Comparison of the performance of four different tools in diagnosing disease-associated anorexia and their relationship with nutritional, functional and clinical outcome measures in hospitalized patients
Comparison of the performance of four different tools in diagnosing disease-associated anorexia and their relationship with nutritional, functional and clinical outcome measures in hospitalized patients
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DOI：
10.1016/j.clnu.2012.11.011
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发表时间：
2013-08-01
影响因子：
6.3
通讯作者：
Laviano, Alessandro
中科院分区：
文献类型：
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作者：
di Trifiletti, Adriana Arezzo;Misino, Paola;Laviano, Alessandro
背景与目的：在住院患者中，食欲不足，即疾病相关性厌食症，是导致食物摄入不足和体重减轻的主要因素，这反过来又增加了发病率和死亡率。在诊断厌食症时，哪种工具应该是首选的，存在争议。本研究旨在评估4种不同工具[食欲自评、FAACT-Espen评分、视觉模拟量表(VAS)和厌食症问卷(AQ)]在评估与疾病相关的厌食症和预测营养及临床变量方面的作用。在获得知情同意后，患者被要求对他们的食欲与前一个月进行自我评估。还提交了VAS、FAACT-Espen评分和厌食症问卷。访谈结束后立即记录食物摄入量。在入院时和出院前记录营养(即体重、身高)、功能(即握力)和临床变量(即住院时间)。结果：我们研究了105例患者(74米：31女；66.2+/-16.3岁)。患者自评、FAACT-Espen评分和厌食症问卷评定的厌食率分别为23%、10%和48%。VAS与食物摄入量之间没有显示出任何相关性。由食欲自我评估确定的厌食症患者与非厌食症患者相比，食物摄入量减少，握力较弱。FAACT-Espen评分与体重、食物摄入量和握力相关，与住院时间无关。由厌食症问卷确定的厌食症患者与非厌食症患者相比，表现为进食量减少、体重减轻、握力减弱和住院时间延长。除了VAS，所有测试的工具都能识别营养和功能变量受损的患者。然而，只有厌食症问卷才能确定住院时间较长的患者。我们的结果表明，在临床实践中，食欲的改变反映了不同的潜在机制，其对临床结果测量的影响可能不同。因此，理想的厌食症评估工具似乎并不存在，但应该根据要评估的结果指标(即预测住院时间的厌食症问卷)来选择。(C)2012年爱思唯尔有限公司和欧洲临床营养与代谢学会。版权所有。
Background & aims: In hospitalized patients, lack of appetite, i.e., disease-associated anorexia, is the main factor determining insufficient food intake and weight loss, which in turn increase morbidity and mortality. Controversies exist on which tool should be preferred when diagnosing anorexia. Aim of the study was to evaluate in hospitalized medical patients, the performance of 4 different tools [i.e., self-assessment of appetite, FAACT-ESPEN score, visual analog scale (VAS), and the Anorexia Questionnaire (AQ)] in assessing disease-associated anorexia and predicting nutritional and clinical variables.Materials and methods: Hospitalized patients consecutively admitted to the Internal Medicine ward at our institution were considered. After informed consent was obtained, patients were asked to self-assess their appetite vs the previous month. The VAS, the FAACT-ESPEN score and the Anorexia Questionnaire were also submitted. Food intake immediately following the interview was recorded. Nutritional (i.e., body weight, height), functional (i.e., handgrip strength) and clinical variables (i.e., length of stay) were registered upon admission and before discharge.Results: We studied 105 patients (74M:31F; 66.2 +/- 16.3 yrs). The prevalence of anorexia as assessed by patients' self assessment, FAACT-ESPEN score, and the Anorexia Questionnaire was 23%, 10% and 48%, respectively. VAS did not show any correlation with food intake. Anorexic patients as identified by the self assessment of appetite showed reduced food intake and weaker handgrip strength than non-anorexic. The FAACT-ESPEN score correlated with body weight, food intake and handgrip strength, but was not related with length of stay. Anorexic patients as identified by the Anorexia Questionnaire showed reduced food intake, lower body weight, weaker handgrip strength and longer hospital stay than non-anorexic patients.Discussion: The prevalence of anorexia significantly varies according to the diagnostic tool used. Except for VAS, all the tested tools identify patients with impaired nutritional and functional variables. However, only the Anorexia Questionnaire identifies patients with longer hospital stay. Our results suggest that in clinical practice, modification of appetite reflects different underlying mechanisms whose impacts on clinical outcome measures may differ. Therefore, an ideal anorexia assessment tool does not appear to exist, but it should be chosen according to the outcome measures to be assessed (i.e., Anorexia Questionnaire to predict length of stay). (C) 2012 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.