Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China.
Department of Rehabilitation Medicine, Shanghai Herson Rehabilitation Hospital, Shanghai, China.
Front Public Health. 2022 Oct 24;10:996447. doi: 10.3389/fpubh.2022.996447. eCollection 2022.
Malnutrition, dynapenia, and sarcopenia are prevalent conditions among patients with maintenance hemodialysis (MHD). They are related to numerous adverse health outcomes. The aim of this study was to compare the effect of three nutritional screening tools on predicting the risk of dynapenia and sarcopenia in patients with MHD.
From July 2020 to April 2021, a total of 849 patients with MHD were enrolled at seven different healthcare facilities in Shanghai, China in this multi-center cross-sectional study. Geriatric nutritional risk index (GNRI), malnutrition inflammation score (MIS), and creatinine (Cr) index were used for nutritional assessment. The cutoff values of muscle mass and strength to define dynapenia, pre-sarcopenia, and sarcopenia were based on the consensus by the Asia Working Group of Sarcopenia in 2019.
Among 849, almost 60% were malnourished with the majority suffering from dynapenia (27.7%), followed by sarcopenia (22.7%), and pre-sarcopenia (6.2%).The area under the receiver-operating characteristic curve for GNRI was 0.722 [95% confidence interval (CI) = 0.684-0.760] and 0.723 (95% CI = 0.663-0.783) in predicting sarcopenia and pre-sarcopenia. The GNRI [odds ratio (OR) =6.28, 95% CI: 4.05-9.73], MIS (OR =1.91, 95% CI: 1.31-2.78), and the Cr index (OR =2.73, 95% CI: 1.71-4.34) were all significantly associated with the risk of sarcopenia. More importantly, the sarcopenia predictability of the GNRI appears greater than the MIS and Cr index, while MIS was similar to the Cr index. Similarly, the superiority of GNRI prediction was also found in pre-sarcopenia, but not in dynapenia.
All the three nutritional screening tools were significantly associated with an increased risk of sarcopenia. The sarcopenia predictability of the GNRI was greater than the MIS and Cr index.
营养不良、动力不足和肌肉减少症在维持性血液透析（MHD）患者中很常见。它们与许多不良健康结果有关。本研究旨在比较三种营养筛查工具对预测 MHD 患者动力不足和肌肉减少症风险的影响。
本多中心横断面研究于 2020 年 7 月至 2021 年 4 月在上海的七家不同医疗机构招募了 849 名 MHD 患者。采用老年营养风险指数（GNRI）、营养不良炎症评分（MIS）和肌酐（Cr）指数进行营养评估。肌肉量和力量的截值用于定义动力不足、前肌肉减少症和肌肉减少症，这些截值基于 2019 年亚洲肌肉减少症工作组的共识。
在 849 名患者中，近 60%存在营养不良，大多数患者患有动力不足（27.7%），其次是肌肉减少症（22.7%）和前肌肉减少症（6.2%）。GNRI 预测肌肉减少症和前肌肉减少症的受试者工作特征曲线下面积分别为 0.722（95%置信区间[CI]：0.684-0.760）和 0.723（95%CI：0.663-0.783）。GNRI[比值比（OR）=6.28，95%CI：4.05-9.73]、MIS（OR=1.91，95%CI：1.31-2.78）和 Cr 指数（OR=2.73，95%CI：1.71-4.34）均与肌肉减少症风险显著相关。更重要的是，GNRI 对肌肉减少症的预测能力似乎大于 MIS 和 Cr 指数，而 MIS 与 Cr 指数相似。同样，GNRI 在预测前肌肉减少症方面也具有优势，但在预测动力不足方面没有优势。
三种营养筛查工具均与肌肉减少症风险增加显著相关。GNRI 对肌肉减少症的预测能力大于 MIS 和 Cr 指数。
