Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland.
Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland.
Nutrition. 2021 Sep;89:111279. doi: 10.1016/j.nut.2021.111279. Epub 2021 Apr 22.
Malnutrition is highly prevalent in patients with aging-related vulnerability defined by very old age (≥80 y), physical frailty or cognitive impairment, and increases the risks for morbidity and mortality. The effects of individualized nutritional support for patients with aging-related vulnerability in the acute hospital setting on mortality and other clinical outcomes remains understudied.
For this secondary analysis of the randomized-controlled Effect of Early Nutritional Support on Frailty, Functional Outcomes, and Recovery of Malnourished Medical Inpatients Trial (EFFORT), we analyzed data of patients at a nutritional risk (Nutritional Risk Screening 2002 score ≥3 points) with aging-related vulnerability, randomized to receive protocol-guided individualized nutritional support to reach specific protein and energy goals (intervention group) or routine hospital food (control group). The primary endpoint was all-cause 30-d mortality.
Of the 881 patients with aging-related vulnerability, 23.4% presented with a frailty syndrome, 81.8% were age ≥80 y and 15.3% showed cognitive impairment. Patients with aging-related vulnerability receiving individualized nutritional support compared with routine hospital food showed a >50% reduction in the risk of 30-day mortality (60 of 442 [13.6%] versus 31 of 439 [7.1%]; odds ratio: 0.48; 95% confidence interval, 0.31-0.76; P = 0.002). Significant improvements were also found for long-term mortality at 180 days, as well as functional outcomes and quality of life measures.
Malnourished patients with aging-related vulnerability show a significant and clinically relevant reduction in the risk of mortality and other adverse clinical outcomes after individualized in-hospital nutritional support compared to routine hospital nutrition. These data support the early screening of patients with aging-related vulnerability for nutritional risk, followed by a nutritional assessment and implementation of individualized nutritional interventions.
营养不良在与衰老相关的脆弱性患者中非常普遍，这些患者的特征包括非常高龄（≥80 岁）、身体虚弱或认知障碍，并且增加了发病和死亡的风险。在急性医院环境中，针对与衰老相关的脆弱性患者进行个体化营养支持对死亡率和其他临床结局的影响仍研究不足。
本研究是对随机对照的早期营养支持对衰弱、功能结局和营养不良的医疗住院患者康复的影响（EFFORT）试验的二次分析，我们分析了存在营养风险（营养风险筛查 2002 评分≥3 分）且具有与衰老相关的脆弱性的患者的数据，这些患者被随机分配接受基于方案的个体化营养支持，以达到特定的蛋白质和能量目标（干预组）或常规医院饮食（对照组）。主要终点是全因 30 天死亡率。
在 881 名具有与衰老相关的脆弱性的患者中，23.4%存在衰弱综合征，81.8%年龄≥80 岁，15.3%存在认知障碍。与常规医院饮食相比，接受个体化营养支持的具有与衰老相关的脆弱性的患者，30 天死亡率的风险降低了 50%以上（442 例中的 60 例[13.6%]与 439 例中的 31 例[7.1%]；优势比：0.48；95%置信区间，0.31-0.76；P=0.002）。在 180 天时的长期死亡率以及功能结局和生活质量测量方面也发现了显著改善。
与常规医院营养相比，具有与衰老相关的脆弱性的营养不良患者接受个体化院内营养支持后，死亡率和其他不良临床结局的风险显著降低，且具有临床相关性。这些数据支持对与衰老相关的脆弱性患者进行早期营养风险筛查，随后进行营养评估和个体化营养干预措施的实施。
