握力指数在社区老年人营养不良筛查中的应用价值

目的: 通过评价社区门诊老年人的营养状况，探讨握力指数在社区老年人营养筛查中的应用价值。方法: 2017年6月至8月在上海市华阳街道社区卫生服务中心，采用定点连续抽样的方法对门诊65岁以上老年人进行微型营养评估短表（mini nutrition assessment-short form,MNA-SF）的问卷调查，同时测定身高、体重、小腿围和握力。握力指数=握力(kg)/身高²(m ²)。结果： ①共有1 276名老年人完成有效调查，其中MNA-SF≤11分(即营养不良风险)104人，营养不良风险发生率8.15%。与营养正常组［（9.57±2.43）kg/m ²］比较，营养不良风险组的握力指数明显降低［（8.31±2.45）kg/m ², P=0.000］。相关性分析显示，握力指数与年龄、BMI、小腿围和MNA-SF评分相关（r分别为－0.337，0.160，0.298，0.194，P值均为0.000）。将自变量小腿围、BMI和握力指数与应变量MNA-SF进行多元线性回归分析，结果显示BMI和握力指数可预测MNS-SF评分，模型为MNA-SF评分=6.895+0.042×握力指数+0.229×BMI。②选取MNA-SF＞11分的104例老人，按照性别和年龄与MNA SF≤11分的老年人进行配对t检验，结果显示，营养不良风险组的握力指数为(8.31±2.50)kg/m ²]，仍然显著低于营养正常组［（9.78±1.89）kg/m ²，P=0.000］ 结论： 社区营养不良风险老年人的握力指数显著降低，握力指数可作为社区老年人营养筛查的参考指标。

The value of Handgrip strength index of the elderly asa predictor of malnutrition risk in a community

Objective: To evaluate the value of handgrip strength(HS) index in malnutrition screening for the elderly in a community. Methods: From June to August 2017, at the Huayang Community Health Service Center in Shanghai,we conducted a mini nutrition assessment-short form (MNS-SF) questionnaire based survey in elderly outpatients by fixed point continuous sampling method. Meanwhile, height, weight, calf circumference, handgrip strength were measured. HS index=Handgrip Strength(kg)/height ²(m ²). Results: ① A total of 1 276 elderly people completed questionnaires and 104 people had an MNA-SF score of less than 12 points. Malnutrition risk rate was 8.15%.The difference in HS index between the malnutrition risk group and the normal nutrition group was statistically significant［(8.31±2.45)kg/m2 vs (9.57±2.43)kg/m ², P=0.000］.There was significant correlation between HS index and age, BMI,calf circumference and MNA-SF score(R＝-0.337，0.160，0.298，0.194, P=0.000）.Multivariate linear regression was performed with leg calf circumference,BMI and HS index as the independent variable and MNA-SF as the dependent variable, it was found that MNA-SF Score=6.895+0.042×HS index+0.229×BMI.② One hundred and four elderly people with MNA-SF greater than 11 points were selected and the parameters were analysed by paired t test by gender and age, the results showed that there were still statistical differences between the two groups in the grip strength index ［the malnutrition risk group vs the normal nutrition group:(8.31±2.50)kg/m ² vs (9.78±1.89)kg/m ², P=0.000］. Conclusion: The grip strength index of the elderly with malnutrition risk were lower, grip strength index could be used as a reference indicator for nutrition screening for the elderly in the community. ［Key words］grip strength index; MNA-SF; community-dwelling elderly; malnutrition screening