Medical University Department, Division of General Internal and Emergency Medicine, Division of Endocrinology and Diabetes, Kantonsspital Aarau, Aarau, Switzerland.
Department of Bioscience and Nutrition, Karolinska Institutet, Stockholm, Sweden.
Am J Clin Nutr. 2024 Nov;120(5):1225-1232. doi: 10.1016/j.ajcnut.2024.09.020. Epub 2024 Sep 21.
Considering sex-specific factors has become an increasingly recognized area for research and practice, in the field of clinical nutrition, there is insufficient evidence regarding differences in clinical presentation, treatment response, and side effects of nutritional therapy among female and male patients.
We hypothesized that the clinical presentation, response to nutritional therapy, and side effects from the intervention would differ in the two sexes.
This secondary analysis investigated differences among female and male patients at risk for malnutrition regarding initial presentation, clinical outcomes, and treatment response in patients included in the Effect of Early Nutritional Support on Frailty, Functional Outcomes, and Recovery of Malnourished Medical Inpatients Trial (EFFORT), a randomized controlled trial comparing individualized nutritional support to usual care.
Of 2028 patients included in the trial, 964 were females and 1064 were males. The nutritional history and clinical presentation of female patients was different: they consumed less food and had a greater loss of appetite than the male population. Male patients had higher risk for mortality at 180 d [27% compared with 19%; adjusted hazards ratio (HR): 1.35; 95% CI: 1.12, 1.63] and further adverse clinical outcomes. However, there was no difference in the effect of nutritional support on mortality among female and male patients (HR: 0.76; 95% CI: 0.45, 1.27, compared with HR: 0.81; 95% CI: 0.54, 1.21, respectively; P-interaction = 0.939).
Results of this multicenter randomized trial suggest that multimorbid female inpatients have a different clinical presentation and are more prone to loss of appetite and reduced daily dietary intake than male inpatients. Importantly, the favorable response to nutritional interventions was similar in both sexes. This trial was registered at clinicaltrials.gov as NCT02517476.
考虑到性别因素，已经成为临床营养领域研究和实践中日益受到关注的领域，但是目前针对女性和男性患者在临床表现、治疗反应和营养治疗副作用方面的差异，仍缺乏充分的证据。
我们假设，女性和男性患者在营养治疗的临床表现、反应和副作用方面存在差异。
本二次分析调查了营养风险患者的初始表现、临床结局和治疗反应在性别方面的差异，这些患者均来自于早期营养支持对衰弱、功能结局和营养不良住院患者恢复效果的影响（EFFORT）试验，这是一项比较个体化营养支持与常规护理的随机对照试验。
在该试验中，共有 2028 例患者，其中 964 例为女性，1064 例为男性。女性患者的营养史和临床表现有所不同：与男性相比，女性患者的食物摄入量更少，且食欲不振的发生率更高。男性患者在 180 d 时的死亡率风险更高[27%比 19%；调整后的危险比（HR）：1.35；95%置信区间（CI）：1.12，1.63]，且进一步发生不良临床结局的风险更高。然而，营养支持对女性和男性患者的死亡率的影响没有差异（HR：0.76；95% CI：0.45，1.27，与 HR：0.81；95% CI：0.54，1.21，相比；P 交互作用=0.939）。
这项多中心随机试验的结果表明，患有多种合并症的女性住院患者与男性住院患者相比，临床表现不同，且更易出现食欲不振和每日膳食摄入量减少。重要的是，两性患者对营养干预的反应均较好。该试验在 clinicaltrials.gov 上注册，编号为 NCT02517476。
