估的一部分；然而，营养不良仍然未被充分认识和管理。我们的调查探讨了欧洲各地老年医生在日常临床实践中使用的营养评估方法。
方法
向欧洲老年医学学院（EAMA，2017-2019 年）的 40 名研究生研究员发送了一份关于老年医学中营养评估方法和工具的 19 项调查，以及任何国家指南的详细信息。
结果
代表 14 个欧洲国家的 40 名合格 EAMA 参与者中有 36 名做出了回应。在临床实践中，MNA 和 MNA-SF 最常用于筛查（分别为 44.1%、52.9%）和诊断（分别为 45.7%、40.0%）营养不良。体重减轻（n=36，100%）、体重指数（n=30，85.7%）和低能量/食物摄入（n=27，77.1%）是最常考虑的临床变量。体重减轻的绝对值和相对值以及在多长时间内减轻，差异很大。这些经常考虑的临床因素有助于验证 GLIM、ASPEN-AND 和 ESPEN 营养不良诊断标准，但这些标准很少使用（GLIM=0%，ASPEN=0%；n=9，ESPEN=25.7%）。14 个国家中有 9 个国家有国家指南，一般建议 MNA 和 MNA-SF 用于社区居住和住院的老年患者。白蛋白常被建议作为营养标志物。
结论
营养评估在老年医学中系统进行；但在老年医生和国家之间差异很大。使指南与新的国际共识保持一致，可能为欧洲各地的老年人提供最佳循证护理。
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