Dr. Suey S.Y. Yeung, Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, N.T., Hong Kong. Tel: +852 3505 2190; Fax: +852 26379215; Email:
J Nutr Health Aging. 2021;25(5):645-652. doi: 10.1007/s12603-021-1610-x.
The Global Leadership Initiative on Malnutrition (GLIM) has recently published criteria for classifying malnutrition. This study investigated the associations between malnutrition and adverse outcomes, and identified which component(s) of the GLIM criteria is/are risk factor(s) of adverse outcomes in Chinese older adults.
A prospective cohort study of Chinese older adults in a healthy ageing study.
Participants' place of residence.
Community-dwelling and institutionalized Chinese older adults aged ≥70 years living in Hong Kong.
Malnutrition at baseline was classified according to selected GLIM criteria. Adverse outcomes including poor self-rated health, functional limitation (Barthel Index), falls, frailty (FRAIL scale), hospitalization and mortality were assessed after a 3-year follow-up. Associations between malnutrition and components of selected GLIM criteria (weight loss, low body mass index (BMI), low muscle mass and disease burden) and each adverse outcome were examined using adjusted binary logistic regression and Cox proportional hazards model. Odds ratio (OR) or hazard ratio (HR) and 95% confidence interval (CI) are presented.
Data of 1576 community-dwelling (45.5% female, 78.1±6.5 years) and 427 institutionalized (69.6% female, 85.5±6.4 years) older adults were included at baseline. Among community-dwelling older adults, malnutrition was associated with frailty (n=899, OR: 2.44, 95% CI: 1.05-5.70) and mortality (n=1007, HR: 1.37, 95% CI: 1.12-1.66). No association was found for other outcomes. Among institutionalized older adults, malnutrition was not associated with any outcomes. Low BMI and low muscle mass were risk factors of frailty; while weight loss was a risk factor of mortality in community-dwelling older adults. Weight loss and disease burden were risk factors of mortality among institutionalized older adults.
The association between malnutrition and frailty and mortality was observed in community but not in institutional settings. Further studies are required to draw more definitive conclusions on the use of GLIM criteria in institutional settings.
全球营养不良领导倡议（GLIM）最近发布了营养不良分类标准。本研究旨在探讨营养不良与不良结局之间的关系，并确定 GLIM 标准的哪个（哪些）组成部分是中国老年人不良结局的危险因素。
一项对香港健康老龄化研究中社区居住和机构居住的中国老年人的前瞻性队列研究。
参与者居住的地方。
居住在香港的 70 岁及以上的社区居住和机构居住的中国老年人。
根据选定的 GLIM 标准对基线时的营养不良进行分类。在 3 年的随访后，评估不良结局，包括自我评估健康状况不佳、功能受限（巴氏指数）、跌倒、虚弱（ frail 量表）、住院和死亡。使用调整后的二项逻辑回归和 Cox 比例风险模型，检查营养不良与选定 GLIM 标准（体重减轻、低体重指数（BMI）、低肌肉量和疾病负担）的组成部分以及每种不良结局之间的关系。呈现比值比（OR）或风险比（HR）和 95%置信区间（CI）。
在基线时，共纳入了 1576 名社区居住的老年人（45.5%为女性，78.1±6.5 岁）和 427 名机构居住的老年人（69.6%为女性，85.5±6.4 岁）。在社区居住的老年人中，营养不良与虚弱（n=899，OR：2.44，95%CI：1.05-5.70）和死亡（n=1007，HR：1.37，95%CI：1.12-1.66）有关。在其他结局中没有发现关联。在机构居住的老年人中，营养不良与任何结局都没有关联。低 BMI 和低肌肉量是虚弱的危险因素；而体重减轻是社区居住的老年人死亡的危险因素。体重减轻和疾病负担是机构居住的老年人死亡的危险因素。
在社区环境中观察到营养不良与虚弱和死亡之间存在关联，但在机构环境中没有观察到这种关联。需要进一步的研究来更明确地确定 GLIM 标准在机构环境中的应用。
