Abstract：
OBJECTIVE: Malnutrition and nutritional risk are risk factors for many adverse health outcomes in older adults, but they have rarely been assessed in China. The aim of this study was to evaluate the availability of Elderly Nutritional Indicators for Geriatric Malnutrition Assessment (ENIGMA), a nutritional scale originally developed to predict mortality, in assessing nutritional risks and predicting adverse health outcomes in Chinese community-dwelling older adults.
METHODS: This was a population-based longitudinal cohort study (Chinese Longitudinal Healthy Longevity Survey), with a 4-y follow-up of 2063 community-dwelling adults aged 65 y or older. Nutritional risks were assessed via the use of ENIGMA and Geriatric Nutritional Risk Index (GNRI) at baseline (the 2014 wave). Cognitive impairment, functional limitation, and frailty were evaluated using the Chinese version of the Mini-Mental State Examination, Instrumental Activities of Daily Living/Instrumental Activities of Daily Living scale, and Frailty Index, respectively, at baseline and 4-y follow-up (the 2018 wave). Mortality was measured by survival status and duration of exposure to death from baseline to follow-up. The associations of nutritional risks with prevalent/incident cognitive impairment, functional limitation and frailty, and 4-y mortality were estimated using logistic regression and Cox proportional hazards regression models, adjusting for confounders. The discriminatory accuracy of ENIGMA and GNRI for these adverse health outcomes were compared by receiver operating characteristic analyses.
RESULTS: According to ENIGMA, 48.6% of the Chinese community-dwelling older adults (age: 86.5±11.3 y) showed moderate and high nutritional risk. Nutritional risks defined by the ENIGMA were significantly associated with increased prevalence and incidence of cognitive impairment, functional limitation, and frailty (odds ratio ranging from 1.79 to 89.6, values ranging from P < 0.001 to 0.048) but were mostly insignificant for that defined by GNRI. With respect to 4-y mortality, nutritional risks as defined by GNRI showed better prediction effects than those defined by ENIGMA. Receiver operating characteristic analyses indicated that nutritional risks defined by ENIGMA had better discriminatory accuracy than those defined by GNRI for prevalent and incident cognitive impairment (C = 0.73 vs 0.64, P < 0.001; C = 0.65 vs 0.59, P = 0.015, respectively), functional limitation (C = 0.74 vs 0.63, P < 0.001 at baseline; C = 0.61 vs 0.56, P = 0.016 at follow-up), frailty (C = 0.85 vs 0.67, P < 0.001 at baseline; C = 0.64 vs 0.55, P < 0.001 at follow-up), and even 4-y mortality (C = 0.68 vs 0.64, P = 0.020).
CONCLUSIONS: ENIGMA could serve as a nutritional risk screening tool that has a robust role in predicting cognitive impairment, functional limitation, and frailty in Chinese community-dwelling older adults. It may be recommended for early nutritional risk screening and has the potential to guide early nutritional intervention in communities and primary care settings in China.
METHODS: This was a population-based longitudinal cohort study (Chinese Longitudinal Healthy Longevity Survey), with a 4-y follow-up of 2063 community-dwelling adults aged 65 y or older. Nutritional risks were assessed via the use of ENIGMA and Geriatric Nutritional Risk Index (GNRI) at baseline (the 2014 wave). Cognitive impairment, functional limitation, and frailty were evaluated using the Chinese version of the Mini-Mental State Examination, Instrumental Activities of Daily Living/Instrumental Activities of Daily Living scale, and Frailty Index, respectively, at baseline and 4-y follow-up (the 2018 wave). Mortality was measured by survival status and duration of exposure to death from baseline to follow-up. The associations of nutritional risks with prevalent/incident cognitive impairment, functional limitation and frailty, and 4-y mortality were estimated using logistic regression and Cox proportional hazards regression models, adjusting for confounders. The discriminatory accuracy of ENIGMA and GNRI for these adverse health outcomes were compared by receiver operating characteristic analyses.
RESULTS: According to ENIGMA, 48.6% of the Chinese community-dwelling older adults (age: 86.5±11.3 y) showed moderate and high nutritional risk. Nutritional risks defined by the ENIGMA were significantly associated with increased prevalence and incidence of cognitive impairment, functional limitation, and frailty (odds ratio ranging from 1.79 to 89.6, values ranging from P < 0.001 to 0.048) but were mostly insignificant for that defined by GNRI. With respect to 4-y mortality, nutritional risks as defined by GNRI showed better prediction effects than those defined by ENIGMA. Receiver operating characteristic analyses indicated that nutritional risks defined by ENIGMA had better discriminatory accuracy than those defined by GNRI for prevalent and incident cognitive impairment (C = 0.73 vs 0.64, P < 0.001; C = 0.65 vs 0.59, P = 0.015, respectively), functional limitation (C = 0.74 vs 0.63, P < 0.001 at baseline; C = 0.61 vs 0.56, P = 0.016 at follow-up), frailty (C = 0.85 vs 0.67, P < 0.001 at baseline; C = 0.64 vs 0.55, P < 0.001 at follow-up), and even 4-y mortality (C = 0.68 vs 0.64, P = 0.020).
