Naber T H, Schermer T, de Bree A, Nusteling K, Eggink L, Kruimel J W, Bakkeren J, van Heereveld H, Katan M B
Department of Gastrointestinal and Liver Diseases, University Hospital Nijmegen, Netherlands. t.naber@
Am J Clin Nutr. 1997 Nov;66(5):1232-9. doi: 10.1093/ajcn/66.5.1232.
The prevalence of malnutrition and its predictive value for the incidence of complications were determined in 155 patients hospitalized for internal or gastrointestinal diseases. At admission, 45% of the patients were malnourished according to the Subjective Global Assessment (physical examination plus questionnaire), 57% according to the Nutritional Risk Index [(1.5 x albumin) + (41.7 x present/usual weight)], and 62% according to the Maastricht Index [(20.68 - (0.24 x albumin) - (19.21 x transthyretin (prealbumin) - (1.86 x lymphocytes) - (0 04 x ideal weight)]. Crude odds ratios for the incidence of any complication in malnourished compared with well-nourished patients during hospitalization were 2.7 (95% CI: 1.4, 5.3) for the Subjective Global Assessment, 2.8 (1.5, 5.5) for the Nutritional Risk Index, and 3.1 (1.5, 6.4) for the Maastricht Index. Odds ratios were reduced to 1.7 (0.8, 3.6), 1.6 (0.7, 3.3), and 2.4 (1.1, 5.4), respectively, after a multivariate analysis that included disease category and disease severity. Because the confounding factors adjusted for are not only a measure of the severity of the disease but may also be influenced by malnutrition itself, the actual risk for complications due to malnutrition could be higher than the adjusted odds ratios. In conclusion, malnutrition was frequent in patients with gastrointestinal disease and other internal diseases at the time of admission. The severity of malnutrition in the patients predicted the occurrence of complications during their hospital stay and this association was not completely explained by confounding factors.
对155名因内科或胃肠道疾病住院的患者进行了营养不良患病率及其对并发症发生率的预测价值的研究。入院时，根据主观全面评定法（体格检查加问卷调查），45%的患者存在营养不良；根据营养风险指数[（1.5×白蛋白）+（41.7×实际体重/平时体重）]，57%的患者存在营养不良；根据马斯特里赫特指数[20.68 - （0.24×白蛋白） - （19.21×转甲状腺素蛋白（前白蛋白）） - （1.86×淋巴细胞） - （0.04×理想体重）]，62%的患者存在营养不良。住院期间，与营养良好的患者相比，营养不良患者发生任何并发症的粗比值比，主观全面评定法为2.7（95%可信区间：1.4，5.3），营养风险指数为2.8（1.5，5.5），马斯特里赫特指数为3.1（1.5，6.4）。在纳入疾病类别和疾病严重程度的多因素分析后，比值比分别降至1.7（0.8，3.6）、1.6（0.7，3.3）和2.4（1.1，5.4）。由于所调整的混杂因素不仅是疾病严重程度的一种衡量指标，而且可能还受营养不良本身的影响，因此营养不良导致并发症的实际风险可能高于调整后的比值比。总之，胃肠道疾病和其他内科疾病患者入院时营养不良情况常见。患者营养不良的严重程度可预测其住院期间并发症的发生，且这种关联不能完全由混杂因素来解释。
