MNA-SFとリハのアウトカム

MNA-SFが高齢リハ患者の臨床的なアウトカムを予測できるかを調査した論文です。オーストラリアの栄養士の論文です。

Andrew Slattery, et al. Does the Mini Nutrition Assessment—Short Form predict clinical outcomes at six months in older rehabilitation patients? Nutrition & Dietetics, DOI: 10.1111/1747-0080.12094

対象はリハ目的で入院した65歳以上の高齢者181人で、後ろ向きコホートのようです。アウトカムは入院期間、入院中の合併症、リハ活動への参加、入院中の機能変化、退院6ヶ月間の急性期病院への再入院と死亡です。

結果ですが、MNA-SFで栄養状態良好は22％、低栄養のおそれありは54％、低栄養は24％でした。低栄養のおそれあり・低栄養群では、入院期間が長く、リハ活動への参加が少なかったです。低栄養群は入院時機能が最も低く、入院中に最も改善しました。

以上より3/4の高齢リハ患者が低栄養のおそれあり・低栄養で、入院時の昨日低下、入院期間、リハ活動への参加と関連していました。低栄養はリハのアウトカムに影響を与えるため、さらなる研究と入院中の栄養状態への注意が必要という結論です。

まさにリハ栄養の論文ですし、後ろ向き研究ですから日本でも十分実現可能な研研究ですし、管理栄養士に行ってほしいです。日本で同じような調査を行えばMNA-SFで低栄養のおそれあり・低栄養の方はより多く、低栄養はリハのアウトカムに影響するでしょう。

Abstract

Aims

This study aimed to determine if nutritional status as assessed by the revised Mini Nutritional Assessment—Short Form is predictive of relevant clinical outcomes within six months in older rehabilitation patients, and to investigate the relationship between admission diagnosis and nutritional status.

Methods

A consecutive retrospective case note audit of 181 patients ≥ 65 years admitted to rehabilitation between May and November 2010 at the Repatriation General Hospital was performed. Nutritional status was assessed using the revised Mini Nutritional Assessment—Short Form. Outcomes measured included length of stay in rehabilitation, complications during admission, participation in rehabilitation activities and change in function during admission. Acute readmissions and mortality were assessed at six months post discharge from rehabilitation.

Results

Thirty-nine (22%) patients had normal nutritional status, 98 (54%) were at risk of malnutrition and 43 (24%) were malnourished. Patients at risk of malnutrition/malnourished had a longer length of stay (P = 0.008) and were more likely to be poor participators in rehabilitation activities (P = 0.006). Malnourished patients had poor function on admission to rehabilitation (P < 0.001) and had the greatest improvement in function during the rehabilitation admission (P = 0.012).

Conclusions

Over three-quarters of older rehabilitation patients were identified as malnourished or at risk of malnutrition, and this was associated with poorer function on admission, increased length of stay and poorer participation in rehabilitation activities. Thus, the issue of malnutrition is a concern as it impacts on clinical outcomes of rehabilitation and therefore, further investigation and attention to nutritional status during admission is required.