调查营养不良和肥胖双重诊断与住院时间、再入院和12个月死亡率之间的关系——一项回顾性观察性单中心研究。

IF 2.9 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN Pub Date : 2025-02-01 DOI:10.1016/j.clnesp.2024.12.026

Emma Sganzerla , Ranjeev Chrysanth Pulle , Donna Hickling , Jack Bell

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引用次数: 0

摘要

目的：尽管肥胖对老年患者的死亡率有保护作用，但肥胖和营养不良的双重诊断可能会使预后恶化。本研究旨在调查65岁及以上诊断为营养不良的肥胖患者是否与肥胖、非营养不良的同龄人有不同的结局。方法：对住院患者进行回顾性研究，纳入2011- 2019年年度营养不良审计的9年数据。肥胖定义为身体质量指数(BMI) > ~ 30kg/m2；营养不良被定义为主观总体评估（SGA） B类或c类。使用Logistic回归分析来考虑营养不良和肥胖同时诊断与结果之间的关系，包括：12个月死亡率、住院时间延长（定义为bb50百分位，非常长，定义为bb1 75百分位）和12个月内再入院。结果：纳入326例65岁及以上的肥胖患者。患者中位年龄为76.1岁，女性占51.8%。37例（11%）营养不良和肥胖，中位BMI为32.9kg/m2。营养不良增加了延长住院时间（OR:3.30, 95% CI 1.58 - 6.91, p = 0.002）和延长住院时间(OR: 4.17, 95% CI 1.89 - 9.21, p =结论：双重诊断为肥胖和营养不良的老年患者的预后比肥胖但非营养不良的同龄人更差。肥胖的存在不应妨碍对老年患者的营养状况进行评估。

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Investigating the associations between a dual diagnosis of malnutrition and obesity and length of stay, readmissions, and 12-month mortality in patients aged >65 yrs admitted to hospital – A retrospective observational single-centre study

Objective

Despite the protective effect of obesity on mortality in older patients, the dual diagnosis of obesity and malnutrition may worsen outcomes. This study aimed to investigate whether obese patients aged 65 years and over with a diagnosis of malnutrition have different outcomes to obese, non-malnourished peers.

Methods

This retrospective study of inpatients included 9 years of data from annual Malnutrition Audits (2011–2019). Obesity was defined as Body Mass Index (BMI) > 30 kg/m²; malnutrition was defined by Subjective Global Assessment (SGA) category B or C. Logistic regression analyses were used to consider the association between a concurrent diagnosis of malnutrition and obesity and outcomes including: 12-month mortality, prolonged length of stay (defined as >50th centile, very prolonged as >75th centile) and hospital readmission within 12 months.

Results

326 obese patients aged 65 years and over were included. Median patient age was 76.1 years, with 51.8 % female. 37 patients (11 %) were malnourished and obese, with a median BMI of 32.9 kg/m². Malnutrition increased the odds of prolonged length of stay (OR:3.30, 95 % CI 1.58–6.91, p = 0.002) and very prolonged length of stay (OR: 4.17, 95 % CI 1.89–9.21, p = <0.001), as well as increased 12-month mortality (OR: 2.89, 95 % CI 1.40–5.96, p = 0.004). Malnutrition was not associated with increased hospital presentations within 12 months (p = 0.531).

Conclusion

Older patients with a dual diagnosis of obesity and malnutrition have worse outcomes than their obese but non-malnourished peers. The presence of obesity should not preclude the assessment of nutritional status in older patients.

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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.