Sophie Allepaerts, University of Liège, Geriatric Department, CHU - NDB, Rue de Gaillarmont, 600, 4032 Chenee, Belgium, Tél : +32 43 67 93 93, E-mail :
J Nutr Health Aging. 2020;24(10):1073-1079. doi: 10.1007/s12603-020-1527-9.
This study aimed 1) to assess the nutritional status of patients hospitalized in a geriatric ward using the recent Global Leadership Initiative on Malnutrition (GLIM) criteria, 2) to determine the balance between the energy intake (EI) with an enriched diet and the energy requirement (ER) using indirect calorimetry, and 3) to assess whether undernutrition is associated with 1-year outcome.
This is a prospective cross-sectional study.
This study was performed in a geriatric unit.
Patients of this geriatric unit were eligible for the study if they agreed to participate and if they did not meet the exclusion criteria (presence of malignant tumour, uncontrolled heart or renal failure, thyroidal disease, uncontrolled sepsis, oedema of the lower limbs, wearing of a pacemaker, biological thyroid dysfunction and inability to perform walking tests).
Rest energy expenditure (REE) was measured by indirect calorimetry within the week of hospitalization. Total energy expenditure (TEE) was obtained by multiplying REE by a physical activity level coefficient and energy expenditure that was related to thermogenesis (i.e., 10% of the total amount of energy ingested over 24 h) was added. Food intake was measured over a 3-day period. Undernutrition was defined using MNA and the criteria of the GLIM leadership. Clinical outcomes included 1-year institutionalisation and mortality.
Seventy-nine patients (84.9 ± 5.3 years) were included. A total of 21 (26.6 %) patients were found undernourished. REE was 1088 ± 181kcal/day (17.8 ± 2.9 kcal/kg/day) and TEE was 1556 ± 258 kcal/day (25.4 ± 4.2 kcal/kg/day). Weight-adjusted REE and TEE were higher in undernourished patients compared to those well-nourished (19.8 ± 3.1 vs. 17.1 ± 2.6 kcal/day and 28.4±4.5 vs. 24.4±3.7 kcal/day) (p<0.05). The lower was the Body Mass Index (BMI), the higher was the energy needs (p<0.01). EI was significantly greater than energy requirements (difference requirements - intake with enriched diet = -354 ± 491 kcal/day; p<0.0001). This difference did not depend on BMI (p=0.82), appendicular skeletal mass index (ASMI) (p=0.63), or the presence of undernutrition (p=0.33). At 1-year follow-up, 15 (19%) patients died and 20 (25.6%) were institutionalized. On multivariable analysis, male gender (OR=5.63; p=0.015) and undernutrition (OR=7.29; p=0.0043) emerged as independently associated with death. On multivariable analysis, only ASMI (OR 0.59 (0.35-0.99), p=0.044) and activities of daily living (ADL) (OR 1.14 (1.00-1.30), p=0.043) were significantly associated with institutionalization.
Undernutrition as assessed by the GLIM criteria remains common in elderly patients hospitalized in a geriatric unit and is associated with increased 1-year mortality but not with institutionalization. Energy requirements are higher in undernourished patients and in patients with a low BMI. Enriched energy intakes could sufficiently cover the energy needs of this population.
本研究旨在：1）使用最近的全球营养不良领导倡议（GLIM）标准评估老年病房住院患者的营养状况；2）通过间接测热法确定富含能量的饮食与能量需求之间的平衡；3）评估营养不良是否与 1 年预后相关。
这是一项前瞻性的横断面研究。
本研究在老年病房进行。
如果同意参与且未满足排除标准（存在恶性肿瘤、无法控制的心或肾功能衰竭、甲状腺疾病、无法控制的败血症、下肢水肿、佩戴起搏器、生物甲状腺功能障碍和无法进行步行测试）的老年病房患者符合研究条件。
住院后一周内通过间接测热法测量静息能量消耗（REE）。总能量消耗（TEE）通过 REE 乘以身体活动水平系数和与产热相关的能量消耗（即 24 小时内摄入总能量的 10%）来获得。通过 3 天的时间来测量食物摄入量。使用 MNA 和 GLIM 标准来定义营养不良。临床结局包括 1 年的住院和死亡率。
共纳入 79 名患者（84.9±5.3 岁）。共有 21 名（26.6%）患者被认为存在营养不良。REE 为 1088±181kcal/天（17.8±2.9kcal/kg/天），TEE 为 1556±258kcal/天（25.4±4.2kcal/kg/天）。与营养良好的患者相比，营养不良患者的体重校正 REE 和 TEE 更高（19.8±3.1 vs. 17.1±2.6 kcal/天和 28.4±4.5 vs. 24.4±3.7 kcal/天）（p<0.05）。体重指数（BMI）越低，能量需求越高（p<0.01）。能量摄入明显大于能量需求（需求-摄入的差值= -354±491 kcal/天；p<0.0001）。这种差异与 BMI（p=0.82）、四肢骨骼质量指数（ASMI）（p=0.63）或营养不良的存在无关（p=0.33）。在 1 年随访时，15 名（19%）患者死亡，20 名（25.6%）患者住院。多变量分析显示，男性（OR=5.63；p=0.015）和营养不良（OR=7.29；p=0.0043）是死亡的独立相关因素。多变量分析显示，只有 ASMI（OR 0.59（0.35-0.99），p=0.044）和日常生活活动（ADL）（OR 1.14（1.00-1.30），p=0.043）与住院显著相关。
使用 GLIM 标准评估的营养不良在老年病房住院患者中仍然很常见，与增加 1 年死亡率相关，但与住院无关。营养不良患者和 BMI 较低的患者能量需求更高。富含能量的饮食摄入可以充分满足这一人群的能量需求。
