The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, 4032, Australia; School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, 4072, Australia.
The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, 4032, Australia.
Clin Nutr. 2021 Apr;40(4):1905-1910. doi: 10.1016/j.clnu.2020.09.003. Epub 2020 Sep 15.
BACKGROUND/AIMS: Crude diagnostic parameters such as BMI limit recognition of malnutrition in overweight and obese patients. This study applied a robust malnutrition diagnostic measure to investigate whether malnutrition impacts clinical outcomes in overweight or obese hip fracture inpatients.
A prospective, consecutive 12-month audit of inpatients admitted to a dedicated hip fracture unit with a BMI of ≥25 for surgical intervention. Univariate and logistic regression analyses were performed to investigate the relationship of demographics (age, gender), comparative measures (type of fracture, Charlson Comorbidity Index (CCI) on admission, time to surgery, type of surgery and anaesthesia, nutrition status) and outcome measures (delirium, time to mobilise post-operatively, length of stay, 12-month mortality). Malnutrition was defined using the International Classification of Diseases, Tenth Revision - Australian Modification protein-energy malnutrition criteria.
127 overweight or obese hip fracture patients for surgical intervention were included in analyses. Patients were predominantly older females (median 81.0, range 48-97 years; 66.9%). Malnutrition prevalence was not infrequent (18.3%) despite the median BMI of 28.3 (range 25.0-63.9). Mortality at 12-months (17.3%) was lower than routinely reported across broader hip fracture populations. Logistic regression modelling demonstrated that malnutrition increased the likelihood of 12-month mortality (OR: 4.47, 95% CI 1.27-15.77; p = 0.020), post-operative delirium (OR: 3.64, 95% CI 1.00 to 13.33; p = 0.051), and delayed post-operative mobility (OR: 3.29, 95% CI 1.05 to 10.31; p = 0.041), in overweight or obese hip fracture patients. Length of stay demonstrated poor association with all predictor measures.
Hip fracture patients who are both overweight or obese, and malnourished, have significantly and substantially worse clinical outcomes than their well-nourished, albeit overweight or obese, counterparts. Comprehensive nutrition assessment measures should be applied to all hip fracture inpatients to ensure appropriate clinical nutrition care is appropriately directed.
背景/目的：BMI 等原始诊断参数限制了对超重和肥胖患者营养不良的识别。本研究应用稳健的营养不良诊断方法，调查超重或肥胖髋部骨折住院患者的营养不良是否会影响临床结局。
对因手术干预而 BMI≥25 入住专门髋部骨折病房的住院患者进行前瞻性、连续 12 个月的审核。进行单变量和逻辑回归分析，以调查人口统计学因素（年龄、性别）、比较指标（骨折类型、入院时 Charlson 合并症指数（CCI）、手术时间、手术类型和麻醉、营养状况）和结局指标（谵妄、术后移动时间、住院时间、12 个月死亡率）与结果之间的关系。使用国际疾病分类，第十版-澳大利亚修正蛋白质能量营养不良标准定义营养不良。
纳入分析的 127 例超重或肥胖髋部骨折手术患者中，患者主要为老年女性（中位数 81.0 岁，范围 48-97 岁；66.9%）。尽管中位数 BMI 为 28.3（范围 25.0-63.9），但营养不良的患病率并不罕见（18.3%）。12 个月死亡率（17.3%）低于更广泛的髋部骨折人群中的常规报告。逻辑回归模型表明，营养不良增加了 12 个月死亡率的可能性（OR：4.47，95%CI 1.27-15.77；p=0.020）、术后谵妄（OR：3.64，95%CI 1.00-13.33；p=0.051）和术后移动延迟（OR：3.29，95%CI 1.05-10.31；p=0.041），在超重或肥胖的髋部骨折患者中。住院时间与所有预测指标的相关性较差。
超重或肥胖且营养不良的髋部骨折患者的临床结局明显差于营养良好的超重或肥胖患者。所有髋部骨折住院患者均应进行全面的营养评估，以确保适当的临床营养护理得到适当指导。
