营养不良住院患者干预后的临床结果评估

IF 7.4 2区医学 Q1 NUTRITION & DIETETICS

Clinical nutrition Pub Date : 2025-09-18 DOI:10.1016/j.clnu.2025.04.034

Yolanda Garcia , Nere Larrea , Josune Martin , Inmaculada Bolinaga , Cristina Sarasqueta , Amaia Perales , Natalia-Covadonga Iglesias , Alfredo Yoldi , Jose M. Quintana

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引用次数: 0

摘要

背景和目的营养不良与较高的死亡率、较低的身体机能和较长的住院时间有关。本研究的目的是评估营养干预对住院的疾病相关性营养不良（DRM）患者的有效性。方法对三所大学附属医院的食管癌、胃癌、胰腺癌、结肠癌和直肠癌、急性胰腺炎或炎症性肠病（IBDs）患者进行临床疗效研究，分为三组：无DRM且无明确营养干预的患者；接受营养干预的中重度DRM患者；以及接受标准治疗的中度至重度DRM患者。采用MUST和GLIM标准诊断DRM。根据结果变量，使用生存、逻辑回归或广义多水平线性多变量模型。结果1051例患者纳入研究。多变量多水平分析显示，DRM组与非DRM组的30天死亡率和90天再入院率无差异。对于90天死亡，没有干预的DRM患者有更高的风险，而有干预的患者没有。两个DRM组的住院时间更长，但感染并发症的发生率没有差异。我们发现入院和出院期间三个营养参数（体重、小腿围和握力）的变化没有差异。结论对住院患者进行营养干预有利于降低出院后死亡率；但为了取得更大的效益，出院后应保持。在ClinicalTrials.gov注册，编号NCT04188990。

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Evaluation of clinical outcomes after an intervention in malnourished hospitalized patients

Background & aims

Malnutrition is associated with higher mortality, lower functional capacity, and longer hospital stays. The goal of this study was to evaluate the effectiveness of a nutritional intervention in patients admitted to a hospital with disease-related malnutrition (DRM).

Methods

Pragmatic effectiveness study of patients recruited at three university hospitals with esophageal, gastric, pancreatic, colon, and rectal cancers, acute pancreatitis, or inflammatory bowel diseases (IBDs), with three groups: patients without DRM with no explicit nutritional intervention; patients with moderate to severe DRM on whom a nutritional intervention was performed; and patients with moderate to severe DRM who received standard care. DRM was diagnosed using the MUST and GLIM criteria. Depending on the outcome variable, survival, logistic regression, or generalized multilevel linear multivariable models were used.

Results

1051 patients were included in the study. Multivariate multilevel analysis showed no difference in 30-day mortality or readmission at 90 days between the DRM groups and those without DRM. For death at 90 days, DRM patients without intervention had a higher risk but those with intervention did not. Length of hospital stay was greater in both of the DRM groups, but there were no differences in the rate of infectious complications. We found no differences in the change in the three nutritional parameters evaluated (weight, calf circumference, and hand-grip strength) between admission and discharge.

Conclusions

Nutritional intervention in hospitalized patients has been shown to be beneficial for post-discharge mortality; however, in order to achieve greater benefits, it should be maintained after discharge.

Registered in ClinicalTrials.gov with ID NCT04188990.

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来源期刊

Clinical nutrition 医学-营养学

CiteScore

14.10

自引率

6.30%

发文量

356

审稿时长

28 days

期刊介绍： Clinical Nutrition, the official journal of ESPEN, The European Society for Clinical Nutrition and Metabolism, is an international journal providing essential scientific information on nutritional and metabolic care and the relationship between nutrition and disease both in the setting of basic science and clinical practice. Published bi-monthly, each issue combines original articles and reviews providing an invaluable reference for any specialist concerned with these fields.