短式簡易營養評估量表(MNA-SF)之體位指標修訂可改進其篩選功能

Population-specific anthropometric cut-points improve the predictive ability of the Short Form Mini Nutritional Assessment (MNA-SF)

游淳翔(CHUN-HSIANG YU)

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:本研究目的為驗證小腿圍是否可取代短式簡易營養評估量表 (Short Form Mini Nutritional Assessment, MNA-SF) 的BMI，使其能更簡易、快速篩選出具營養不良風險之危險群。
方法:本研究採立意取樣，以中部某地區醫院65歲或以上參加健檢之社區居家老人為對象 (男137人、女160人)。研究內容包含問卷訪談及血液生化指標檢測部份，收集個案之社會人口學、健康狀況、生活習慣及MNA量表等各題資料。本研究以MNA-SF三版本與MNA台灣修訂兩版分析個案之營養狀況。以Spearman相關係數 (Spearman's Correlation) 分析MNA-SF三版本之功能。以Friedman Test與 Wilcoxon Signed-Rank Test進行篩選結果之差異性。使用ROC AUC (Receiver operating characteristic area under the curve) 分析MNA-SF三版本與MNA台灣修訂兩版之敏感度和特異度。
結果:MNA-SF原版及兩修定版分別判定18.9, 13.1及12.1%老人具營養風險。兩MNA台灣修訂版分別判定11.4%, 9.4%老人具營養風險。MNA-SF原量表與兩修訂版本篩選之結果均具顯著差異，而兩修定版之篩選結果則無顯著差異，顯示兩修訂版之篩選功效比原量表好。三版本之總分與血紅素及血清白蛋白呈顯著正相關 (p<0.05)，過去六個月住院天數及最近三個月急診次數與三版本之總分呈負相關 (p<0.05)，兩修定版比原量表與急診次數及住院天數具有更高之相關性。
結論:MNA-SF原量表篩選具營養風險者比率高於兩台灣修訂版，原量表之BMI分切點對於亞洲人來說標準較高，而產生高估營養風險率。修訂一為依台灣老人量身訂做的工具，故其營養篩選的功能應比原量表強。修訂二刪除BMI值用小腿圍替代，與修訂一均可有效的篩選具營養風險者。本研究結果顯示MNA-SF-T2以小腿圍取代BMI，免測量老人的身高及體重與計算BMI，亦可有效篩選社區老人之營養風險。更方便、快速的篩檢出具營養風險者，更有利於臨床照護人員使用，若能及早發現老人營養不良的潛在問題，有助於提升照護品質與工作效率，減少醫療支出，進而增進老人生活品質。

關鍵字

短式簡易營養篩選 ； 營養風險 ； 老人營養 ； 驗證

並列摘要

Background: The Mini Nutritional Assessment (MNA) is a popular tool for assessing the nutritional status of the elderly. MNA has a short form version comprised of the first 6 questions of the long form MNA for screening risk of malnutrition. Replacement of BMI with expanded scores of mid-arm circumference and calf circumference has been shown to improve the predictive ability of the tool.
Objective: This study attempted to determine whether replacing CC for BMI in short form could also improve the predictive activity of the tool.
Method: The study employed a purposive sampling and recruited 297 consecutive elderly subjects who attended an area hospital for health examination during the summer of 2008. Subjects who agreed to participate in the study were interviewed with a structure questionnaire for eliciting personal data and answers to questions in the MNA. Biochemical data were obtained from their laboratory reports. Subject's nutritional status was evaluated with three (the original and two modified) versions of the MNA and two modified long form versions. Results were analyzed with Friedman Test, Wilcoxon Signed-rank Test and Spearman's correlation. Receiver operating characteristic area under the curve (ROC AUC) was used to analyze the agreement between the results of the short form versions and of the long-form versions.
Results: The original short form version graded significantly greater proportions of elderly at risk of malnutrition than the two modified versions. The two modified versions graded similar proportions of elderly at risk of malnutrition. Overall, the short form T-2 version has the best predictive ability among the three versions. Conclusion: Short form MNA-T2 appears to have the best predictive ability among the three short form versions. MNA-T2 has the advantage of not requiring weight and height measurements for calculation BMI. The version presumable can improve the work efficiency of the primary care workers because patients nutritional risk screening can be completed more quickly. Thus, the tool has the potential to improve the job efficiency of the primary care workers. It can also help to improve the quality of life of the elderly patients.

並列關鍵字

Short form Mini Nutritional Assessment ； Nutritional risk ； Geriatric nutrition ； Validation

參考文獻

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