Nutritional screening on hospital admission and one-year clinical outcomes in a prospective cohort of older patients

IF 2.9 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN Pub Date : 2024-10-11 DOI:10.1016/j.clnesp.2024.10.006

Gianluca Isaia , Roberto Presta , Enrico Brunetti , Clelia Maria Cacciatore , Francesca Carbonara , Eleonora Berardo , Cristina Villosio , Francesca Cicerchia , Paolo Mulatero , Simona Bo , Mario Bo

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引用次数: 0

Abstract

Background & aims

Malnutrition negatively affects the prognosis and quality of life of hospitalized patients. However, there are several gaps between evidence-based knowledge and current clinical practice. Our primary aim was to describe the prevalence of malnutrition risk in a cohort of in a cohort of older inpatients; secondly, we explored its predictors and its independent impact on 12-month survival.

Methods

Prospective study focused on patients aged 65 years and older consecutively admitted for any reason to the acute geriatric and general medical units of an Italian university hospital. Comprehensive geriatric assessment data, including the short form of the Mini Nutritional Assessment (MNA-SF), were collected within 48 hours of admission. The prevalence of malnutrition and risk of malnutrition according to the MNA-SF represented the main outcome. Correlations among clinical variables, nutritional status, and one-year survival were analyzed using multivariable and Cox models.

Results

Among 594 patients (median age: 84 years, 49.5 % female), mostly living at home with moderate functional autonomy, 82.3 % were identified as probably malnourished or at risk of malnutrition according to MNA-SF (39.9 % and 42.4 %, respectively). Malnutrition and the risk of malnutrition were positively associated with living alone at home (OR 2.803, 95%CI 1.567–5.177, p < 0.001), and negatively associated with autonomy in IADL (OR 0.765, 95%CI 0.688–0.846, p < 0.001) and the best performance at HST (OR 0.901, 95%CI 0.865–0.936; p < 0.001). After 12 months, 31.8 % of patients was dead and mortality was positively correlated with malnutrition according to MNA-SF (OR 2.493, 95%CI 1.345–4.751, p = 0.004), institutionalization (OR 2.815, 95%CI 1.423–5.693, p = 0.003) and severe cognitive impairment (OR 1.701, 95%CI 1.031–2.803, p = 0.036).

Conclusion

Malnutrition is common among older inpatients upon admission, primarily influenced by their functional and cognitive status, and it is linked to a worse prognosis. Early incorporation of thorough nutritional and functional assessments into clinical practice is crucial to improve prognosis prediction and enable timely, focused interventions targeting modifiable causal factors in a patient-centered approach.

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前瞻性老年患者队列中入院时的营养筛查和一年的临床结果。

背景与目的：营养不良会对住院病人的预后和生活质量产生负面影响。然而，循证知识与当前的临床实践之间还存在一些差距。我们的主要目的是描述一组老年住院患者中营养不良风险的发生率；其次，我们探讨了营养不良的预测因素及其对 12 个月生存期的独立影响：前瞻性研究的对象是因各种原因连续入住意大利一所大学医院急诊老年病科和普通内科的 65 岁及以上患者。研究人员在患者入院 48 小时内收集了全面的老年病学评估数据，包括迷你营养评估（MNA-SF）简表。主要结果是根据 MNA-SF 评估营养不良的发生率和营养不良的风险。采用多变量和 Cox 模型分析了临床变量、营养状况和一年生存率之间的相关性：在 594 名患者（中位年龄：84 岁，49.5% 为女性）中，大部分人都住在家中，具有中等程度的功能自主能力，根据 MNA-SF 标准，82.3% 的患者被确定为可能营养不良或有营养不良风险（分别为 39.9% 和 42.4%）。营养不良和营养不良风险与独居呈正相关（OR 2.803，95%CI 1.567-5.177，p 结论：营养不良和营养不良风险与独居呈正相关（OR 2.803，95%CI 1.567-5.177，p 结论）：营养不良在老年住院患者入院时很常见，主要受其功能和认知状况的影响，而且与预后较差有关。及早将全面的营养和功能评估纳入临床实践对于改善预后预测至关重要，并能以患者为中心，针对可改变的致病因素进行及时、有针对性的干预。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical nutrition ESPEN NUTRITION & DIETETICS-

CiteScore

4.90

自引率

3.30%

发文量

512

期刊介绍： Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.