The impact of nutritional support on malnourished inpatients with aging-related vulnerability
The impact of nutritional support on malnourished inpatients with aging-related vulnerability
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DOI：
10.1016/j.nut.2021.111279
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发表时间：
2021-06-03
期刊：
影响因子：
4.4
通讯作者：
Schuetz, Philipp
中科院分区：
文献类型：
--
作者：
Baumgartner, Annic;Pachnis, Daphne;Schuetz, Philipp
目的：营养不良在具有与衰老相关的脆弱性（定义为非常老的年龄（>80岁）、身体虚弱或认知障碍）的患者中非常普遍，并且增加发病率和死亡率的风险。个体化营养支持对急性医院环境中与年龄相关的脆弱性患者的死亡率和其他临床结局的影响仍有待研究。研究方法：对于早期营养支持对营养不良住院患者虚弱、功能结局和恢复的随机对照效应试验（EFFORT）的二次分析，我们分析了营养风险患者的数据（2002年营养风险筛查得分>3分），易受衰老影响，随机接受方案指导的个体化营养支持，以达到特定的蛋白质和能量目标（干预组）或常规医院食品（对照组）。主要终点为30天全因死亡率。结果如下：在881例与年龄相关的脆弱性患者中，23.4%的患者表现为脆弱综合征，81.8%的患者年龄>80岁，15.3%的患者表现为认知障碍。与常规医院食物相比，接受个体化营养支持的衰老相关脆弱性患者显示30天死亡率风险降低>50%（442例中的60例[13.6%] vs 439例中的31例[7.1%];比值比：0.48; 95%置信区间，0.31-0.76; P = 0.002）。在180天的长期死亡率以及功能结局和生活质量指标方面也有显着改善。
Objectives: Malnutrition is highly prevalent in patients with aging-related vulnerability defined by very old age (>80 y), physical frailty or cognitive impairment, and increases the risks for morbidity and mortality. The effects of individualized nutritional support for patients with aging-related vulnerability in the acute hospital setting on mortality and other clinical outcomes remains understudied. Methods: For this secondary analysis of the randomized-controlled Effect of Early Nutritional Support on Frailty, Functional Outcomes, and Recovery of Malnourished Medical Inpatients Trial (EFFORT), we analyzed data of patients at a nutritional risk (Nutritional Risk Screening 2002 score >3 points) with aging-related vulnerability, randomized to receive protocol-guided individualized nutritional support to reach specific protein and energy goals (intervention group) or routine hospital food (control group). The primary endpoint was all-cause 30-d mortality. Results: Of the 881 patients with aging-related vulnerability, 23.4% presented with a frailty syndrome, 81.8% were age >80 y and 15.3% showed cognitive impairment. Patients with aging-related vulnerability receiving individualized nutritional support compared with routine hospital food showed a >50% reduction in the risk of 30-day mortality (60 of 442 [13.6%] versus 31 of 439 [7.1%]; odds ratio: 0.48; 95% confidence interval, 0.31-0.76; P = 0.002). Significant improvements were also found for long-term mortality at 180 days, as well as functional outcomes and quality of life measures.