METHODS: This is a prospective study in patients over 65 years of age hospitalized with a diagnosis of hip fracture. A nutritional assessment was performed using several tools: the Mini Nutritional Assessment Short Form (MNA-SF), the Subjective Global Assessment (SGA), and the GLIM criteria. For the definition of low muscle mass, four different methods were used: hand grip strength (HGS), calf circumference (CC), anthropometry, and bioelectrical impedance (BIA). Mortality was registered at three, six and twelve months.
RESULTS: 300 patients were included, 79.3% female, mean age 82.9 ± 7.1 years. The MNA-SF found 42% at risk of malnutrition, and 37.3% malnourished. Using SGA, there were 44% with moderate malnutrition, and 21.7% with severe malnutrition. In application of the GLIM criteria, 84.3%, 47%, 46%, and 72.7% of patients were malnourished when HGS, anthropometry, BIA, and CC were used, respectively. Mortality was 10%, 16.3% and 22% at 3, 6 and 12 months, respectively. In malnourished patients according to MNA-SF, mortality was 5.7 times greater [95%CI 1.3-25.4; p = 0.022] at 6 months and 3.8 times greater [95%CI 1.3-11.6; p = 0.018] at 12 months. In malnourished patients according to SGA, mortality was 3.6 times greater [95%CI 1.02-13.04; p = 0.047] at 3 months, 3.4 times greater [95%CI 1.3-8.6; p = 0.012] at 6 months and 3 times greater [95%CI 1.35-6.7; p = 0.007] at 12 months.
CONCLUSIONS: The prevalence of malnutrition in patients admitted for fragility hip fracture is high. The SGA and MNA-SF are postulated as adequate tools to diagnose malnutrition in these patients, with predictive value for mortality at three, six, and twelve months.
方法:这是一项对65岁以上诊断为髋部骨折住院患者的前瞻性研究。使用几种工具进行营养评估:迷你营养评估简表(MNA-SF),主观全球评估(SGA),和GLIM标准。对于低肌肉质量的定义,使用了四种不同的方法:手握力(HGS),小腿周长(CC),人体测量学,和生物电阻抗(BIA)。死亡率是在三点登记的,六个月和十二个月。
结果:包括300例患者,79.3%女性,平均年龄82.9±7.1岁。MNA-SF发现42%的人有营养不良的风险,37.3%营养不良。使用SGA,有44%的人患有中度营养不良,21.7%患有严重营养不良。在GLIM标准的应用中,84.3%,47%,46%,72.7%的患者在HGS时营养不良,人体测量学,BIA,和CC被使用,分别。死亡率是10%,在3、6和12个月时分别为16.3%和22%,分别。根据MNA-SF,在营养不良的患者中,6个月时死亡率为5.7倍[95CI1.3-25.4;p=0.022],12个月时死亡率为3.8倍[95CI1.3-11.6;p=0.018].根据SGA,在营养不良的患者中,3个月时死亡率高3.6倍[95CI1.02-13.04;p=0.047],6个月时增加3.4倍[95CI1.3-8.6;p=0.012],12个月时增加3倍[95CI1.35-6.7;p=0.007]。
结论:脆性髋部骨折患者营养不良发生率较高。SGA和MNA-SF被认为是诊断这些患者营养不良的适当工具,具有3岁时死亡率的预测价值,六,还有十二个月.