高齢入院患者の不十分な食事摂取に関連する要因

高齢入院患者の不十分な食事摂取に関連する要因を前向きコホート研究で検討した論文を紹介します。

Mudge AM, Ross LJ, Young AM, Isenring EA, Banks MD. Helping understand nutritional gaps in the elderly (HUNGER): a prospective study of patient factors associated with inadequate nutritional intake in older medical inpatients. Clin Nutr. 2011 Jun;30(3):320-5.

134人の高齢者（平均年齢80歳）のうち、41％しか安静時エネルギー消費量を満たす経口摂取をしていませんでした。平均エネルギー摂取量は1220kcal、18.1 kcal/kg/dayでした。多変量解析では、食欲低下、BMI高値、感染症かがんの診断、せん妄、食事に介助が必要といった要因が、不十分な食事摂取に関連していました。

高齢者のNSTで栄養介入するときには、これらの要因の有無を評価すべきといえます。すべてが改善できる要因ではありませんが、一部（特に食欲低下、BMI高値、感染症の診断、せん妄、食事に介助が必要）は改善できる可能性があります。

また、このような高齢患者が廃用症候群という診断のもとで入院リハが必要となった場合、41％しか安静時エネルギー消費量を満たす経口摂取をしていません。そのため、その他の59％の患者には、レジスタンストレーニングや持久力増強訓練の適応がありません。軽負荷の維持的な機能訓練しか行えないということになります。このことからもリハ栄養が重要だといえると思います。
Abstract
BACKGROUND; AIMS: Malnutrition and poor intake during hospitalisation are common in older medical patients. Better understanding of patient-specific factors associated with poor intake may inform nutritional interventions. The aim of this study was to measure the proportion of older medical patients with inadequate nutritional intake, and identify patient-related factors associated with this outcome.
METHODS: Prospective cohort study enrolling consecutive consenting medical inpatients aged 65 years or older. Primary outcome was energy intake less than resting energy expenditure estimated using weight-based equations. Energy intake was calculated for a single day using direct observation of plate waste. Explanatory variables included age, gender, number of co-morbidities, number of medications, diagnosis, usual residence, nutritional status, functional and cognitive impairment, depressive symptoms, poor appetite, poor dentition, and dysphagia.
RESULTS: Of 134 participants (mean age 80 years, 51% female), only 41% met estimated resting energy requirements. Mean energy intake was 1220 kcal/day (SD 440), or 18.1 kcal/kg/day. Factors associated with inadequate energy intake in multivariate analysis were poor appetite, higher BMI, diagnosis of infection or cancer, delirium and need for assistance with feeding.

CONCLUSIONS: Inadequate nutritional intake is common, and patient factors contributing to poor intake should be considered in designing nutritional interventions.