Investigation into the prevalence of malnutrition, sarcopenia and frailty in very old hospitalised patients and relationship with clinical outcomes

IF 2.6 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN Pub Date : 2025-09-09 DOI:10.1016/j.clnesp.2025.08.036

Adrian Slee , Manuela Sumar Vignau , Paul Bassett , Xinrui Jin , Junyi Guo , David Smithard

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引用次数: 0

Abstract

Background and aims

Malnutrition, sarcopenia and frailty represent common conditions in the geriatric population that have a detrimental impact on quality of life and clinical outcomes. These syndromes also display resembling clinical features and may often co-exist, aggravating adverse health outcomes. This study aimed to investigate the prevalence and co-occurrence of the conditions in a very old aged cohort of hospital patients, and the associations with clinical outcomes.

Methods

A registered clinical audit was performed in a Hospital setting and data collected from older patients aged >85 years of age, between 2019 and 2024. Malnutrition risk was assessed using the nutritional screening tool (NST), geriatric nutritional risk index (GNRI) and global leadership initiative malnutrition (GLIM) criteria. Sarcopenia screening was evaluated with the SARC-F (Strength, Assistance in walking, Rising from a chair, Climbing stairs, and Falls) questionnaire and frailty using the clinical frailty scale (CFS). The prevalence and concurrence of the conditions was calculated, alongside the analysis of in-hospital mortality risk and routine blood biomarkers (albumin, C-reactive protein, urea, creatinine and haemaglobin).

Results

768 audits were included for analysis and the median age was 89 years (87–92). Malnutrition was detected in 28.4 %, 32.8 % and 41.2 % of patients by NST, GNRI and GLIM respectively, while the prevalence of sarcopenia was 68.3 % and 73.2 % for frailty. Between 20.8 % and 29.2 % of patients presented all three conditions concomitantly, while 79.2 %–85.1 % had at least one. Cox regression analysis between geriatric syndromes and the risk of in-hospital death showed that high malnutrition risk by NST (adjusted HR = 1.78, p = 0.03), as well as the presence of sarcopenia by SARC-F (adjusted HR = 2.60, p = 0.001) and severe frailty (adjusted HR = 4.89, p < 0.001), were all significantly associated with an increased risk of mortality. Likewise, biomarker levels differed depending on the presence of conditions, with reduced albumin showing most significant associations with heightened risk/presence of malnutrition, sarcopenia and frailty.

Conclusion

The study showed a high prevalence and overlap between the explored conditions in this large, very old aged cohort, with nearly a third of patients presenting all three simultaneously, which may present significant health burden. Further research is needed to optimise the screening and assessment of conditions and establishing most accurate tools and techniques, to enhance clinical practical and potentially better guide interventions potentially affecting clinical outcomes.

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高龄住院患者营养不良、肌肉减少症和虚弱的患病率及其与临床结果的关系调查

背景和目的：营养不良、肌肉减少症和虚弱是老年人群中的常见疾病，对生活质量和临床结果有不利影响。这些综合征也表现出类似的临床特征，并可能经常共存，加重了不良的健康后果。本研究旨在调查老年住院患者的患病率和共发率，以及与临床结果的关系。方法：在2019年至2024年期间，在一家医院进行注册临床审计，并收集年龄在bb0 ~ 85岁之间的老年患者的数据。采用营养筛查工具（NST）、老年营养风险指数（GNRI）和全球领导倡议营养不良（GLIM）标准评估营养不良风险。通过SARC-F（力量、行走辅助、从椅子上站起来、爬楼梯和跌倒）问卷和临床虚弱量表（CFS）评估骨骼肌减少症筛查。计算了这些疾病的患病率和并发性，同时分析了住院死亡率风险和常规血液生物标志物（白蛋白、c反应蛋白、尿素、肌酐和血红蛋白）。结果：纳入768例审计人员进行分析，年龄中位数为89岁（87 ~ 92岁）。NST、GNRI和GLIM分别检出率为28.4%、32.8%和41.2%，肌少症检出率为68.3%，虚弱检出率为73.2%。20.8%至29.2%的患者同时出现这三种情况，而79.2%至85.1%的患者至少有一种情况。老年综合征与院内死亡风险之间的Cox回归分析显示，NST组存在高营养不良风险（校正HR = 1.78, p=0.03）， SARC-F组存在肌肉减少症（校正HR = 2.60, p=0.001）和严重虚弱（校正HR = 4.89, p）。该研究显示，在这个庞大的高龄队列中，所探索的病症的患病率和重叠率很高，近三分之一的患者同时出现这三种病症，这可能会带来重大的健康负担。需要进一步的研究来优化条件的筛选和评估，建立最准确的工具和技术，以提高临床实用性，并可能更好地指导可能影响临床结果的干预措施。

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.