外来リハ患者の栄養状態

外来リハ患者の栄養状態を横断研究で調査した論文を紹介します。

Kaur S, Miller MD, Halbert J, Giles LC, Crotty M. Nutritional status of adults participating in ambulatory rehabilitation. Asia Pac J Clin Nutr. 2008;17(2):199-207.

対象は総合病院（急性期リハあり）を退院した後に外来リハを行っている患者229人です。MNAで調査したところ、5%が低栄養、58%が低栄養の恐れありと判定されました。疾患別に脳卒中、待機的整形外科手術後、その他に分類すると、「その他」がもっとも栄養状態が悪いという結果でした。

私は「その他」の中に、廃用症候群の患者が少なからず含まれていると推測しています。つまり、脳卒中や整形外科術後の患者より廃用症候群の患者で、低栄養がより問題になるという考えです。

身体機能は、低栄養、低栄養の恐れあり、栄養状態良好で明らかな差はありませんでした。しかし、SF-36の精神面の得点は、栄養状態良好の群で有意に高い結果でした。

以上の結果より、外来リハ患者でも低栄養の問題が大きいと言えます。入院リハ患者ほどではありませんが、外来リハ患者でもリハ栄養管理（MNA-SFによるスクリーニング、リハ栄養評価）を行い、必要な患者にはリハと同時に栄養介入を行うことが必要だと思います。

Abstract
AIMS: To assess the overall nutritional status of older adults participating in ambulatory rehabilitation and determine its association with relevant outcomes including physical function and quality of life.

DESIGN: Cross-sectional.

SETTING: Ambulatory rehabilitation service in the Southern region of Adelaide, Australia.

SUBJECTS: A total of 229 participants recruited as part of a RCT between June 2005 and June 2006, stroke (n=83), elective orthopedic procedure (n=44) and other medical condition (n=102).

METHODS: Nutritional status was measured using Mini Nutritional Assessment (MNA), Simplified Nutrition Appetite Questionnaire (SNAQ) and Body Mass Index. Functional performance was assessed using the Modified Barthel Index (MBI) and quality of life was measured using the Short Form-36 (SF-36).

RESULTS: Sixty-three percent of participants were malnourished or at risk of malnutrition according to the MNA and a third had a risk of >or= 5% weight loss in the subsequent six months, according to the SNAQ. Participants with a diagnosis other than stroke or elective orthopedic procedure were the most vulnerable, with 53% (n=74/140) classified as at risk of malnutrition or malnourished and a longer length of stay in hospital. Functional performance was no different for participants assessed as at risk of malnutrition or malnourished compared to the well nourished, but the SF-36 mental component score was significantly higher for those who were well nourished (p=0.003).

CONCLUSION: Findings emphasise the magnitude of the malnutrition problem in ambulatory rehabilitation settings. Further research is required to evaluate the resource implications against expected benefits of providing nutrition interventions at this point.