高齢者の低栄養とQOL：メタ解析

高齢者の低栄養とQOLの関係をみたメタ解析を紹介します。

Solah Rasheed, Robert Thomas Woods. Malnutrition and quality of life in older people: a systematic review and meta-analysis. Ageing Research Reviews, http://dx.doi.org/10.1016/j.arr.2012.11.003

高齢者の低栄養とQOLを調査したコホート研究と介入研究の系統的レビューとメタ解析です。結果ですが、低栄養の場合にQOLが低いことが多い（オッズ比2.85; 95%信頼区間:2.20~3.70）でした。栄養改善によって、身体的QOLと精神的QOLに有意な改善を認めました。

以上より、低栄養はQOL低下と関連し、栄養改善によってQOLの身体的側面と精神的側面の両者を改善できるという結論です。ただし、研究の質が低く、栄養とQOLの評価方法が異なるため、結論の解釈には留意が必要です。

栄養改善で身体的QOLと精神的QOLを改善できるのであれば、より高齢者の低栄養を見逃さずに早期発見、早期介入することが望まれます。問題は栄養改善しにくい侵襲や悪液質といった炎症が原因の低栄養に対して、どう早期から評価、介入、改善していくかだと感じます。

Abstract

Although the effects of malnutrition on morbidity and mortality of older people is well established, there has been little work done to investigate the relationship between malnutrition and quality of life(QoL) in this population. In order to facilitate further research and to aggregate existing evidence into a clear overview, a systematic review was conducted. The objective was to identify the literature on the topic, review the findings systematically, and assess the association between nutritional status and QoL. MEDLINE, EMBASE, CINAHL and Web of Science were searched for relevant studies published up to April 2011. References within identified studies also searched. The primary author extracted all data using a purpose-built form, and evaluated the quality of the studies using a published checklist. A second reviewer checked a random sample of articles independently.

Evidence in the current review comes from both cohort studies and intervention trials. Results from the former suggested that individuals with malnutrition are more likely to experience poor QoL (OR: 2.85; 95% CI: 2.20 - 3.70, p < 0.001). Consistent with this, interventions designed to improve nutritional status can also lead to significant improvements in QoL, both physical (standard mean difference 0.23, CI: 0.08 to 0.38, p = 0.002) and mental aspects (standard mean difference 0.24, CI: 0.11 to 0.36, p < 0.001). However, the results should be interpreted with caution in view of the poor quality of the included studies and the heterogeneity of methods employed in the assessment of both nutritional status and QoL. Future studies should carefully characterise their participants and use standardised parameters for nutritional and QoL assessments in order to achieve better evaluation and comparability of study results.

Highlights

► Malnutrition is common in older people, frequently over looked and results in poorer quality of life. ► Nutrition support for older people enhances both physical and mental aspects of their quality of life. ► More research is required to confirm the effects of nutrition support on quality of life. ► Opportunities exist to improve, standardise and evaluate nutritional and quality of life measures. ► Standardised use of assessments is essential for evaluation and comparison of studies better.