KU Leuven LUCAS - Centre for Care Research and Consultancy, Minderbroedersstraat 8, 3000, Leuven, Belgium.
KU Leuven Population Studies in Oral Health - Department of Oral Health Sciences, Kapucijnenvoer 7 Blok a - Bus 7001, 3000, Leuven, Belgium.
Clin Nutr. 2020 Nov;39(11):3477-3482. doi: 10.1016/j.clnu.2020.03.010. Epub 2020 Mar 13.
BACKGROUND & AIMS: As malnutrition is an important modifiable risk factor for poor clinical outcomes, it is important to target malnourished older people and older people at risk of malnourishment. The Global Leadership Initiative on Malnutrition (GLIM) recently reached a consensus for a global definition of malnutrition. The primary aim of this study was to apply the interRAI Home Care (interRAI HC) instrument to fit the GLIM definition criteria of malnutrition to the closest. A second goal was to identify potential risk factors associated with malnutrition using this comprehensive assessment and to quantify their association.
This is a case control study, which retrospectively determines the exposure to the risk of malnutrition and estimates its potential risk factors. The longitudinal data came from a larger study called Protocol 3. Eligibility criteria were a minimum age of 65 years old, a minimum score of 6 on the Edmonton Frail Scale or at least a moderate level of functional impairment measured by a Belgian version of the Katz scale. Older people with an official dementia diagnosis were also eligible. Bivariate analysis was performed and logistic regression models were developed in order to identify significant determinants of malnutrition.
The data consisted of 6334 frail older people (mean age: 80.6 ± 6.9, 70.6% female). About 2.4% became malnourished within a follow-up period of one year after baseline. The adjusted logistic regression yielded significant odds ratios for dysphagia (OR 2.2), loss of appetite (OR 1.8), bladder incontinence (OR 1.5) and low fluid intake (OR 1.5). Diabetes (OR 0.5) and visits to the physician (OR 0.5) had both a significant reverse effect.
This study was the first large longitudinal research to explore the risk factors of malnutrition with a comprehensive assessment instrument as the interRAI HC, applying it to the recent GLIM definition criteria. The worldwide use of the interRAI instruments makes these findings relevant for global clinical practice and research. Adapting the interRAI instruments to the GLIM definition improves accurate detection, prevention and early treatment of malnourishment, avoiding further health deterioration in older people.
由于营养不良是导致临床结局不佳的重要可改变风险因素，因此针对营养不良的老年人和有营养不良风险的老年人非常重要。全球营养不良领导倡议（GLIM）最近就营养不良的全球定义达成了共识。本研究的主要目的是应用 interRAI 家庭护理（interRAI HC）工具，使其最接近 GLIM 定义标准。第二个目标是使用这种全面评估方法确定与营养不良相关的潜在危险因素，并量化其关联。
这是一项病例对照研究，回顾性确定了营养不良的风险暴露情况，并估计了其潜在的危险因素。纵向数据来自一项名为 Protocol 3 的更大规模研究。入选标准为年龄至少 65 岁，埃德蒙顿虚弱量表评分至少为 6 分或比利时版 Katz 量表至少为中度功能障碍，有正式的痴呆症诊断的老年人也符合条件。进行了单变量分析，并建立了逻辑回归模型，以确定营养不良的显著决定因素。
数据包括 6334 名虚弱的老年人（平均年龄：80.6±6.9，70.6%为女性）。在基线后一年的随访期间，约有 2.4%的人出现营养不良。调整后的逻辑回归得出了吞咽困难（OR 2.2）、食欲不振（OR 1.8）、膀胱失禁（OR 1.5）和低液体摄入（OR 1.5）的显著比值比。糖尿病（OR 0.5）和看医生（OR 0.5）都有显著的反向作用。
本研究是第一项利用综合评估工具 interRAI HC 探索营养不良危险因素的大型纵向研究，将其应用于最近的 GLIM 定义标准。全球范围内使用 interRAI 工具使这些发现与全球临床实践和研究相关。将 interRAI 工具适应 GLIM 定义标准可以提高对营养不良的准确检测、预防和早期治疗，避免老年人的健康状况进一步恶化。
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