Title

以簡易營養評估(MNA)台灣修訂版評估內科住院病人的營養狀況

Translated Titles

Assessment of the nutritional status of hospitalized elderly patients with modified Mini Nutritional Assessment (MNA)

Authors

柯玟玟

Key Words

營養評估 ; 簡易營養評估量表 ; 住院病人 ; Hospitalized patients ; Malnutrition ; ; Frail elderly ; Nutritional assessment.

PublicationName

亞洲大學長期照護研究所學位論文

Volume or Term/Year and Month of Publication

2008年

Academic Degree Category

碩士

Advisor

蔡仲弘

Content Language

繁體中文

Chinese Abstract

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。

English Abstract

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.

Topic Category 醫藥衛生 > 社會醫學
健康學院 > 長期照護研究所
Reference
  1. 吳淑如、杜敏世 (2001)‧護理之家住民健康問題探討‧長期照護雜誌,5(1),54-65。
    連結:
  2. 邱怡玟、林文元、謝柏均、李家霙、邱瓊慧(2005)‧長期照護機構住民營養狀態評估指標之研究‧實證護理,1(2),112-121。
    連結:
  3. 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。
    連結:
  4. 葉莉莉、溫敏杰、徐碧卿、彭巧珍(2000)‧居家護理個案管理半年期間血清白蛋白與血色素狀態探討‧護理研究,8(4),447-458。
    連結:
  5. 詹吟菁、翁玉青、洪麗珍、黃美娜、林姿利、王銘富(2000)。台中縣地區居家老年失能病患之營養現況‧中華民國營養學會雜誌,25(2),82-90。
    連結:
  6. 蔡秀玲、張素瓊、郭靜香(2005)‧迷你營養評估量表應用於護理之家老人營養狀況評估‧中華民國營養學會雜誌,30(3),135-145。
    連結:
  7. 戰臨茜、高森永、金惠民、李美琁(2002)‧北台灣社區與機構中老人的營養狀況及預測因子‧中華民國營養學會雜誌,27(3):147-158。
    連結:
  8. 戰臨茜、金惠民、李美璇(2003)‧居家營養照護人力培訓課程及實效性探討‧中華民國營養學會雜誌,28(3),138-147。
    連結:
  9. 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。
    連結:
  10. Bonnefoy, M., Jauffret, M., Kostka, T., & Jusot, J. F. (2002). Usefulness of calf circumference measurement in assessing the nutritional state of hospitalized elderly people. Gerontology, 483 (3), 162-169.
    連結:
  11. 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.
    連結:
  12. Cereda, E., & Vanottia, A. (2007). The new Geriatric Nutritional Risk Index is a good predictor of muscle dysfunction in institutionalized older patients. Clinical Nutrition, 26 (1), 78-83.
    連結:
  13. de Groot, L. C., Beck, A. M., Schroll, M., & Staveren, W. A .(1998). Evaluating the DETERMINE your nutritional health checklist and the Mini Nutritional Assessment as tools to identify nutritional problems in elderly Europeans. European Journal of Clinical Nutrition, 52(12), 877-883.
    連結:
  14. Feldblum, I., German, L., Castel, H., Harman-Boehm, I., Bilenko, N., Eisinger, M, Fraser, D., & Shahar, D. R. (2007). Characteristics of undernourished older medical patients and the identification of predictors for undernutrition status. Nutrition Journal, 6(37), 1-9.
    連結:
  15. Forbes, G. B. (2002). Perspectives on body composition. Current Opinion in Clinical Nutrition & Metabolic Care, 5(1), 25-30.
    連結:
  16. Flanel, D. F., & Fairchid, M. M. (1995). Continuous quality improvement in inpatient clinical nutrition services. J Am Diet Assoc, 9(5), 65-75.
    連結:
  17. Gariballa, S., & Forstera, S. (2007). Between underlying disease and nutritional status following acute Associations illness in older people. Clinical Nutrition, 26, 466-473.
    連結:
  18. Izawa, S., Kuzuya, M., Okada, K., Enoki, H., Kanda, S., Kanda, S., et al. (2006). The nutritional status of frail elderly with care needs according to the mini-nutritional assessment. Clinical Nutrition, 25 (6), 962-967.
    連結:
  19. Izawa, S., Kuzuya, M., Okada, K., Enoki, H., Kanda, S., Kanda, S., et al. (2006). The nutritional status of frail elderly with care needs according to the mini-nutritional assessment. Clinical Nutrition, 25 (6), 962-967.
    連結:
  20. Jensen, G. L., Friedmann, J. M., Coleman, D. C. & Smiciklas-Wright, H. (2001). Screening for hospitalization and risks among community- dwelling older person. American Journal of Clinical Nutrition, 74(2), 201-205.
    連結:
  21. Keller, H. H., & Ostbye, T. (2003). Nutritional risk and time to death, predictive validity of SCREEN (Seniors in the Community Risk Evaluation for Eating and Nutrition). Journalof Nutrition and Health Aging, 7 (1), 274-279.
    連結:
