Association of Frailty and Malnutrition With Long-term Functional and Mortality Outcomes Among Community-Dwelling Older Adults Results From the Singapore Longitudinal Aging Study 1
Association of Frailty and Malnutrition With Long-term Functional and Mortality Outcomes Among Community-Dwelling Older Adults Results From the Singapore Longitudinal Aging Study 1
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DOI：
10.1001/jamanetworkopen.2018.0650
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发表时间：
2018-07-01
影响因子：
13.8
通讯作者：
Ng, Tze-Pin
中科院分区：
文献类型：
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作者：
Wei, Kai;Nyunt, Ma-Shwe-Zin;Ng, Tze-Pin
重要性 身体虚弱和营养不良在老年人中普遍存在，可能与功能和死亡结果相关。目的 评估老年人中与身体虚弱和营养不良单独和组合相关的健康结果。设计、设置和参与者 基于人群的队列研究（新加坡纵向老龄化研究 1）。其中包括2804名基线时（2003年9月1日至2005年12月23日）年龄为55岁或以上的新加坡社区居住成年人，每2至3年进行2次随访（从2005年3月Z至2007年9月10日，以及从2007年11月13日至2009年12月12日）和截至 2017 年 3 月 31 日的 12 年死亡率随访。数据分析时间为 2017 年 7 月 1 日至 9 月 28 日。 主要结果和测量 基线身体虚弱（弗里德标准），参与者根据总分分为虚弱（3-5 分）、脆弱（1-2 分）或健壮（0 分），以及营养状况（营养筛查计划确定您的营养健康检查表和迷你营养评估简表 [MNA-SF]）。测量基线（流行）和随访（事件）工具/基本日常生活活动（IADL/ADL）残疾、生活质量差（QOL）和死亡率。通过比值比 (OR) 和风险比 (HR) 及其 95% CI 来估计相关性。 结果 参与者（平均 [SD] 年龄。66.0 [7.7] 岁；1033 [36.8%] 男性；2611 [93.1%] 中国人）包括 1021 名（37.6%），被归类为 MNA-SF 正常营养 (R-NN) 的稳健者， 330 名 (12.2%) 身体健康，伴有 MNA-SF 处于危险/营养不良 (R-ARM) 状态，734 名 (27.0%) 处于虚弱/虚弱，MNA-SF 营养正常 (PFF-NN) 状态，631 名 (23.2%) 处于虚弱/虚弱，伴有 MNA-SF 处于危险/营养不良 (PFF-ARM) 状态。其中2804名参与者。 44 人缺失虚弱状态，78 人缺失 MNA-SF 营养状况；因此，共有 88 名参与者缺乏虚弱营养状况。在横断面分析中，R-NN 组的 IADL/ADL 残疾发生率最低 (169 [16.9%])，仅 PFF-ARM 组 (249 [40.2%]) 的 IADL/ADL 残疾发生率大幅增加（OR. 1.88：95% CI，1.40-2.53）。 R-NN 组中生活质量差的发生率最低 (142 [14.1%])，PFF-ARM 组中其他虚弱和营养状况组的增加最高 (255 [41.3%]) (OR, 2.61; 95% CI, 1.96-3.49)。在纵向分析中，与 R-NN 组 (132 [19.2%]) 相比，虚弱和营养状况组中仅与不良生活质量事件显着相关的 PFF-ARM 组 (89 [34.8%]) 最高（OR，1.70；95% CI，1.17-2.48）。 R-NN 组的死亡率最低（每 100 人年 0.54 人），PFF-ARM 组的死亡率最高（每 100 人年 3.04 人）（HR，1.72；95% CI，1.01-2.92）。基于营养筛查计划对营养状况的测量得出的结果相似。 结论和相关性 据报道，由于营养不良而导致的不良健康结果往往更可能与身体虚弱有关。营养不良的体弱/虚弱老年人可能会成为干预措施的目标，以预防或延迟不良的功能和死亡结果。
IMPORTANCE Physical frailty and malnutrition are prevalent among older adults and may be associated with functional and mortality outcomes.OBJECTIVE To assess the health outcomes associated with physical frailty and malnutrition singly and in combination among older adults.DESIGN, SETTING, AND PARTICIPANTS Population-based cohort study (Singapore Longitudinal Aging Study 1). Included were 2804 community-dwelling adults in Singapore aged 55 years or older at baseline (September 1, 2003, to December 23, 2005), with 2 follow-ups at 2- to 3-year intervals (from March Z 2005, to September 10, 2007, and from November 13, 2007, to December 12, 2009) and a 12-year mortality follow-up to March 31, 2017. Data analysis was from July 1 to September 28, 2017.MAIN OUTCOMES AND MEASURES Baseline physical frailty (Fried criteria) with participants categorized according to the total score as frail (3-5 points), prefrail (1-2 points), or robust (0 point), and nutritional status (Nutrition Screening Initiative DETERMINE Your Nutritional Health Checklist and Mini Nutritional Assessment Short-Form [MNA-SF]). Baseline (prevalent) and follow-up (incident) instrumental/basic activities of daily living (IADL/ADL) disability, poor quality of life (QOL), and mortality were measured. Estimates of association were by odds ratios (ORs) and hazard ratios (HRs) and their 95% CIs.RESULTS The participants (mean [SD] age. 66.0 [7.7] years; 1033 [36.8%] male; 2611 [93.1%] Chinese) included 1021(37.6%) categorized as robust with MNA-SF normal nutrition (R-NN), 330 (12.2%) robust with MNA-SF at risk/malnourished (R-ARM), 734 (27.0%) prefrail/frail with MNA-SF normal nutrition (PFF-NN), and 631(23.2%) prefrail/frail with MNA-SF at risk/malnourished (PFF-ARM). Among these 2804 participants. 44 had missing frailty status, and 78 had missing MNA-SF nutritional status; therefore, 88 participants in total had missing frailty-nutritional status. In cross-sectional analyses, the prevalence of IADL/ADL disability was lowest among the R-NN group (169 [16.9%]) and increased substantially only among the PFF-ARM group (249 [40.2%]) (OR. 1.88: 95% CI, 1.40-2.53). Poor QOL prevalence was lowest among the R-NN group (142 [14.1%]), and the increase in other frailty and nutritional status groups was highest in the PFF-ARM group (255 [41.3%]) (OR, 2.61; 95% CI, 1.96-3.49). In longitudinal analyses, significant association with only incident poor QOL across frailty and nutritional status groups was highest in the PFF-ARM group (89 [34.8%]) compared with the R-NN group (132 [19.2%]) (OR, 1.70; 95% CI, 1.17-2.48). The mortality rate was lowest in the R-NN group (0.54 per 100 person-years) and highest in the PFF-ARM group (3.04 per 100 person-years) (HR, 1.72; 95% CI, 1.01-2.92). The results based on the Nutrition Screening Initiative measure of nutritional status were similar.CONCLUSIONS AND RELEVANCE Reported adverse health outcomes attributed to poor nutrition often appear more likely to be associated with physical frailty. Prefrail/frail older persons with poor nutrition might be targeted for interventions to prevent or delay adverse functional and mortality outcomes.