簡易營養評估量表之驗證及安養機構住民的營養風險評估

Validation of a modified MNA for assessing the nutritional status of elderly in long-term care institutions in Taiwan

黃荻坭(TI-NI HUANG)

指導教授 ： 蔡仲弘

亞洲大學/健康學院/長期照護研究所/碩士(2008年)

摘要

本研究採立意取樣以經修訂的簡易營養評估量表(Mini Nutritional Assessment, MNA)評量中部某養護中心297 (男132，女165)位老年住民的營養狀況。MNA修訂一以台灣族群代表性的體位指標取代原分切點，修訂二省略其中的BMI題但調整上臂圍及小腿圍的配分以維持相同的總分。研究以結構式問卷進行個別訪談並收集血液生化資料。問卷內容包括個案基本資料、健康狀況及簡易營養評估(包括體位測量)。結果顯示依修訂一評定24人(8.1%)為營養不良，157人(52.9%)具營養風險，116人(39%)營養良好。依修訂二評定28人(9.4%)為營養不良，164人(55.2%)具營養風險，105人(35.4%)營養良好。兩修訂版評估之結果(MNA總分)皆與主要營養指標如血清白蛋白、小腿圍、臂中圍呈顯著相關。以複迴歸分析發現個案營養狀況之主要預測指標為血清白蛋白(B=1.482, P<0.01)，近三個月體重變化(B=0.316, P<0.001)，六個月住院天數(B=-0.061, P<0.001) 及小腿圍(B=0.585, P<0.001)。本研究顯示修訂的簡易營養評估量表可以更方便與快速的評估台灣老年人的營養狀況。定期的營養評估可以早期的發現高營養風險者，可及時的介入以減低疾病風險，亦可節省醫療開支。

關鍵字

營養風險 ； 營養評估 ； 簡易營養評估 ； 老人

並列摘要

Abstract
Objective: The study was conducted to determine whether a version of the MNA (Mini Nutritional Assessment) modified according to population-specific anthropometric cut-points have improved functionality in assessing the nutritional status of elderly residents in long-term care institutions in Taiwan.
Methods: Using a purposive sampling design, the study recruited 297 subjects (132 men and 165 women) from a large long-term care center in Central Taiwan as study subjects. To be qualified, subjects must be a resident for >30 days, without acute infection or disease and able to communicate. Each subject was interviewed with a structured questionnaire for personal data, health conditions and answers to the MNA, and also measured for anthropometric parameters. Biochemical data were obtained from their routine examinations carried out by the center. The nutritional status of each subject was evaluated with two modified versions of the MNA. Version I (MNA-TI) adopted population-specific anthropometric cut-points while version II (MNA-TII) further had the BMI question deleted from the scale and adjusted the scoring. The study protocol was approved by the IRB of Asia University.
Results: MNA-TI graded 8.1% malnourished, 52.9% at risk of malnutrition and 39% normal whereas MNA-TII graded 9.4, 55.2 and 35.4%, respectively. The results of the two versions were not different from each. The results of both versions were significantly correlated with the major nutritional indicators such as serum albumin, calf-circumference and mid-arm circumference. Regression analysis further indicated that serum albumin, calf-circumference, weight change during the past three months and hospital length of stay were the factors associated with the MNA scores.
Conclusion: Results of this study suggest that MNA which adopted population-specific anthropometric cut-points and a further modified version without BMI can effectively grade the nutritional status of elderly in long-term care institutions. MNA is a simple, easy-to-use and non-invasive tool. Removal of BMI from the scale further enhances its application in frail or disabled individuals.

並列關鍵字

Nutritional assessment ； malnutrition ； calf circumference ； elderly ； Taiwan

參考文獻

楊瑞珍、黃璉華、胡幼慧、白璐(1995)：自費安養機構老人的自覺健康狀況。護理雜誌，3(4)：353-362。

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。

金惠民、田玫、廖英茵(2002)：老人居家照護個案營養專業介入之成效探討。中華民國營養學會雜誌，27(4)：232-238。

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(4), 656-662.

李世代、廖英茵(2004)：老人常見的營養問題—以長期照護機構老年住民之經驗為例。護理雜誌，51(5)：21-25。