中国老年人群中营养不良与认知功能的关系：来自中国健康与养老追踪调查研究的证据
The Relationship of Malnutrition With Cognitive Function in the Older Chinese Population: Evidence From the Chinese Longitudinal Healthy Longevity Survey Study.
作者信息
Sun Boran, Zhao Yihao, Lu Wenli, Chen Yongjie
机构信息
Department of Epidemiology and Statistics, School of Public Health, Tianjin Medical University, Tianjin, China.
出版信息
Front Aging Neurosci. 2021 Nov 22;13:766159. doi: 10.3389/fnagi.2021.766159. eCollection 2021.
Few studies have explored the relationship between malnutrition measured by the Geriatric Nutritional Risk Index (GNRI) and cognitive performance. This study aimed to investigate the association of malnutrition with cognitive function in the Chinese population. It was a prospective longitudinal study and used three waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) data in 2011-2012, 2014, and 2017-2018. Participants aged 60 years or older without mental illness and cerebrovascular diseases were eligible. The GNRI was used to assess nutritional status as follows: normal nutrition (a GNRI > 98), mild malnutrition (92 ≤ a GNRI ≤ 98), and moderate-to-severe malnutrition (a GNRI < 92). Cognitive performance was evaluated by the Mini-Mental State Examination (MMSE) scores. The relationship between the GNRI and cognitive function was analyzed using a linear mixed-effects model. A total of 1,632 subjects were analyzed, including 741 males and 891 females. Of these, 65.0, 19.4, and 15.6% of subjects were at normal nutritional status, mild, and moderate-to-severe malnutrition, respectively. After adjusting for potential confounders, participants under mild and moderate-to-severe malnutrition status have a lower MMSE score [β (95% CI): -0.95 (-1.60, -0.25) and -1.39 (-2.21, -0.57), respectively], compared with those having normal nutrition. Also, there was a linear trend in the association of malnutrition risk with cognitive function in the total population [β (95% CI): -0.74 (-1.13, -0.35)]. However, a significant association of malnutrition with cognitive function was observed only among illiterate females aged above 90 years. This study suggested that there was a significant relationship between the GNRI and cognitive function in the Chinese elderly. Furthermore, subjects with more serious malnutrition have a worse cognitive function, especially in the oldest illiterate females. Clinicians should put more emphasis on assessing the nutritional and cognitive status of the elderly to timely intervene and prevent cognitive impairment.
很少有研究探讨用老年营养风险指数（GNRI）衡量的营养不良与认知表现之间的关系。本研究旨在调查中国人群中营养不良与认知功能的关联。这是一项前瞻性纵向研究，使用了2011 - 2012年、2014年以及2017 - 2018年三轮中国健康与养老追踪调查（CLHLS）的数据。年龄在60岁及以上且无精神疾病和脑血管疾病的参与者符合条件。GNRI用于评估营养状况如下：营养正常（GNRI > 98）、轻度营养不良（92 ≤ GNRI ≤ 98）以及中重度营养不良（GNRI < 92）。认知表现通过简易精神状态检查表（MMSE）评分进行评估。使用线性混合效应模型分析GNRI与认知功能之间的关系。总共分析了1632名受试者，其中男性741名，女性891名。其中，分别有65.0%、19.4%和15.6%的受试者处于正常营养状况、轻度以及中重度营养不良状态。在调整潜在混杂因素后，与营养正常的参与者相比，处于轻度和中重度营养不良状态的参与者MMSE评分较低[β（95%置信区间）：分别为 -0.95（-1.60，-0.25）和 -1.39（-2.21，-0.57）]。此外，在总体人群中，营养不良风险与认知功能的关联存在线性趋势[β（95%置信区间）：-0.74（-1.13，-0.35）]。然而，仅在90岁以上的文盲女性中观察到营养不良与认知功能之间存在显著关联。本研究表明，在中国老年人中，GNRI与认知功能之间存在显著关系。此外，营养不良更严重的受试者认知功能更差，尤其是在年龄最大的文盲女性中。临床医生应更加重视评估老年人的营养和认知状况，以便及时进行干预并预防认知障碍。
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