GLIM定义的住院老年人营养不良：筛查工具的患病率和诊断准确性

摘要(中文译文)

旨在以全球营养不良领导倡议（GLIM）标准作为参考方法，确定住院老年人营养不良的患病率，并评估常用营养筛查工具的诊断效能。在这项前瞻性横断面研究中，对入住内科病房的60岁以上成人在入院48小时内进行评估。使用营养风险筛查2002（NRS-2002）、微型营养评估简表（MNA-SF）、营养不良通用筛查工具（MUST）以及欧洲临床营养与代谢学会（ESPEN）诊断定义进行营养风险筛查。以GLIM标准作为参考方法对营养不良进行分类。计算灵敏度、特异度、预测值、似然比和Cohen's kappa系数。共纳入202名参与者；33.2%（n=67）符合GLIM定义的营养不良标准。营养不良的参与者年龄更大，体质指数、白蛋白和血红蛋白水平低于营养良好的参与者。营养不良风险患病率以MUST最高（61.9%），其次为MNA-SF（43.6%）和NRS-2002（31.2%）。MNA-SF和MUST的灵敏度最高（94%），而ESPEN表现出完美的特异度（100%），但灵敏度较低（25.4%）。与GLIM的一致性以MNA-SF最强（κ=0.700）。在住院的60岁以上成人中，每三人中就有一人符合GLIM定义的营养不良标准。在评估的工具中，MNA-SF在灵敏度与GLIM参考方法的一致性之间提供了最有利的平衡，支持其用于老年住院患者的常规筛查。

Abstract

To determine the prevalence of malnutrition in hospitalized older adults using the Global Leadership Initiative on Malnutrition (GLIM) criteria as the reference method and to evaluate the diagnostic performance of commonly used nutrition screening tools. In this prospective cross-sectional study, adults aged > 60 years admitted to internal medicine wards were assessed within 48 h of admission. Nutritional risk was screened using the Nutritional Risk Screening 2002 (NRS-2002), Mini Nutritional Assessment-Short Form (MNA-SF), Malnutrition Universal Screening Tool (MUST), and the European Society for Clinical Nutrition and Metabolism (ESPEN) diagnostic definition. Malnutrition was classified using GLIM criteria as the reference method. Sensitivity, specificity, predictive values, likelihood ratios, and Cohen's kappa were calculated. A total of 202 participants were included; 33.2% (n = 67) met GLIM-defined malnutrition criteria. Malnourished participants were older and had lower body mass index, albumin, and haemoglobin levels than well-nourished participants. The prevalence of malnutrition risk was highest with MUST (61.9%), followed by MNA-SF (43.6%) and NRS-2002 (31.2%). MNA-SF and MUST showed the highest sensitivity (94%), whereas ESPEN demonstrated perfect specificity (100%) but low sensitivity (25.4%). Agreement with GLIM was strongest for MNA-SF (κ = 0.700). In hospitalized adults aged > 60 years, one in three met GLIM-defined malnutrition criteria. Among the evaluated tools, MNA-SF provided the most favourable balance of sensitivity and agreement with the GLIM reference method, supporting its use for routine screening in geriatric inpatient settings.

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