簡易營養評估量表評估成年智能障礙者營養風險之可行性

Assessment of the nutritional status of adults with intellectual disabilities in a long-term care institution with modified Mini Nutritional Assessment (MNA) in Taiwan

許秀月(Hsh Hshiu-Yueh)

指導教授 ： 蔡仲弘

亞洲大學/健康學院/長期照護研究所在職專班/碩士(2009年)

摘要

智能障礙者的營養不良與飲食攝取、疾病、住院、感染、認知、獨立功能等息息相關，並且增加其疾病風險及影響生活品質。本研究主旨在瞭解以台灣修訂版簡易營養評估量表(Mini Nutritional Assessment, MNA)評估成年智能障礙者營養狀況的可行性。研究方法採立意取樣，以台灣中部某身心障礙福利服務機構內十八歲以上之智障者為研究對象，共收案104(男59，女45)位。以原MNA量表、MNA-T1(MNA台灣修訂一版)及MNA-T2(MNA台灣修訂二版)三版本為研究工具，分別評估個案之營養狀況。MNA-T1量表是以台灣族群代表性的體位指標取代原分切點，MNA-T2量表則省略其中的BMI，但調整臂中圍及小腿圍配分以維持相同的總分。研究結果顯示原MNA量表篩檢出7位(6.7%)為營養不良者，29位(27.9%)為具營養風險者；MNA-T1量表篩檢出7位(6.7%)為營養不良及15位(14.4%)具營養風險；MNA-T2量表篩檢出6位(5.8%)為營養不良及18位(17.3%)具營養風險。以Friedman Test檢定結果顯示三版本間所測結果具顯著差異，以Wilcoxon Signed-Rank事後檢定原量表與修訂一(Z = -6.597, P<0.001)及修訂二(Z = -6.056, P<0.001)之結果具有顯著差異，而MNA-T1與MNA-T2所測之結果則不具顯著差異(Z = -1.538, P = 0.124)。各主要營養指標如血紅素、日常生活活動功能、住院天數、急性門診或急診次數、慢性病數及處方藥物種類與MNA三版量表呈現相關。以複迴歸分析發現營養狀況之主要預測指標為日常生活活動功能(β=0.564, P<0.001)，急性門診或急診次數(β=-0.337, P<0.001)及住院天數(β=-0.193, P<0.01)。本研究顯示依台灣族群修訂之MNA-T2能提供臨床專業人員及照護者對成年智能障礙者之營養風險作有效率的評估，是一個具簡易、有效、非侵入性的營養評估工具。定期評估可提早發現住民營養風險，及時介入營養支持，可減低疾病風險及增進智能障礙者的生活品質。

關鍵字

簡易營養評估，營養評估，營養風險，智能障礙者

並列摘要

Assessment of nutritional status with modified Mini Nutritional assessment (MNA) of adults with Intellectual Disabilities in a long-term care institution in Taiwan

Background: Nutritional abnormalities in individuals with mental disability can affect their susceptibility to diseases and infections, hospitalization, cognition status, activities of daily living (ADL) and even the quality of life. Routine monitoring of their nutritional status is important for avoiding these extra risks.
Objective: This study was aimed to examine the possibility of using the Mini Nutritional Assessment (MNA) for monitoring the nutritional status of adults with mental disability.
Design: Purposive sampling.
Setting: A religious group-managed living center for mentally disabled persons in Central Taiwan
Methods: 104 (59 male & 45 female) adult residents of the center were recruited to participate in the study after each of their guardians signed an informed consent. Each subject was interviewed and anthropometrically measured. Their interview dates were arranged to correspond with their annual physical check-up covered under the Universal Healthcare Insurance Program of Taiwan. The interview included personal data and questions in the MNA. The nutritional status of each subject was assessed with three versions of the MNA, the original, MNA-T1 which adopted population-specific anthropometric cut-points, and MNA-T2 which had the BMI in the scale replaced with calf-circumference (CC).
Results: Results showed the original MNA rated 7 (6.7%) subjects malnourished and 29 (27.9%) at risk of malnutrition; MNA-T1 rated 7 (6.7%) and 15 (14.4%), and MNA-T2 rated 6 (5.8%) and 18 (17.3%), respectively. Analysis of these results with Friedman Test suggested significant differences existed among the versions. Post hoc analysis with Wilcoxon signed-Rank test revealed that the pattern of nutritional status predicted with the original MNA was significantly different from that predicted with the MNA-T1 and T2, but the patterns predicted with the two modified versions were not different from each other. MNA scores of the three versions were also significantly correlated with hemoglobin, ADL, hospital length of stay, number of emergency visit, number of chronic diseases and number of prescribed medicine. Regression analysis indicated that ADL, emergency visit and hospital length of stay were the major associated factors of the nutritional status.
Conclusions: Results of this study indicate that the MNA, especially version T2, can be an effective tool for routine monitoring the nutritional risk status of Taiwanese adults with mental disabilities. The tool can enhance the efficiency of the primary healthcare workers. Routine monitoring of the nutritional risk status coupled with timely intervention can reduce the risk associated with malnutrition and can also help to enhance the quality of life of the mentally disabled individuals.

並列關鍵字

Mini Nutritional Assessment ； Nutritional assessment, Nutritional risk, Mental disability

參考文獻

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