刪除BMI的簡易營養評估量表台灣修訂版能有效地評估精神病人的營養狀況

A modified Mini Nutritional Assessment(MNA)without BMI can effectively assess the nutritional status of neuropsychiatric patient

周元棣(Yuanti-Chou)

指導教授 ： 蔡仲弘

亞洲大學/健康學院/長期照護研究所/碩士(2009年)

摘要

目的--本研究目的為驗證台灣修訂版簡易營養評估量表(Mini Nutritional Assessment, MNA)在刪除BMI時，是否依然能有效的評估精神病人之營養不良風險，以及比較兩修訂版本之差異。
方法--本研究採立意取樣的方式，以中部某區域教學醫院罹患慢性精神疾病3個月以上急性發作之住院病人，意識清醒且具語言及表達能力，為研究之對象。研究內容包括血液生化指標檢測、體位測量及問卷訪談以收集個案之基本資料及營養與健康狀況指標。以MNA兩台灣修訂版評估受測者的營養狀況。修訂一採用台灣族群代表性的體位指標分切點，而修訂二則更省略BMI題並將其配分轉嫁到上臂中圍(mid-arm circumference, MAC)及小腿圍(calf circumference, CC)兩題。以SPSS/Window 10.0統計軟體分析資料。以皮爾森相關(Pearson’s Correlation)分析比較兩版本之功能。輔以Wilcoxon Signed-Rank Test分析評估結果之差異性。最後以多元迴歸分析影響營養狀況的因素。
結果—兩修訂版本皆篩選出8 位個案(7.6%)為營養不良，而具營養風險者則依序為21.9及20.0%。統計顯示兩修訂版之間則無顯著差異。兩修訂版與血清白蛋白，呈現約相同程度的統計相關性。與BMI、罹患精神疾病年齡、壓力狀態、處方藥物數、CNAQ 總分及近3個月體重改變量%皆呈現高度的統計相關性。由此顯示修訂二雖將BMI一題去除但仍保持其良好的功能。對精神病人而言修訂二版本更優於修訂一。
結論-- MNA經修訂的台灣版簡易營養評估量表，毋須測量個案之身高及體重算得BMI，相對於生化指標便捷甚多，對照護人員而言更容易使用，是為一大進展，並使MNA功能大為提昇。似乎對精神病人的營養評估是有良好效用，亦有助於提升照護品質及照護人員的職場風險與效能。

關鍵字

簡易營養評估量表 ； 精神病人 ； 護理 ； 照護者

並列摘要

Objective: The aim of this study was to determine whether a modified version of the Mini Nutritional Assessment (MNA) without body mass index (BMI) can effectively identify individuals at risk of malnutrition among patients with neuropsychiatric disorders. The study also compares two versions with each other.
Methods: The study involved 105 patients in the acute phase of confirmed neuropsychiatric disorders in a regional hospital in central Taiwan. All subjects were cognitively able to have effective verbal communication. The study included serum biochemical and anthropometric measurements, and an on-site, in-person interview using a questionnaire survey to elicit participants' sociodemographic status, anthropometric measurements, healthcare-related biochemical indicators and answers to the MNA. Subjects' nutritional statuses were graded with a version of MNA that adopted population-specific anthropometric cut-points or one further with the BMI question removed and its assigned score redistributed to other anthropometric questions. Results were analyzed with Pearson's Correlation Analysis, and with multiple regression analysis to determine the association of the nutritional status with the major functional indicators.
Results: The two versions identified the same (7.6%) patients malnourished. The MNA-TI predicted 21.9% and the MNA-TII predicted 20.0% patients at risk of malnutrition. Post hoc analysis indicated that results with the original version were different from that predicted with the two modified versions whereas the patterns predicted by the two modified versions were not different from each other. Among the parameters examined, serum albumin concentrations showed the weakest correlations with MNA scores. The total MNA scores of both modified versions were very highly significantly correlated with subjects' BMI, duration of psychiatric disease, number of prescribed drugs, self-assessed appetite status, stress status and % weight loss. Total MNA scores were also significantly correlated with serum albumin concentrations. Both versions of the MNA had comparable r values. The MNA-TII version shows better or at least equal functionality compared to MNA-TI in predicting the nutritional status of neuropsychiatric patients.
Conclusion: Adoption of population-specific anthropometric cut-points improves the functionality of the MNA in neuropsychiatric patients, a non-Caucasian population, and the improved functionality is maintained in a version without BMI (with adjusted MAC and CC scores). The MNA is a valuable and effective tool for identifying individuals at risk of malnutrition among neuropsychiatric patients. A MNA without BMI has greater applicability and can enhance professional efficiency of healthcare workers.

並列關鍵字

Mini Nutritional Assessment ； neuropsychiatric patients ； nursing ； healthcare workers

參考文獻

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