CONCLUSIONS: ENIGMA could serve as a nutritional risk screening tool that has a robust role in predicting cognitive impairment, functional limitation, and frailty in Chinese community-dwelling older adults. It may be recommended for early nutritional risk screening and has the potential to guide early nutritional intervention in communities and primary care settings in China.
摘要：
目标：营养不良和营养风险是老年人许多不良健康结局的危险因素，但他们很少在中国被评估。这项研究的目的是评估老年人营养指标的可用性用于老年营养不良评估（ENIGMA），最初开发的营养量表用于预测死亡率，评估中国社区老年人的营养风险和预测不良健康结局。
方法：这是一项基于人群的纵向队列研究（中国纵向健康长寿调查），对2063名65岁或以上的社区居民进行了4年的随访。通过在基线（2014年浪潮）使用ENIGMA和老年营养风险指数（GNRI）评估营养风险。认知障碍,功能限制，使用中文版的简易精神状态检查法对虚弱进行评估，日常生活工具活动/日常生活工具活动量表，和脆弱指数，分别,在基线和4年随访时（2018年浪潮）。死亡率是通过生存状态和从基线到随访的死亡暴露持续时间来衡量的。营养风险与普遍/偶发认知障碍的关联，功能限制和脆弱，和4岁死亡率使用逻辑回归和Cox比例风险回归模型进行估计，适应混杂因素。通过接受者操作特征分析，比较了ENIGMA和GNRI对这些不良健康结果的判别准确性。
结果：根据ENIGMA，48.6％的中国社区居住老年人（年龄：86.5±11.3岁）表现出中度和高度营养风险。ENIGMA定义的营养风险与认知障碍的患病率和发生率显着相关。功能限制，和虚弱（比值比在1.79至89.6之间，值在P<0.001至0.048之间），但与GNRI定义的比值大多不显著。关于4岁死亡率，GNRI定义的营养风险比ENIGMA定义的预测效果更好。受试者工作特征分析表明，ENIGMA定义的营养风险比GNRI定义的普遍和偶然认知障碍具有更好的辨别准确性（C=0.73vs0.64，P<0.001；C=0.65vs0.59，P=0.015），功能限制（基线时C=0.74vs0.63，P<0.001；随访时C=0.61vs0.56，P=0.016），虚弱（基线时C=0.85vs0.67，P<0.001；随访时C=0.64vs0.55，P<0.001），甚至4年死亡率（C=0.68vs0.64，P=0.020）。
结论：ENIGMA可以作为一种营养风险筛查工具，在预测认知障碍方面具有强大的作用，功能限制，和脆弱的中国社区居住的老年人。它可能被推荐用于早期营养风险筛查，并有可能指导中国社区和初级医疗机构的早期营养干预。
方法：这是一项基于人群的纵向队列研究（中国纵向健康长寿调查），对2063名65岁或以上的社区居民进行了4年的随访。通过在基线（2014年浪潮）使用ENIGMA和老年营养风险指数（GNRI）评估营养风险。认知障碍,功能限制，使用中文版的简易精神状态检查法对虚弱进行评估，日常生活工具活动/日常生活工具活动量表，和脆弱指数，分别,在基线和4年随访时（2018年浪潮）。死亡率是通过生存状态和从基线到随访的死亡暴露持续时间来衡量的。营养风险与普遍/偶发认知障碍的关联，功能限制和脆弱，和4岁死亡率使用逻辑回归和Cox比例风险回归模型进行估计，适应混杂因素。通过接受者操作特征分析，比较了ENIGMA和GNRI对这些不良健康结果的判别准确性。
结果：根据ENIGMA，48.6％的中国社区居住老年人（年龄：86.5±11.3岁）表现出中度和高度营养风险。ENIGMA定义的营养风险与认知障碍的患病率和发生率显着相关。功能限制，和虚弱（比值比在1.79至89.6之间，值在P<0.001至0.048之间），但与GNRI定义的比值大多不显著。关于4岁死亡率，GNRI定义的营养风险比ENIGMA定义的预测效果更好。受试者工作特征分析表明，ENIGMA定义的营养风险比GNRI定义的普遍和偶然认知障碍具有更好的辨别准确性（C=0.73vs0.64，P<0.001；C=0.65vs0.59，P=0.015），功能限制（基线时C=0.74vs0.63，P<0.001；随访时C=0.61vs0.56，P=0.016），虚弱（基线时C=0.85vs0.67，P<0.001；随访时C=0.64vs0.55，P<0.001），甚至4年死亡率（C=0.68vs0.64，P=0.020）。
结论：ENIGMA可以作为一种营养风险筛查工具，在预测认知障碍方面具有强大的作用，功能限制，和脆弱的中国社区居住的老年人。它可能被推荐用于早期营养风险筛查，并有可能指导中国社区和初级医疗机构的早期营养干预。
