Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy.
Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy.
Clin Nutr. 2020 Dec;39(12):3687-3694. doi: 10.1016/j.clnu.2020.03.029. Epub 2020 Apr 4.
This study aimed to investigate the association between different nutritional and anthropometric parameters with the risk of hospitalizations and death within 18 months from nursing home admission. Our hypothesis was that measures of malnutrition could be more strongly associated with worse clinical outcomes than measures of overweight/obesity.
This prospective study involved 144 older adults newly admitted in nursing home and followed up over 18 months. A multidimensional assessment focusing on clinical, functional and cognitive status was performed at baseline. Assessment also included body mass index (BMI), waist circumference, calf circumference, MNA Short-Form (MNA-SF), and serum albumin and lymphocytes levels. Anthropometric measurements were repeated at 6 months. Data on hospitalizations and mortality over the study period, with their respective causes, were obtained from administrative data. The associations between baseline nutritional parameters and the risk of hospitalizations or death were analyzed through multinomial logistic regressions and Cox regressions, respectively.
During the follow-up, 64 individuals (44.4%) were hospitalized, and 52 (36.1%) died. Residents who reported low MNA-SF and calf circumference at nursing home admission had more than threefold-increased odds of hospitalizations compared with their healthier counterparts. Adults with low calf circumference also had the highest mortality (HR = 3.39, 95%CI:1.80-6.39), while more attenuated results were observed for low serum albumin, MNA-SF, and BMI (either when considering cut-offs of excess weight or malnutrition). When assessing the associations between 0 and 6 month changes in calf circumference and mortality in the following 12 months, we found that each 1 cm decrease in calf circumference increased the one-year mortality by 29% (95%CI 1.04-1.60).
Malnutrition, but not overweight/obesity, seems associated with a higher risk of hospitalization and mortality after nursing home admission. Monitoring calf circumference, in particular, may help in the early detection of individuals who are potentially vulnerable to adverse health-related outcomes after institutionalization.
本研究旨在探讨营养和人体测量参数与养老院入院后 18 个月内住院和死亡风险的关系。我们的假设是，营养不良的测量指标与较差的临床结局的相关性可能强于超重/肥胖的测量指标。
本前瞻性研究纳入了 144 名新入住养老院的老年人，并进行了 18 个月的随访。在基线时进行了针对临床、功能和认知状态的多维评估。评估还包括体重指数（BMI）、腰围、小腿围、MNA 简短表格（MNA-SF）和血清白蛋白及淋巴细胞水平。在 6 个月时重复进行人体测量测量。通过行政数据获得研究期间的住院和死亡数据及其各自的原因。通过多项逻辑回归和 Cox 回归分别分析基线营养参数与住院或死亡风险的关系。
在随访期间，64 人（44.4%）住院，52 人（36.1%）死亡。与健康状况较好的人相比，养老院入院时报告 MNA-SF 和小腿围较低的居民住院的可能性增加了两倍以上。小腿围较低的成年人的死亡率也最高（HR=3.39，95%CI：1.80-6.39），而血清白蛋白、MNA-SF 和 BMI 较低的结果则更为减弱（无论是考虑超重还是营养不良的切点）。在评估小腿围在 0 至 6 个月期间的变化与随后 12 个月内的死亡率之间的关系时，我们发现小腿围每减少 1 厘米，一年死亡率就增加 29%（95%CI 1.04-1.60）。
营养不良而不是超重/肥胖似乎与养老院入院后住院和死亡风险增加有关。监测小腿围，特别是可以帮助早期发现那些在机构化后可能面临不良健康相关结局的脆弱个体。
