Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Geriatric Education and Research Institute, Singapore, Singapore.
Br J Nutr. 2022 Aug 14;128(3):509-520. doi: 10.1017/S0007114521003433. Epub 2021 Sep 6.
We previously developed a malnutrition risk index, the Elderly Nutritional Index for Geriatric Malnutrition Assessment (ENIGMA) with good predictive accuracy for mortality risk in an original population cohort (SLAS1). Herein, we further evaluate the concurrent and predictive validity of the ENIGMA construct in an external validation cohort (SLAS-2) of 2824 community-dwelling older adults aged 55+ years. They were assessed on the ENIGMA index, Mini Nutritional Assessment-Short Form (MNA-SF) and the Geriatric Nutritional Risk Index (GNRI), known correlates of malnutrition, and baseline and follow-up functional dependency and 10-year mortality risk. Higher ENIGMA risk categories were significantly associated ( < 0·001) with lower education, living alone, smoking, low physical activity, BMI < 18·5 kg/m, poorer muscle strength and functional mobility, exhaustion, physical frailty, homocysteine, glomerular filtration rate, Hb, red and white blood cell counts, platelets, systemic inflammation indexes, metabolic syndrome, CVD, cognitive impairment and depressive symptoms (Geriatric Depression Scale ≥ 5). ENIGMA scores showed statistically significant ( < 0·001) correlations but low-to-moderate concordance with MNA-SF ( = 0·148, agreement = 45·9 %, kappa = 0·085) and GNRI scores ( = 0·156, agreement = 45·8 %, kappa = 0·096). Controlling for known correlates of malnutrition, only high-risk ENIGMA among the indexes significantly predicted baseline functional dependency (OR = 1·64, 95 % CI 1·01, 2·65) and mortality (hazard ratio = 1·65 (95 % CI 1·04, 2·62). ENIGMA marginally out-performed MNA-SF and GNRI in predicting baseline functional dependency (AUC: 0·625 . 0·584 . 0·526), follow-up functional dependency (AUC: 0·594 . 0·525 . 0·479) and 10-year mortality risk (AUC: 0·641 . 0·596 . 0·595). The concurrent and predictive validity of the ENIGMA construct is replicated in an external evaluation study of community-dwelling older persons.
我们之前开发了一个营养不良风险指数，即老年营养不良评估的营养指数（ENIGMA），该指数在原始人群队列（SLAS1）中对死亡率风险具有良好的预测准确性。在此，我们进一步评估了该指数在 2824 名年龄在 55 岁及以上的社区居住老年人的外部验证队列（SLAS-2）中的同期和预测有效性。对他们进行了 ENIGMA 指数、微型营养评估-简短表格（MNA-SF）和营养风险指数（GNRI）评估，这些都是营养不良的已知相关因素，以及基线和随访时的功能依赖性和 10 年死亡率风险。较高的 ENIGMA 风险类别与较低的教育程度、独居、吸烟、低体力活动、BMI<18.5kg/m2、较差的肌肉力量和功能移动性、疲惫、身体虚弱、同型半胱氨酸、肾小球滤过率、Hb、红细胞和白细胞计数、血小板、全身炎症指标、代谢综合征、心血管疾病、认知障碍和抑郁症状（老年抑郁量表≥5）显著相关（<0.001）。ENIGMA 评分与 MNA-SF（=0.148，一致性=45.9%，kappa=0.085）和 GNRI 评分（=0.156，一致性=45.8%，kappa=0.096）呈统计学显著相关（<0.001），但相关性较低（0.148）至中度（0.096）。在控制了营养不良的已知相关因素后，仅高风险的 ENIGMA 指数在预测基线时的功能依赖性方面具有显著意义（OR=1.64，95%CI 1.01-2.65）和死亡率（风险比=1.65（95%CI 1.04-2.62）。ENIGMA 在预测基线功能依赖性（AUC：0.625、0.584、0.526）、随访时的功能依赖性（AUC：0.594、0.525、0.479）和 10 年死亡率风险（AUC：0.641、0.596、0.595）方面的性能略优于 MNA-SF 和 GNRI。ENIGMA 结构的同期和预测有效性在对社区居住老年人的外部评估研究中得到了复制。
