簡易營養評估(MNA)台灣修訂版比原版更精準判別護理之家住民的營養狀況

Adoption of population-specific anthropometric cut-points improves the functionality of the Mini Nutritional Assessment in nursing home residents in Taiwan

廖秋映(Liao Chiu-Ying)

指導教授 ： 蔡仲弘

亞洲大學/健康學院/長期照護研究所/碩士(2007年)

摘要

目的：本研究比較簡易營養評估(Mini Nutritional Assessment, MNA)原版及兩台灣修訂版評估護理之家住民營養狀況之功能並分析其預測因子。
方法：以中部某護理之家入住30天以上，無急性疾病或感染之住民103位為研究對象。以問卷訪談、體位測量及血液生化指標檢測收集資料。
結果：以MNA原版、修訂一及修訂二評估住民的營養狀況，顯示營養不良者依序為29, 23及27%，具營養風險為51.5, 47.6及41.7%，營養良好為19.4, 29 及31%。以Friedman Test及Wilcoxon符號等級檢定分析三版本所測之結果，顯示原量表與修訂一及二所評之結果具顯著差異(Z = -6.922, P<0.001及Z = -4.836, P<0.001)，但修訂一與二所評之結果則無差異(Z = -0.618, P = 0.536)。血清白蛋白、日常生活功能、憂鬱量表、生活滿意度、慢性病數、急診次數及住院天數等指標均與三版本之總分呈顯著相關(P<0.05)，且多與修訂二之相關最強，修訂一次之。這些結果顯示兩修訂版本之評估功能比原版強而兩修訂版間則無差異。於回歸分析中顯示日常生活功能(B = -0.422, P<0.0001)、慢性病數(B = -0.366, P>0.0001)、血清白蛋白(B = 0.167, P<0.05)及年齡(B = -0.149, P>0.05)可有效預測MNA得分，其整體解釋變異量為59.4% (F = 21.87, P<0.0001)。
結論：台灣修訂版MNA具有比原版量表更強之評估功能，MNA修訂二(不需BMI)可更精確的判別護理之家住民的營養狀況，是更簡便、準確的營養評估工具。護理之家住民約有七成營養不良或具風險，日常生活功能、慢性病數、血清白蛋白及年齡為營養狀況主要預測因子，可提供日後營養不良之預防及介入之參考。

關鍵字

簡易營養評估 ； 營養風險 ； 體位測量 ； 老年人

並列摘要

Objective: The study aimed to investigate the functionalities of the original and modified MNA (Mini Nutritional Assessment) in assessing the nutritional status of nursing home residents and to identify the factors associated with the nutritional status.
Methods: With a purposive design, the study recruited 103 >65 y residents who were free of acute disease/infection and had a >3 months residence of a nursing home in Central Taiwan as study subjects. An on-site face-to-face interview was carried out on each subject to elicit personal data, health condition and answers to questions in the MNA and CNAQ (Council on Nutrition Appetite Questionnaire). Anthropometrical indicators were also measured. Serum biochemical parameters were obtained from their routine measurements which were maintained by the institution. Subjects' nutritional status was assessed with three versions of the MNA, the original, the MNA-TI which adopted population-specific anthropometric cut-points, and the MNA-TII which further eliminated BMI from the scale and adjusted the scoring. The study protocol was approval by Asia University.
Results: The original version graded 27% malnourished, 52% at risk of malnutrition and 20% normal; MNA-TI graded 18.5, 53 and 23%, and MNA-TII graded 23, 47 and 30%, respectively. Analysis with Frieman Test and Wilcoxon Signed-rank post hoc tests showed that the distribution of nutritional status graded with the original MNA was different from that of the two modified versions, but results between the two modified versions were not different from each other. Results also showed that serum albumin, calf circumference, the number of chronic diseases and activities of daily living were significantly correlated with MNA scores. Regression analysis indicates that activities of daily living and calf-circumference are the two major predictors while number of chronic diseases and serum albumin are also significant predictors of the nutritional status.
Discussion: Results suggest that MNA modified according to population-specific anthropometric cut-points has improved functionality over the original version. It also shows that MNA-TII which is without BMI can function at least equally well as MNA-TI. Approximately 70% of nursing home residents are at risk of malnutrition. Results of this study suggest that the MNA is useful as a tool for routine monitoring of the nutritional status of nursing home elderly.

並列關鍵字

Mini Nutritional Assessment ； Nutritional risk ； Anthropometric measurements ； Elderly

參考文獻

戰臨茜、高森永、金惠民、李美璇 (2002)。北台灣社區與機構中老人的營養狀況及其預測因子。中華民國營養學會雜誌，27(3)，147-158。

簡怡雯、黃美智、廖芳瑄、陳佳君、謝明哲 (2003)。住院病人營養評估新模式之建立。中華民國營養學會雜誌，28(4)，200-209。

Tsai, A. C., Ho, C. S., & Chang, M. C. (2007). Population-specific anthropometric cut-points improve the functionality of the Mini Nutritional Assessment (MNA) in elderly Taiwanese. Asia Pacific Journal of Clinical Nutrition, 16, 656-662.

Tsai, A. C., Ku, P. Y., & Tsai, J. D. (2008). Population-specific anthropometric cutoff standards improve the functionality of the Mini Nutritional Assessment without BMI in institutionalized elderly in Taiwan. The Journal of Nutrition, Health and Aging (in the press).

行政院衛生署國民健康局 (2006)。民國92年台灣地區中老年身心社會生活狀況長期追蹤(第五次)調查成果報告。行政院衛生署國民健康局。