老年门诊人群营养不良风险与炎症生物标志物的关系。
The relationship between malnutrition risk and inflammatory biomarkers in outpatient geriatric population.
机构信息
Department of Toxicology and Environmental Diseases, Jagiellonian University Medical College, Kraków, Poland.
University Hospital, Kraków, Poland.
出版信息
Eur Geriatr Med. 2020 Jun;11(3):383-391. doi: 10.1007/s41999-020-00303-4. Epub 2020 Mar 6.
PURPOSE
Malnutrition is an underestimated, but significant problem among older persons. It is described as a consequence of genetic and environmental factors, lack of physical activity, and co-morbidities. However, a key role of a geriatrician is to further explore the multidimensional complexity of this issue. The aim of this study was to identify the relationship between nutritional status and different factors, particularly focusing on inflammatory biomarkers.
METHODS
Nutritional status was assessed using Mini-Nutritional-Assessment with a score below 24 (out of 30) defined as malnutrition. Different serum biomarkers of inflammation were measured, such as High-Sensitivity-C-Reactive-Protein (hsCRP), Interleukin-6 (IL-6), Interleukin-8 (IL-8), Interleukin-18(IL-18), osteoprotegerin(OPG), and Soluble-Receptor-For-TNF-alfa(sTNFRII). Medical history, mental status (Mini-Mental-State-Examination, Geriatric-Depression-Scale) and activities of daily living (using Instrumental-Activities-of-Daily-Living-Scale) were used in the evaluation. The relationship between nutritional status and the factors listed was assessed.
RESULTS
The mean age of 76 examined persons (40.8% female) from the outpatient clinic was 71 years. Malnutrition risk was recognized in 29%. The following factors significant in univariate regression were used in stepwise regression analysis: age, sex, mental status (MMSE, GDS), valve disease, number of diseases, IADL. Stepwise regression revealed that the risk of malnutrition was increased by the presence of valve disease, number of diseases, and female sex. Factors that increased the risk of malnutrition were: logsTNFRII (OR = 3.09; 95% CI 1.07-8.96), IL-8 (OR = 1.09; 95% CI 1.00-1.18), and OPG (OR = 1.27; 95% CI 1.02-1.57). Risk of malnutrition was negatively associated with Il-18(OR = 0.995; 95% CI 0.991-0.999).
CONCLUSIONS
Chronic inflammation and immunologic process are likely contributors to the complex etiopathogenesis of malnutrition in older persons.
目的
营养不良是老年人中被低估但很严重的问题。它被描述为遗传和环境因素、缺乏身体活动和合并症的结果。然而，老年病医生的一个关键作用是进一步探索这个问题的多维复杂性。本研究的目的是确定营养状况与不同因素之间的关系，特别是重点关注炎症生物标志物。
方法
使用 Mini-Nutritional-Assessment 评估营养状况，得分低于 24 分（满分 30 分）定义为营养不良。测量了不同的血清炎症生物标志物，如高敏 C 反应蛋白（hsCRP）、白细胞介素 6（IL-6）、白细胞介素 8（IL-8）、白细胞介素 18（IL-18）、护骨素（OPG）和可溶性肿瘤坏死因子受体 II（sTNFRII）。评估中使用了病史、精神状态（简易精神状态检查、老年抑郁量表）和日常生活活动（使用工具性日常生活活动量表）。评估了营养状况与列出的因素之间的关系。
结果
来自门诊的 76 名被检查者（40.8%为女性）的平均年龄为 71 岁。识别出有 29%的人存在营养不良风险。单因素回归中具有统计学意义的因素包括年龄、性别、精神状态（MMSE、GDS）、瓣膜病、疾病数量、IADL。逐步回归显示，瓣膜病、疾病数量和女性性别会增加营养不良的风险。增加营养不良风险的因素包括：logsTNFRII（OR=3.09；95%CI 1.07-8.96）、IL-8（OR=1.09；95%CI 1.00-1.18）和 OPG（OR=1.27；95%CI 1.02-1.57）。营养不良的风险与 Il-18（OR=0.995；95%CI 0.991-0.999）呈负相关。
结论
慢性炎症和免疫过程可能是老年人营养不良复杂发病机制的原因。
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