MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, SO16 6YD, UK.
NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK.
Aging Clin Exp Res. 2022 Sep;34(9):2031-2039. doi: 10.1007/s40520-022-02171-3. Epub 2022 Jul 1.
Malnutrition is a serious concern in older populations. Simple screening approaches are needed to identify signs of early nutritional risk in older people, to allow intervention before overt malnutrition develops, along with the poorer health outcomes associated with it, such as sarcopaenia and frailty. The main aim of this study was to compare nutrition risk scores, calculated from the DETERMINE Checklist ('Determine Your Nutritional Health', also known as the Nutrition Screening Initiative Checklist), with physical function variables in a group of community-dwelling older adults. Another aim was to assess the prevalence of nutrition risk using the DETERMINE and the MUST (Malnutrition Universal Screening Tool).
Participants of the Hertfordshire Cohort Study (HCS) were recruited and visited at home by a trained researcher. Self-reported physical function was assessed using the SF-36 PF (Short Form-36 Physical Function) scale. The Short Physical Performance Battery (SPPB) was performed, which included the assessment of gait speed, chair rise time and standing balance. Handgrip strength was measured using a Jamar dynamometer. Frailty was assessed according to the presence of at least three of the following Fried frailty criteria: unintentional weight loss, weakness, self-reported exhaustion, slow gait speed and low physical activity. Nutrition risk scores were calculated from the DETERMINE checklist (range 0-21). Nutritional risk was also assessed using the MUST. Analyses were adjusted for sex, age, age left education and number of comorbidities.
In the study, 176 participants (94 men and 82 women), median age 83.3 (IQR 81.5-85.7) years, were assessed. Almost half (47%) scored either 'moderate' (score 3-5) or 'high' (score ≥ 6) nutritional risk (9% were at high risk), using the DETERMINE checklist, whereas 8% were at risk using the MUST. Higher nutrition risk scores, calculated from DETERMINE, were associated with poorer self-reported physical function (difference in SF-36 PF score: - 0.36, 95% CI (- 0.60, - 0.12) SD per unit increase in nutrition risk score, P = 0.004) and higher odds of being frail (odds ratio Fried frailty: 2.23, 95% CI (1.15, 4.33), P = 0.017). There were no significant associations between DETERMINE nutrition risk scores and the other variables examined.
Cross-sectional associations between higher nutrition risk scores, assessed from the DETERMINE checklist, and poorer self-reported physical function and greater likelihood of frailty suggest that this screening tool may have utility for screening older populations. Prospective studies are required to explore the ability of the tool to predict poor physical function and frailty, though these data suggest it has potential for early, simple detection of nutritional problems in community-living older adults.
营养不良是老年人群体中一个严重的问题。需要简单的筛选方法来识别老年人早期营养风险的迹象，以便在明显营养不良发展之前进行干预，同时还可以预防与营养不良相关的较差的健康结果，如肌肉减少症和虚弱。本研究的主要目的是比较来自 DET E R MINE 清单（“确定您的营养健康”，也称为营养筛查倡议清单）的营养风险评分与一组社区居住的老年人的身体功能变量。另一个目的是使用 DET E R MINE 和 MUST（营养不良普遍筛查工具）评估营养风险的患病率。
赫特福德郡队列研究（HCS）的参与者在家中由经过培训的研究人员招募并进行家访。自我报告的身体功能使用 SF-36 PF（Short Form-36 身体功能）量表进行评估。进行了简短的身体表现电池测试（SPPB），其中包括步态速度、椅子上升时间和站立平衡的评估。使用 Jamar 测力计测量握力。根据以下至少三个弗雷德虚弱标准来评估虚弱：非故意体重减轻、虚弱、自我报告的疲惫、步态速度慢和体力活动少。营养风险评分是从 DET E R MINE 清单中计算出来的（范围 0-21）。使用 MUST 还评估了营养风险。分析调整了性别、年龄、离开教育的年龄和合并症的数量。
在这项研究中，评估了 176 名参与者（94 名男性和 82 名女性），中位年龄为 83.3 岁（IQR 81.5-85.7）岁。使用 DET E R MINE 清单，近一半（47%）的人评分处于“中度”（评分 3-5）或“高”（评分≥6）营养风险（9%处于高风险），而使用 MUST 的人有 8%处于风险之中。更高的 DET E R MINE 评分与较差的自我报告身体功能相关（SF-36 PF 评分差异：-0.36，95%CI（-0.60，-0.12）每单位营养风险评分增加，P=0.004），并且虚弱的可能性更高（弗雷德虚弱的优势比：2.23，95%CI（1.15，4.33），P=0.017）。DETE R MINE 营养风险评分与其他检查变量之间没有显著关联。
从 DET E R MINE 清单评估的较高营养风险评分与较差的自我报告身体功能和更大的虚弱可能性之间的横断面关联表明，该筛选工具可能对筛选老年人群有用。需要前瞻性研究来探讨该工具预测身体功能不佳和虚弱的能力，尽管这些数据表明它具有早期简单检测社区居住的老年人群体营养问题的潜力。
