两种营养风险评估方法在老年2型糖尿病住院病人中的应用

目的应用老年营养风险指数(geriatric nutritional risk index,GNRI)及控制营养状态评分(controlling nutritional status,CONUT) 2种营养风险筛查工具对年龄≥65岁的老年2型糖尿病病人进行营养风险筛查,比较2种筛查工具的应用效果,并探讨2种评估方法与相应实验室指标的相关性。方法对213例住院老年2型糖尿病病人采用2种筛查工具进行营养风险筛查,计算体质量指数(BMI),并测定总蛋白(TP)、白蛋白(ALB)、总胆固醇(TC)、甘油三酯(TG)、淋巴细胞计数(LY)、血红蛋白(Hb)、血清钙(Ca)、骨钙素(OC)、25(OH)D3水平;比较不同性别营养风险的发生率;采用kappa值、McNemar-Bowker检验比较2种营养风险筛查方法的评估效果;对2种方法之间及其与实验室指标的相关性进行分析。结果 GNRI评估工具筛查出无营养风险、轻度营养风险、中度营养风险、重度营养风险发生率分别为80. 7%,15. 0%,3. 8%,0. 5%; CONUT评估方法分别为27. 2%,47. 9%,23. 9%,0. 9%。不同性别在采用GNRI或CONUT评估方法检出存在营养风险的发生率差异无统计学意义。2种筛查工具一致性较差(κ=0. 08),CONUT检出营养风险的发生率高于GNRI,2种方法有正相关性(r=0. 267,P<0. 001); GNRI、CONUT与年龄呈正相关,GNRI与BMI、TP、ALB、TG、LY、Hb、Ca呈负相关; CONUT与TP、ALB、TC、TG、LY、Ca呈负相关。结论 CONUT可用于老年2型糖尿病住院病人的初步营养风险筛查。

Comparison of two methods of nutritional assessment in elderly patients with type 2 diabetes

Objective Geriatric nutritional risk index(GNRI)and Controlling nutritional status(CONUT)were applied in nutritional assessment for the elderly hospitalized patients with type 2 diabetes.The effectiveness of two screening tools was compared,and the correlation with the corresponding laboratory indexes was explored.Methods A total of 213 elderly hospitalized patients aged 65 and over with type 2 diabetes were evaluated with GNRI and CONUT for nutritional screening.Simultaneously,body mass index(BMI)was calcutated,the levels of total protein(TP),albumin(ALB),total cholesterol(TC),triglyceride(TG),lymphocyte count(LY),hemoglobin(Hb),calcium(Ca),osteocalcin(OC)and 25(OH)D3 were measured.The morbidity of nutritional risk in different sex was compared.Kappa value and McNemar-bowker test were used to compare the evaluation results of two nutritional risk screening methods.The correlation between the two nutritional risk screening methods were analyzed,and the relationship of the two methods with laboratory indicators was analyzed.Results The incidence rates of no nutritional risk,mild nutritional risk,moderate nutritional risk and severe nutritional risk by the GNRI scoring were 80.7%,15.0%,3.8%,0.4%,but those by the CONUT scoring were 27.2%,47.9%,23.9%,0.9%,respectively.There was no statistical difference in the prevalence of nutritional risk between different genders using GNRI or CONUT assessment methods.The consistency of the two screening tools was poor(κ=0.08).CONUT has a higher detection rate for nutritional risk than GNRI.There was a positive correlation between the two approaches(r=0.267,P<0.001).GNRI and CONUT showed positive correlation with age.GNRI showed negative correlation with BMI,TP,ALB,TG,LY,Hb and Ca.CONUT showed negative correlation with TP,ALB,TC,TG,LY and Ca.Conclusions CONUT can be used for early nutrition risk screening for elderly patients with type 2 diabetes.