比較短式簡易營養評估量表與萬用營養不良篩檢工具篩選台灣居家老人營養風險之功能

A comparison of the nutrition risk-screening ability of the MNA-SF and MUST in community-living elderly in Taiwan

陳婷婷(Ting-Ting Chen)

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

背景–老年人由於老化導致活動力減少及基礎代謝率下降，消化及吸收功能也衰退，容易造成營養不良，及增加罹病率及死亡風險。而改善營養狀況可延緩老化及減少疾病發生。故一個快速、有效、簡易又低成本的營養不良篩檢工具是必要的。此一工具的適切運用將可適時偵測營養風險。
目的–本研究目的為比較台灣修訂版短式簡易營養評估量表 (Mini Nutritional Assessment-Short Form, MNA-SF) 與台灣修訂版萬用營養不良篩檢工具 (Malnutrition Universal Screening Tool, MUST) 運用於評估居家老人之營養不良篩選功能，及分析居家老人營養不良之預測因子。
方法–本研究採立意取樣，以中部某地區醫院65歲以上參加年度健康檢查的居家老人男88人及女112人為樣本。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-SF與MUST原版本及兩台灣修訂版本評估受測者的營養狀況。兩量表的修訂一皆採用台灣族群代表性的體位指標分切點，而修訂二則以小腿圍分切點取代BMI分切點。以SPSS/Window 10.0統計軟體分析資料。以Friedman Test及Wilcoxon Signed-Rank Test分析兩量表評估結果之差異性且進一步也分析敏感度、特異度與Kappa一致性係數 (Kappa coefficient of agreement)。以Spearman’s相關係數 (Spearman’s correlation coefficient) 比較MNA-LF, MNA-SF與MUST各版本之功能。以複回歸 (Multiple Regression) 分析影響營養狀況的因素。
結果–MNA-SF三版本判定具營養風險者分別為18.0%, 13.0%, 11.0%；而MUST三版本中，原量表判定5.5 %個案具高度營養風險者及7.5%具中度風險者，修訂一判定2.5%及6.0%，修訂二判定4.0%及4.5%。Kappa一致性係數顯示，MNA-SF及MUST修訂版比原量表有更好的一致性及特異度，但MNA-SF三版本判別具營養風險者的能力優於MUST。複迴歸分析顯示年齡、血清白蛋白及食慾狀況為營養不良的危險因子。
結論–本研究顯示MNA-SF可能較適用於判別居家老人的營養風險，而MUST則可能較適用於判別臨床病人的營養風險。其中MNA-T2-SF以小腿圍取代BMI也能有效判別居家老人的營養風險。此一修訂可以不必為了計算BMI值而測量個案之身高及體重，有助於提升護理人員工作效率及節省醫療成本，也能改善老人的生活品質。本研究亦發現年齡、血清白蛋白、食慾狀況為預測居家老人營養狀況的主要因子。

關鍵字

營養評估量表 ； 營養狀況 ； 居家老人 ； 營養風險

並列摘要

Background--Aging is associated with impaired physiological functions such as reduced GI functions, decreased metabolic rate and diminished physical activity. These changes can lead to malnutrition and increase risk of disease and mortality. Proper nutrition is important in delaying aging and reducing these risks. Nutritional screening/assessment is the key to early detection of malnutrition. Thus, a fast, effective and low-cost tool is essential for routine screening of the risk of malnutrition.
Objective--The objective of this study was to compare the malnutrition-screening ability of the modified Taiwan versions of Mini Nutritional Assessment short-form (MNA-SF) with Malnutrition Universal Screening Test (MUST), and to determine the predictors of malnutrition in elderly Taiwanese.
Methods--The study employed a purposive design and recruited 200 (88 men and 112 women) ≥65y elderly who attended regional hospital for annual health examination. After signing an informed consent, each subject was interviewed with a structured questionnaire for eliciting personal data, lifestyle and health statuses and answers to questions in the MNA. Biochemical data were taken from subjects' medical records. Each subject was rated for the risk of malnutrition with the MNA and MUST, each in three versions, the original, Taiwan version-1 which adopted population-specific anthropometric cut-points, and version-2 which replaced CC for BMI in the scale. Statistical analyses were carried out with SPSS/Window 10.0 Statistical Software Package (Chicago, IL). Friedman Test and Wilcoxon Signed-Rand Test were used to determine the significance of differences among the versions. Spearman's correlation analysis was used to determine the significance of relationship between the MNA or MUST scores with each of the health-related variables. Multivariate linear regression analysis was conducted to determine the factors that may impact the nutritional risk status of the elderly.
Results--The original, T1 and T2 versions of short-form MNA rated 18.0, 13.0, and 11.0% of participants at risk of malnutrition. The original MUST version rated 5.5% at high risk and 7.5% at moderate risk; MUST-T1 rated 2.5% and 6.0%; and MUST-T2 rated 4.0% and 4.5%, respectively. The modified versions of the MNA-SF and MUST have improved Kappa values and the specificity over the original versions. But the MNA-SF versions have better malnutrition-predictive ability than MUST versions. Regression analyses indicate that age, serum albumin and appetite status are the major factors impacting one's nutritional risk status.
Conclusion--Results of this study suggest that MNA-SF versions have superior nutritional-risk predictive ability over MUST versions. But MUST versions appear to be better suited for predicting the nutritional risk of clinical patients. The replacement of CC for BMI in T2 versions maintains the predictive ability of the tool. Since measurement of body weight and height can be difficult in frail elderly, the T2 versions represent an improvement in nutrition assessment. Without requiring the measurement of weight and height, the tool can be used more easily and can help to make routine nutritional screening a realistic goal. This study also finds age, serum albumin and appetite status the major predictors of malnutrition in Taiwanese elderly.

並列關鍵字

Nutritional assessment tools ； Nutritional status ； community-living elderly ； Nutritional risk

參考文獻

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.

Chen, C, C., Schilling, L. S., & Lyder, C. H. (2001). A concept analysis of malnutrition in the elderly. Journal of Advanced Nursing, 36 (1), 131-142.

Cheng, H. S., See, L. C., & Shieh, Y. H. (2001). Estimating stature from knee height for adults in Taiwan. Chang Gung Medical Journal, 24 (9), 547-556.

Chumlea, W. C., Guo, S. S., Wholihan, K., Cockram, D., Kuczmarski, R. J., & Johnson, C. L. (1998). Stature prediction equations for elderly non-Hispanic white, non-Hispanic black, and Mexican-American persons developed from NHANES III data. Journal of the American Dietetic Association, 98 (2),137-142.

Cohendy, R., Rubenstein, L. Z., & Eledjam, J. J. (2001). The Mini Nutritional Assessment-Short Form for preoperative nutritional evaluation of elderly patients. Aging, 13 (4), 293-297.