在宅虚弱高齢者に栄養剤投与で機能低下予防

在宅の虚弱（Frailty）高齢者に対する栄養剤投与による機能低下予防効果をみたRCTを紹介します。

Chang-O Kim, Kyung-Ryun Lee: Preventive Effect of Protein-Energy Supplementation on the Functional Decline of Frail Older Adults With Low Socioeconomic Status: A Community-Based Randomized Controlled Study. J Gerontol A Biol Sci Med Sci (2012) doi: 10.1093/gerona/gls167 First published online: August 9, 2012

リサーチクエスチョンは以下の通りです。

P：在宅の虚弱高齢者（歩行速度0.6m/s以下、MNA24点以下）が
I：栄養剤（400ml、400kcal、蛋白25g、必須アミノ酸9.4gうち60％はロイシン）を12週間飲むと
C：栄養剤を飲まない場合と比較して
O：機能低下を予防できる
D：ランダム化比較試験

結果ですが、Physical Functioningは介入群で改善傾向でした（p=0.052）。Short Physical Performance Batteryは介入群で有意に機能低下を予防しました（p=0.039）。握力と片脚立位には有意差を認めませんでした。

以上より、在宅の虚弱（Frailty）高齢者に対する栄養剤投与は、機能低下を予防できるという結論です。在宅でRCTを行ったのは素晴らしいですね。MNA24点以下で低栄養のおそれありもしくは低栄養に該当する虚弱高齢者に対しては、栄養療法単独でも有効な可能性があります。

Abstract

Background. Chronic undernutrition is a common condition in older people with low socioeconomic status and is clearly an important component of frailty. However, it is uncertain whether protein-energy supplementation can prevent functional decline in this group.

                   

Methods. Eighty-seven frail older adults (usual gait speed, <0 .6=".6" 12="12" 200-ml="200-ml" 25g="25g" 400="400" 400ml="400ml" 9.4g="9.4g" acids="acids" additional="additional" also="also" amino="amino" an="an" and="and" as="as" assessment="assessment" assigned="assigned" battery.="battery." cans="cans" change="change" commercial="commercial" controlled="controlled" controls="controls" day="day" did="did" either="either" energy="energy" enrolled="enrolled" essential="essential" for="for" formula="formula" functioning="functioning" gait="gait" grip="grip" group="group" hand="hand" in="in" intervention="intervention" kcal="kcal" liquid="liquid" m="m" measured="measured" mini="mini" not="not" nutritional="nutritional" of="of" one-legged="one-legged" or="or" outcome="outcome" outcomes="outcomes" p="p" participants="participants" per="per" performance="performance" physical="physical" primary="primary" protein="protein" provided="provided" randomized="randomized" randomly="randomly" receive="receive" second="second" secondary="secondary" short="short" speed="speed" stance="stance" strength="strength" supplement.="supplement." test="test" the="the" this="this" timed="timed" to="to" trial.="trial." two="two" up-and-go="up-and-go" usual="usual" variables.="variables." was="was" water="water" weeks="weeks" were="were" which="which">                   

Results. Physical Functioning increased by 5.9% (1 point) in the intervention group, although no change was observed in the control group (p =.052). Short Physical Performance Battery remained stable in the intervention group, although it decreased by 12.5% (1 point) in controls (p = .039). Usual gait speed decreased by 1.0% in the intervention group versus 11.3% (0.04 m/second) in controls (p = .039). Timed up-and-go improved by 7.2% (1.1 seconds) in the intervention group and worsened by 3.4% (0.9 seconds) in controls (p = .038). There were no differences between groups in hand grip strength or one-legged stance performance.

                   

Conclusions. The results indicate that protein-energy supplementation administered to frail older adults with low socioeconomic status shows evidence of reducing the progression of functional decline.