  22. Kuzuya, M., Kanda, S., Koike, T., Suzuki, Y., Satake, S., & Iguchi, A. (2005). Evaluation of Mini-Nutritional Assessment for Japanese frail elderly. Nutrition, 21 (4), 498-503.
    連結:
  23. Kuzuya, M., Izawa, S., Enoki, H., Okada, K., & Iguchi, A. (2007). Is serum albumin a goog marker for malnutrition in the physically impaired elderly? Clinical Nutrition, 26 (1), 84-90.
    連結:
  24. Meyyazhagan, S., & Palmer, R. M. (2002). Nutritional requirements with aging prevention of disease. Clinic in Geriatric Medicine, 18, 557-576.
    連結:
  25. Stechmiller, J. K. (2003). Early nutritional screening of older adults. Journal Infusion Nursing, 26 (3), 170-177.
    連結:
  26. Suominen, M., Muurinen, S., Routasalo, P., Soini, H., Suur-Uski, I., Peiponen, A., et al. (2005). Malnutrition and associated factors among aged residents in all nursing homes in Helsinki. Eur J Clin Nutr, 59(4), 578-583.
    連結:
  27. Tsai, A. C., Ho, C. S., & Chang, M. C. (2007a). 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.
    連結:
  28. Tsai, A. C., Ho, C. S., & Chang, M. C. (2007b). Assessing the prevalence of malnutrition with the Mini Nutritional Assessment (MNA) in a nationally representative sample of elderly Taiwanese. Journal of Nutrition, Health & Aging, 14, 239-243.
    連結:
  29. Tsai, A. C., & Ku, P. Y. (2008). Population-specific Mini Nutritional Assessment effectively predicts the nutritional state and follow-up mortality of institutionalized elderly Taiwanese regardless of cognitive status. British Journal of Nutrition 100, 152-158.
    連結:
  30. Tsai, A. C., & Shih, C. L., (2009). A population-specific Mini Nutritional Assessment can effectively grade the nutritional status of stroke rehabilitation patients in Taiwan. Journal of Clinical Nursing 18,82-88.
    連結:
  31. Tsai, A. C., Ku, P. Y., & Tsai, J. D. (2009). Population-specific anthropometric cutoff standards improve the functionality of the Mini Nutritional Assessment without BMI in institutionalized elderly in Taiwan. The Journal of Nutrition, Health and Aging (in the press).
    連結:
  32. Tsai, A. C., Chou, Y. T., Chang, T. L., Chang-Lee, S. Nu., & Tsay S. (2009). A modified Mini Nutritional Assessment without BMI can effectively assess the nutritional status of neuropsychiatric patients. Journal of Clinical Nursing, doi: 10.1111/j.1365-2702.2008.02686.x
    連結:
  33. Vellas, B., Lauque, S., Andrieu, S., Nourhashemi, F., Rolland, Y., & Baumgartner, R. (2001). Nutrition assessment in the elderly. Current Opinion in Clinical Nutrition and Metabolic Care, 4 (1), 5-8.
    連結:
  34. Westergren, A., Unosson, M., Ohlsson, O., Lorefält, B., & Hallberg, I. R. (2002). Eating difficulties, assisted eating and nutritional status in elderly (≥65 years) patients in hospital rehabilitation. International Journal of Nursing Studies, 39(3), 341-351.
    連結:
  35. 中文部分:
  36. 英文部分:
  37. Bleda, M. J., Bolibar, I., Parés, R., & Salvà, A. (2002). Reliability of the Mini Nutritional Assessment (MNA) in institutionalized elderly people. The Journal of Nutrition, Health and Aging, 6 (2), 134-137.
  38. Bankhead, R. R. (1999). Intergration of management practice. Nursing Case Management, 4(3), 122-130.
  39. Chumlea, W. C. (2006). Is the MNA in valid different populations and across practice settings? The Journal of Nutrition, Health and Aging, 10, 524-533.
  40. Chumlea, W. C. (2006). Is the MNA in valid different populations and across practicesettings? The Journal of Nutrition, Health and Aging, 10, 524-533.
  41. Omerbegovic, M., Duric, A., & Duric, K. (2005). Pre-operative nutritional status as a morbidity factor in surgical patients. Medicinski Arhiv, 59 (5), 331-334.
  42. Thomas, D. R., Zdrowski, C. D., Wilson, M. M., Conright, K. C., Lewisc, T. S., & Morley, J. E. (2002). Malnutrition in subacute care. The American Journal of Clinical Nutrition, 75 (2), 308-313.
Times Cited
  1. 謝素琴(2011)。行經冠狀動脈繞道手術術後一星期的營養探討。臺灣大學護理學研究所學位論文。2011。1-70。