Assessment of the nutritional status of hospitalized elderly patients with modified Mini Nutritional Assessment (MNA)
營養評估 ； 簡易營養評估量表 ； 住院病人 ； Hospitalized patients ； Malnutrition ； ； Frail elderly ； Nutritional assessment.
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背景及目的: 住院病人常因食慾不振、熱量攝取不足而招致營養不良或失衡，影響病情發展，甚至增加死亡風險。台灣針對急診內科住院病人作營養評估之研究不多。故本研究之主旨在評估急診內科入住病房病人之營養風險。 方法：本研究藉由簡易營養評估原量表(Mini Nutritional Assessment, MNA)與台灣修訂量表，評估住院病人的營養風險。於2008年3月初針對住院24小時後之病患，於徵詢其參與研究之意願後，評估其營養風險，共收案109位。以原版及兩台灣修訂版本的簡易營養評估量表評估其營養狀況。MNA修訂一以台灣族群代表性的體位指標取代原分切點，修訂二則省略其中的BMI題項並調整臂中圍(Mid-arm circumference, MAC)及小腿圍(Calf circumference, CC)的配分，但維持相同的總分。 結果：研究結果顯示原量表評定43人(47.3%)為營養不良，36人(39.6%)具營養風險，12人(13.2%)營養良好;修訂一評定38人(41.8%)為營養不良，23人(25.3%)具營養風險，30人（33.0%）營養良好;而修訂二評定49人(53.8%)為營養不良，29人(31.9%)具營養風險，13人(14.3%)營養良好。以Wilcoxon Signed-Rank Test則顯示原量表結果與修訂二(Z=-4.082, p=0.109)之結果不具顯著差異；又原量表與修訂一(Z=-3.742, p<0.001)及修訂一與修訂二結果皆具顯著差異(Z=-4.082, p<0.001)。 結論：結果顯示內科住院病患之營養風險極高。約半數病被評定為營養不良的; 另25~40%具營養風險。MNA為臨床上適用多種病患的營養不良篩選及追蹤評值的實用工具，促使達到更有效的營養照顧。台灣修定二版因不必測量身高及體重，使用更為方便省時。定期的營養評估可在住院病人體重下降前，早期監測、追蹤並給予營養支持，快速提供全人系統的照護。
Abstract Background: Malnutrition is common in the elderly, especially among those who are hospitalized. Elderly in-patients often have depressed appetite, reduced food intake and nutritional imbalance. These conditions increase disease risks and even mortality. Objective: The study was aimed to (a) assess the nutritional status of hospitalized elderly patients, and (b) to validate the predictive ability of two modified versions of the Mini Nutritional Assessment (MNA) in elderly hospitalized patients. Methods: The study employed purposive sampling and recruited 109 consecutive elderly (≥65y) new patients who were hospitalized during March 2009 in an area hospital in rural Central-Western Taiwan. At approximately 24 hours after their arrival subjects were interviewed for assessing their nutritional statuses with three versions of the MNA, the original, the modified Taiwan version 1 (T-1) and Taiwan version 2 (T-2). T-1 was the same as the original version in all aspects except the anthropometric questions (Questions F, Q & R) where population specific BMI, mid-arm circumference (MAC) and calf-circumference (CC) cut-points replaced the original cut-points whereas T-2 omitted the BMI question and redistributed its scores to MAC and CC questions and adopted incremental cut-points and scoring. All versions maintained the same total scores and rating system. Results were statistically analyzed with SPSS 12.0 Software Package. Friedman Test and Wilcoxon Signed-rank Test were used to determine the significance of differences among the results graded with the three versions. Multivariate linear regression analysis was applied to determine the variables associated with the nutritional status. The study protocol was approved by the hospital IRB and all patients or their legal guardians signed an informed written concent. Results: Among the 109 patients, only 91 had complete data and those were used for further analyses. The original MNA scale rated 43 (47.3%) patients malnourished, 36 (39.6%) at risk of malnutrition and only 12 (13.2%) normal; T-1 rated 38 (41.8%), 23 (25.3%) and 30 (33.0%), respectively; and T-2 rated 49 (53.8%), 29 (31.9%) and 13 (14.3%) normal. Analyses with Friedman Test and Wilcoxon Signed-rank Test indicated that result rated with the T-1 version was different from that rated with the original and the T-2 versions whereas no difference was detected between results rated with the original and T-2 versions. Conclusion: Results indicate that malnutrition is prevalent among elderly hospitalized patients and also suggest that for frail elderly hospitalized patients, T-2 which has increased MAC and CC weightings to replace BMI weighting in the scale may better reflect the nutritional risk status. Routine assessment and timely intervention is the key to improving the nutritional status of frail elderly. T-2 is a tool particularly suitable for assessing the nutritional status of these frail patients.
健康學院 > 長期照護研究所