Tajima Tomihiko, Nakashima Hirotaka, Nagae Masaaki, Komiya Hitoshi, Fujisawa Chisato, Watanabe Kazuhisa, Yamada Yosuke, Umegaki Hiroyuki
Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Aichi, Japan.
Department of Emergency Room General Medicine, Hyogo Prefectural Amagasaki General Medical Center, Higashinaniwa-Cho, Amagasaki, 660-8550, Hyogo, Japan.
Aging Clin Exp Res. 2025 May 26;37(1):170. doi: 10.1007/s40520-025-03076-7.
Undernutrition is a prevalent issue among hospitalized older adults. Dietary intake is a major factor in nutritional status. Although insufficient dietary intake during hospitalization has been well documented, little research has focused on dietary intake at discharge, which may reflect the patient's true dietary intake capacity. Furthermore, it would be desirable for energy intake to be estimated in a clinically feasible way.
This study aimed to assess pre-discharge energy intake using routinely recorded dietary intake data, and to examine the association between pre-discharge energy intake and post-discharge mortality in older inpatients.
A prospective cohort study was conducted in a geriatric ward. Energy intake in the 3 days prior to discharge was estimated using visually assessed dietary intake data recorded in medical records. The primary outcome was 3-month post-discharge mortality.
A total of 257 patients (mean age 84.7 years) was included. The mean pre-discharge energy intake was 1327 ± 315 kcal/day, with 74.7% of patients failing to meet recommended energy intake levels. Within 3 months post-discharge, 18 patients (7.0%) had died. Cox regression analysis revealed that higher pre-discharge energy intake was associated with lower post-discharge mortality (per 100 kcal/day, hazard ratio 0.75, 95% confidence interval 0.65-0.86), independent of other prognostic factors such as comorbidities and functional status.
Many patients did not reach their recommended energy intake at discharge. Integrating routine monitoring of pre-discharge energy intake into discharge planning could trigger timely nutritional interventions and goal-of-care discussions, thereby improving post-discharge outcomes.
营养不良是住院老年患者中普遍存在的问题。饮食摄入是营养状况的主要因素。虽然住院期间饮食摄入不足已有充分记录，但很少有研究关注出院时的饮食摄入，而这可能反映患者的真实饮食摄入能力。此外，以临床可行的方式估计能量摄入将是可取的。
本研究旨在使用常规记录的饮食摄入数据评估出院前的能量摄入，并探讨老年住院患者出院前能量摄入与出院后死亡率之间的关联。
在一个老年病房进行了一项前瞻性队列研究。出院前3天的能量摄入通过病历中记录的视觉评估饮食摄入数据进行估计。主要结局是出院后3个月的死亡率。
共纳入257例患者（平均年龄84.7岁）。出院前平均能量摄入为1327±315千卡/天，74.7%的患者未达到推荐的能量摄入水平。出院后3个月内，18例患者（7.0%）死亡。Cox回归分析显示，出院前能量摄入较高与出院后死亡率较低相关（每100千卡/天，风险比0.75，95%置信区间0.65-0.86），独立于其他预后因素，如合并症和功能状态。
许多患者出院时未达到推荐的能量摄入量。将出院前能量摄入的常规监测纳入出院计划可以引发及时的营养干预和护理目标讨论，从而改善出院后的结局。
