Lansey S, Waslien C, Mulvihill M, Fillit H
Department of Geriatrics, Mount Sinai Medical Center, New York, NY 10029.
Gerontology. 1993;39(6):346-53. doi: 10.1159/000213553.
Although common among the hospitalized frail elderly, malnutrition is often unrecognized by clinicians, and its identification is fought with difficulty due to inadequate nutritional assessment methods and standards. This study compared the use of percent ideal body weight (%IBW) and anthropometry in the assessment of malnutrition in the hospitalized frail elderly. Approximaty 45% of patients studied had at least two anthropometric measurements below the 5th percentile, a level reflecting severe malnutrition. However, only 28% of patients were found to be less than 90% IBW, a level reflecting only mild to severe changes in body weight. Serum albumin was below normal (< 35 g/l) in 30% of patients. The total lymphocyte count was below normal (< 1,500 cells/mm3) in 53%, and was severely depressed (< 800 cells/mm3) in 24%. Thus, despite the use of stringent anthropometric criteria indicating severe malnutrition, anthropometry appeared more sensitive than %IBW as a measure of malnutrition in the hospitalized frail elderly. Furthermore, acute illness causes changes in commonly employed blood measures which make them unreliable in the assessment of malnutrition in this population. Anthropometry may prove to be the most stable, easily performed, and sensitive measure of malnutrition in the hospitalized frail elderly. However, further studies are clearly needed, including the development of appropriate anthropometric reference standards for the very old, a population that commonly suffers malnutrition.
虽然营养不良在住院的体弱老年人中很常见，但临床医生往往未能识别，而且由于营养评估方法和标准不完善，识别营养不良存在困难。本研究比较了理想体重百分比（%IBW）和人体测量法在评估住院体弱老年人营养不良中的应用。约45%的研究患者至少有两项人体测量指标低于第5百分位数，这一水平反映严重营养不良。然而，仅发现28%的患者理想体重低于90%，这一水平仅反映体重有轻度至重度变化。30%的患者血清白蛋白低于正常水平（<35 g/l）。53%的患者淋巴细胞总数低于正常水平（<1500个细胞/mm³），24%的患者淋巴细胞总数严重降低（<800个细胞/mm³）。因此，尽管使用了表明严重营养不良的严格人体测量标准，但在评估住院体弱老年人的营养不良方面，人体测量法似乎比理想体重百分比更敏感。此外，急性疾病会导致常用血液指标发生变化，使其在评估该人群营养不良时不可靠。人体测量法可能是评估住院体弱老年人营养不良最稳定、最易操作且最敏感的方法。然而，显然需要进一步开展研究，包括为经常遭受营养不良的高龄人群制定合适的人体测量参考标准。
