营养对衰弱影响的研究进展

衰弱是一种临床上较为常见的老年综合征，能引起一系列不良健康事件。营养作为衰弱可改变的危险因素之一，在衰弱的发生发展中具有重要作用。本文结合近年相关文献，就营养对衰弱影响的相关研究进展进行综述，发现营养不良和营养过剩及能量、蛋白质、微量元素摄入不足可能增加衰弱风险，而健康的膳食模式能降低衰弱风险。

Frailty-related Factors and Degree of Association of Frailty with Malnutrition in Elderly Inpatients

Background　Frailty and malnutrition are common problems in the elderly people.Malnutrition has attracted more and more attention as a modifiable risk factor for frailty in recent years.Early identification of malnutrition and timely delivery of targeted interventions may delay or even reverse frailty.Objective　To explore the prevalence and associated factors of frailty，and the degree of association of frailty with malnutrition in elderly inpatients，to provide a reference for frailty intervention research.Methods　From September 2018 to May 2019，362 inpatients≥60 old years from Department of Gerontology and Geriatrics，Beijing Friendship Hospital，Capital Medical University were enrolled.The Comprehensive Geriatric Assessment （CGA），FRAIL scale，and Mini-Nutritional Assessment-Short Form （MNA-SF） were used by professionals to assess the prevalence of geriatric syndrome，frailty，and malnutrition，respectively.The number of patients with frailty was counted.Multivariate Logistic regression was used to identity the influencing factors of frailty.Spearman rank correlation analysis was used to analyze the degree of association of frailty and malnutrition.Results　Of the 362 cases，91（25.1%） were identified with frailty，172（47.5%） with prefrailty，99（27.4%） with robust health；27（7.5%） were identified with malnutrition，125（34.5%） with risk of malnutrition，210（58.0%） with normal nutrition.Multivariate Logistic regression analysis showed that diabetes〔OR=2.844，95%CI（1.309，6.178）〕，malnutrition〔OR=6.055，95%CI（1.580，23.200）〕，IADL score〔OR=0.603，95%CI（0.523，0.695）〕，hemoglobin〔OR=0.981，95%CI（0.964，0.998）〕and hs-CRP level〔OR=1.017，95%CI（1.004，1.030）〕 were influencing factors of frailty（P<0.05）.The FRAIL score decreased with the increase of BMI（rs=-0.244），MNA-SF score（rs=-0.585），hemoglobin（rs=-0.360），albumin（rs=-0.420），TC（rs=-0.164），TG（rs=-0.117），HDL-C（rs=-0.124） and LDL-C（rs=-0.151），but increased with the decrease of age（rs=0.537），blood urea nitrogen（rs=0.172） and creatinine（rs=0.168）（P<0.05）.Conclusion　In our study，the prefrail cases accounted for about half of all the cases，which deserves attention.Diabetes，malnutrition，activities of daily living，hemoglobin，and hs-CRP may be associated with frailty.In particular，nutritional status may be has a more significant association with frailty.In view of this，clinicians should pay attention to functional status assessment and comorbidity management in elderly hospitalized patients.