HU University of Applied Sciences, Research Group Innovations in Preventive Health Care, Heidelberglaan 7, 2584 CS Utrecht, the Netherlands.
HAN University of Applied Sciences, Research Group Nutrition, Dietetics and Lifestyle, Kapittelweg 33, Postbus 6960, 6503 GL Nijmegen, the Netherlands.
Clin Nutr ESPEN. 2022 Jun;49:163-171. doi: 10.1016/j.clnesp.2022.03.007. Epub 2022 Mar 12.
BACKGROUND & AIM: Malnutrition adversely influences a broad range of physical and psychological symptoms. Although polypharmacy is often mentioned to be associated with malnutrition, especially in older people it is unclear to what extent. The aim of this systematic review was to investigate the extent of the association between polypharmacy and malnutrition in older people.
The methodology followed the guidelines of the Cochrane Collaboration. Literature search was performed in PubMed, CINAHL and Embase. The population of interest for this systematic review were people of 65 years and older with polypharmacy. Because there is ambiguity with regard to the actual definition of malnutrition and polypharmacy, in this systematic review all articles describing malnutrition prevalence rates were included, regardless of the criteria used. Both observational and intervention studies were screened for eligibility. Selection and quality assessment of the included full text studies was assessed by two reviewers independently. A level of evidence and methodological quality score was adjudged to each article based on this assessment.
A total of 3126 studies were retrieved by the literature search, of which seven studies were included in this systematic review. There was considerable variation in the definition of polypharmacy between studies. Two studies defined polypharmacy as the use of five or more drugs, two studies as the use of six or more drugs, two studies provided a mean and standard deviation that corresponded to the minimum of five drugs, and one study distinguished between polypharmacy (five or more drugs) and excessive polypharmacy (ten or more drugs). However, all studies showed a statistically significant association between (the risk) of becoming malnourished and polypharmacy regardless the instrument or criterion used to define risk of malnutrition. Studies presented the associations respectively as OR ≥ 1.177, p-value ≤ 0.028, β ≥ -0.62 and r ≥ -0.31.
This review demonstrated a statistically significant association between polypharmacy and malnutrition. Further research is required to determine the magnitude of the effect by increased number of drugs in combination with the type of drugs, on the risk of malnutrition.
营养不良会对广泛的身体和心理症状产生不利影响。尽管经常提到多药治疗与营养不良有关，尤其是在老年人中，但尚不清楚这种关联的程度。本系统评价的目的是调查老年人中多药治疗与营养不良之间的关联程度。
本研究遵循 Cochrane 协作组的指南。在 PubMed、CINAHL 和 Embase 中进行文献检索。本系统评价的目标人群是 65 岁及以上的多药治疗患者。由于对于营养不良和多药治疗的实际定义存在歧义，因此在本系统评价中，无论使用何种标准，所有描述营养不良患病率的文章均被纳入。筛选出符合条件的观察性研究和干预性研究。两名评审员独立评估纳入的全文研究的选择和质量。根据这一评估，对每篇文章的证据水平和方法学质量评分进行了评判。
通过文献检索共检索到 3126 篇研究，其中有 7 篇研究被纳入本系统评价。研究中多药治疗的定义差异很大。两项研究将多药治疗定义为使用五种或更多种药物，两项研究将其定义为使用六种或更多种药物，两项研究提供了与最低使用五种药物对应的平均值和标准差，一项研究区分了多药治疗（五种或更多种药物）和过度多药治疗（十种或更多种药物）。然而，无论使用何种仪器或标准来定义营养不良风险，所有研究均显示出多药治疗与营养不良之间存在统计学显著的关联。研究分别呈现的关联为 OR≥1.177，p 值≤0.028，β≥-0.62 和 r≥-0.31。
本综述表明多药治疗与营养不良之间存在统计学显著的关联。需要进一步研究以确定随着药物数量的增加以及药物类型的增加对营养不良风险的影响程度。
