Malnutrition is associated with poor rehabilitation outcome in elderly inpatients with hospital-associated deconditioning a prospective cohort study

J Rehabil Medに投稿していた高齢の廃用症候群の低栄養とリハの予後に関する論文が、ようやくEpub ahead of printになりました。まだオープンアクセスではないはずですが、下記のHPで全文見れます。

Wakabayashi H, Sashika H. Malnutrition is associated with poor rehabilitation outcome in elderly inpatients with hospital-associated deconditioning a prospective cohort study. J Rehabil Med, DOI: 10.2340/16501977-1258, Epub ahead of print

http://www.medicaljournals.se/jrm/content/?doi=10.2340%2F16501977-1258&preview=1

この研究をする中で、廃用症候群における廃用性筋萎縮は、サルコペニアを考慮したリハ栄養の視点で考えて対応しないといけないことを確信しました。その点でリハ栄養の考え方を生みだすきっかけとなった研究といえます。

今まできちんとした研究をしないで学会発表、講演、依頼原稿執筆ばかりしてきました。ようやくImpact Factorが2.134でリハのTop journalの1つであるJ Rehabil Medに論文を掲載できて、ほっとしています。

リハ栄養という言葉や考え方は3-4年前に比べればいくらか普及したと思いますが、リハ栄養の土台（エビデンス）作り（IFのある英語雑誌への原著論文掲載）は遅れていました。でもようやく土台作りの第一歩を踏み出すことができました。

今後は一発屋で終わらないように自分がリハ栄養のエビデンスを発信し続けることと、リハ栄養のエビデンスを発信できる仲間を増やすことが、当面の私の使命です。とはいえ研究だけでなくリハ栄養の臨床、教育、管理面でも頑張ります。

Abstract:

Objective: To investigate the association between nutritional status and rehabilitation outcome in elderly inpatients with hospital-associated deconditioning. Design: A prospective cohort study. Subjects/patients: One hundred sixty-nine consecutive elderly inpatients diagnosed with hospital-associated deconditioning. Methods: Nutritional status at referral was assessed by the Mini Nutritional Assessment Short Form at the University Medical Center. Body mass index, haemoglobin, albumin, total lymphocyte count, C-reactive protein, cause of malnutrition, and feeding route were also investigated. Primary outcome was Barthel Index score at discharge. Results: A total of 148 patients (87.6%) were malnourished, and 21 were at risk for malnutrition. There were no patients with normal nutritional status. Malnourished patients had a lower Barthel Index score at discharge than those at risk for malnutrition. Chronic disease-related malnutrition, oral intake, and parenteral nutrition were associated with the Barthel Index score at discharge. There were significant correlations between the Barthel Index score at discharge and nutritional score, albumin, and total lymphocyte count. In multiple regression analysis, Mini Nutritional Assessment Short Form, albumin, and chronic disease-related malnutrition were significantly associated with the Barthel Index score at discharge. Conclusion: Most elderly inpatients with hospital-associated deconditioning are malnourished. Nutritional status, albumin, and chronic disease-related malnutrition are associated with poor rehabilitation outcome in hospital-associated deconditioning.