改善老年人与衰老相关的虚弱状态：一项以营养为重点的计划的结果

Q3 Nursing

Clinical Nutrition Open Science Pub Date : 2025-09-04 DOI:10.1016/j.nutos.2025.08.010

Carlos Cano-Gutierrez , Luis Carlos Venegas-Sanabria , Gabriel Gomez , Estephania Chacón-Valenzuela , María Fernanda Dueñas , Daniela Gracia , Juan Diego Misas , Elkin Garcia-Cifuentes , Suela Sulo , Leocadio Rodríguez-Mañas

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引用次数: 0

摘要

医疗保健专业人员今天的目标是通过减少与衰老有关的虚弱的影响来延长老年人的健康寿命。为了更健康的老龄化，我们目前的分析量化了营养不良、社区生活的老年人接受介入性营养护理时发生的虚弱变化。方法：我们招募年龄≥60岁、营养不良或有筛查风险的门诊研究参与者（Mini Nutrition Assessment-Short Form, MNA-SF）。为了进行准实验分析，我们根据Fried表型标准选择了那些体弱或体弱的人（n=524）。每个人都接受了全面的以营养为重点的质量改进计划(QIP) -营养和身体活动咨询，每天服用口服营养补充剂60天（确保服用羟甲基丁酸酯®和Glucerna®，雅培，美国），随访至第90天。我们将结果量化为从基线到干预后的变化(i)总体虚弱状态（虚弱，虚弱前期，正常）或（ii）五个阳性Fried虚弱标准的数量（体重减轻，疲惫，低体力活动，慢速步态和肌肉无力），使用变化类别更糟，相同或更好。我们还测量了基线和干预后的营养状态（MNA-SF）、精神状态/认知状态（Mini-Mental state Exam， MMSE）、抑郁/心理健康（Geriatric depression Scale， GDS）和残疾（Barthel指数，BI）。我们应用逻辑回归分析来确定预测干预后虚弱状态改善的因素。结果基线时，参与者平均年龄为74.2（±8.7）岁，71% （n=372/524）的参与者体弱，29% （n=152/524）的参与者体弱；16.2% （n=85/524）营养不良，83.8% （n=439/524）处于危险状态。到研究第90天，34.4%（180/524）的参与者虚弱状态较好，而55% （n=288/524）的参与者虚弱状态较差。较好的虚弱状态还与较高的MNA-SF评分（12.3比9.1,P < 0.001）、较高的MMSE评分（28.1比27.7,P < 0.05）、较低的GDS评分（3.3比4.5,P < 0.001）、较高的BI评分（96.9比96.1,P < 0.05）相关，与改善的精神状态/认知状态相关。Logistic回归分析显示，MNA-SF评分的改善可预测以营养为重点的QIP干预对虚弱的改善。具体而言，从体弱或体弱改善到正常的个体MNA-SF评分平行增加的可能性是其他人的近8倍（优势比为7.83,95% CI 4.3-15.2, P < 0.01）。结论通过解决营养不良这一脆弱的危险因素，可以支持健康老龄化。我们发现，在以营养为重点的QIP之后，社区生活的老年人获得了更好的虚弱状态。值得注意的是，营养状况的改善预示着虚弱状态的改善，并与之平行。

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Improving aging-related frailty status among older adults: Results of a nutrition-focused program

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Improving aging-related frailty status among older adults: Results of a nutrition-focused program

Background

Healthcare professionals today aim to boost the years older people live in good health by reducing the impact of aging-related frailty. Toward healthier aging, our current analysis quantified frailty changes that occurred when poorly nourished, community-living, older adults received interventional nutrition care.

Methods

We recruited outpatient study participants ≥ 60 years and malnourished or at-risk on screening (Mini Nutrition Assessment-Short Form, MNA-SF). For quasi-experimental analysis, we selected those who were prefrail or frail by Fried phenotype criteria (n=524). Each followed a comprehensive nutrition-focused Quality Improvement Program (QIP)—counseling on nutrition and physical activity, daily consumption of oral nutritional supplements for 60 days (Ensure with Hydroxymethylbutyrate® and Glucerna®, Abbott, USA), with follow-up through day 90. We quantified outcomes as changes from baseline to post-intervention for (i) overall frailty status (frail, prefrail, normal) or (ii) number of positive Fried frailty criteria of five (weight loss, exhaustion, low physical activity, slow gait speed, and muscular weakness) using change categories Worse, Same, or Better. We also measured baseline and post-intervention status of nutritional state (MNA-SF), mental state/cognitive status (Mini-Mental State Exam, MMSE), depression/psychological health (Geriatric Depression Scale, GDS), and disability (Barthel Index, BI). We applied logistic regression analyses to identify factors that predicted post-intervention improvement in frailty status.

Results

At baseline, the mean age of participants was 74.2 (±8.7) years, 71% (n=372/524) of participants were prefrail, and 29% (n=152/524) were frail; 16.2% (n=85/524) were malnourished, and 83.8% (n=439/524) were at risk. By study day 90, 34.4% (180/524) of participants had a better frailty status, while 55% (n=288/524) met fewer frailty criteria. Better frailty status was also associated with significantly higher MNA-SF score (12.3 vs 9.1, P < 0.001), improved mental state/cognitive status as higher MMSE score (28.1 vs 27.7, P < 0.05), decreased depression/improved psychological health as lower GDS score (3.3 vs 4.5, P < 0.001), and greater independence as higher BI score (96.9 vs 96.1, P < 0.05). Logistic regression analyses showed that MNA-SF score improvement was predictive of frailty improvement in response to the nutrition-focused QIP intervention. Specifically, individuals who experienced improvement from prefrail or frail to normal were nearly 8-times more likely than others to have a parallel increase in MNA-SF score (Odds ratio of 7.83, 95% CI 4.3–15.2, P < 0.01).

Conclusion

Healthy aging can be supported by addressing poor nutritional status, a frailty risk contributor. We found that community-living older adults achieved a better frailty status after following a nutrition-focused QIP. Notably, improved nutritional status predicted and paralleled improvement in frailty status.