Clin Nutr:营养不良的住院患者该不该使用营养补充剂?

2016-02-22 Seven L 译 MedSci原创

住院期间营养不良的老年人有很高的再入院和死亡风险。研究者进行了一项多中心、随机、安慰剂对照的双盲试验,评估含有β-羟基-β-甲基丁酸的高蛋口服白营养补充剂(HP-HMB)能否改善住院期间营养不良的老年人出院结局(再入院和死亡风险)。该研究纳入了≥65岁、营养不良(主观综合评估(SGA) B或C级)、因充血性心力衰竭、急性心肌梗死、肺炎、慢性阻塞性肺疾病住院的患者。其中328人进行标准护理+HP-H

住院期间营养不良的老年人有很高的再入院和死亡风险。研究者进行了一项多中心、随机、安慰剂对照的双盲试验,评估含有β-羟基-β-甲基丁酸的口服高蛋白营养补充剂(HP-HMB)能否改善住院期间营养不良的老年人出院结局(再入院和死亡风险)。

该研究纳入了≥65岁、营养不良(主观综合评估[SGA]B或C级)、因充血性心力衰竭、急性心肌梗死、肺炎、慢性阻塞性肺疾病住院的患者。其中328人进行标准护理+HP-HMB(每天2次),324人为安慰剂对照组。以出院后90天内死亡率和非计划再入院率作为主要结局指标。其他结局指标包括出院后30天和60天死亡或再入院率、住院时长(LOS)、SGA分级、体重和日常活动(ADL)。

研究数据显示, HP-HMB组和对照组主要结局指标相似(26.8% vs 31.1%)。出院后90天再入院率在两组间无差异,不过90天死亡率HP-HMB组更低(4.8% vs. 9.7%; RR 0.49, 95% CI, 0.27 to 0.90; p = 0.018)。为了预防1例死亡而需要治疗的人数为20.3 (95% CI: 10.9, 121.4)。此外与对照组相比, HP-HMB可改善患者出院后90天的营养状况(SGA 分级, OR, 2.04, 95% CI: 1.28, 3.25, p = 0.009),增加出院后30天的体重(p = 0.035)。LOS和ADL在两组间差异不大。

研究结果表明,虽然在复合终点上两组间差异不大,但是HP-HMB可降低出院后90天的死亡率,改善营养状态。

原始出处:

Deutz NE, Matheson EM,et al.Readmission and mortality in malnourished, older, hospitalized adults treated with a specialized oral nutritional supplement: A randomized clinical trial.Clin Nutr. 2016 Feb;35(1):18-26. doi: 10.1016/j.clnu.2015.12.010.


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  1. [GetPortalCommentsPageByObjectIdResponse(id=2059016, encodeId=70e3205901666, content=<a href='/topic/show?id=ee8e881e23f' target=_blank style='color:#2F92EE;'>#营养补充剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88172, encryptionId=ee8e881e23f, topicName=营养补充剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4a4d285, createdName=日月, createdTime=Fri Sep 30 10:57:00 CST 2016, time=2016-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=66131, encodeId=4c4266131d9, content=很好,, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Feb 28 11:56:00 CST 2016, time=2016-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=66132, encodeId=84d36613262, content=有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Feb 28 11:56:00 CST 2016, time=2016-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=65213, encodeId=4b3565213e8, content=自己恢复最好, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib260FNcic8ThYZTmbW36JHpvHcnIog7VbWIQjibo1kwuH9obXRJJtqHn1hYHHLG0DpIMIBVFPhBBpQOJWDk1rbib2Y/0, createdBy=d27274268, createdName=sillywu, createdTime=Tue Feb 23 06:56:00 CST 2016, time=2016-02-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=65201, encodeId=f330652011f, content=good, beContent=null, objectType=article, channel=null, level=null, likeNumber=121, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuK9CDibOwszLoEBg36ZXqzB5NDasNV9GTfFDmBicM1V8hUS4OtTicG3IiaFIKq4wqD23LUxORRJXqjVs/0, createdBy=00e81647535, createdName=I come, createdTime=Mon Feb 22 22:57:00 CST 2016, time=2016-02-22, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=2059016, encodeId=70e3205901666, content=<a href='/topic/show?id=ee8e881e23f' target=_blank style='color:#2F92EE;'>#营养补充剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88172, encryptionId=ee8e881e23f, topicName=营养补充剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4a4d285, createdName=日月, createdTime=Fri Sep 30 10:57:00 CST 2016, time=2016-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=66131, encodeId=4c4266131d9, content=很好,, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Feb 28 11:56:00 CST 2016, time=2016-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=66132, encodeId=84d36613262, content=有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Feb 28 11:56:00 CST 2016, time=2016-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=65213, encodeId=4b3565213e8, content=自己恢复最好, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib260FNcic8ThYZTmbW36JHpvHcnIog7VbWIQjibo1kwuH9obXRJJtqHn1hYHHLG0DpIMIBVFPhBBpQOJWDk1rbib2Y/0, createdBy=d27274268, createdName=sillywu, createdTime=Tue Feb 23 06:56:00 CST 2016, time=2016-02-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=65201, encodeId=f330652011f, content=good, beContent=null, objectType=article, channel=null, level=null, likeNumber=121, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuK9CDibOwszLoEBg36ZXqzB5NDasNV9GTfFDmBicM1V8hUS4OtTicG3IiaFIKq4wqD23LUxORRJXqjVs/0, createdBy=00e81647535, createdName=I come, createdTime=Mon Feb 22 22:57:00 CST 2016, time=2016-02-22, status=1, ipAttribution=)]
    2016-02-28 忠诚向上

    很好,

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=2059016, encodeId=70e3205901666, content=<a href='/topic/show?id=ee8e881e23f' target=_blank style='color:#2F92EE;'>#营养补充剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88172, encryptionId=ee8e881e23f, topicName=营养补充剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4a4d285, createdName=日月, createdTime=Fri Sep 30 10:57:00 CST 2016, time=2016-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=66131, encodeId=4c4266131d9, content=很好,, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Feb 28 11:56:00 CST 2016, time=2016-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=66132, encodeId=84d36613262, content=有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Feb 28 11:56:00 CST 2016, time=2016-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=65213, encodeId=4b3565213e8, content=自己恢复最好, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib260FNcic8ThYZTmbW36JHpvHcnIog7VbWIQjibo1kwuH9obXRJJtqHn1hYHHLG0DpIMIBVFPhBBpQOJWDk1rbib2Y/0, createdBy=d27274268, createdName=sillywu, createdTime=Tue Feb 23 06:56:00 CST 2016, time=2016-02-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=65201, encodeId=f330652011f, content=good, beContent=null, objectType=article, channel=null, level=null, likeNumber=121, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuK9CDibOwszLoEBg36ZXqzB5NDasNV9GTfFDmBicM1V8hUS4OtTicG3IiaFIKq4wqD23LUxORRJXqjVs/0, createdBy=00e81647535, createdName=I come, createdTime=Mon Feb 22 22:57:00 CST 2016, time=2016-02-22, status=1, ipAttribution=)]
    2016-02-28 忠诚向上

    有用

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=2059016, encodeId=70e3205901666, content=<a href='/topic/show?id=ee8e881e23f' target=_blank style='color:#2F92EE;'>#营养补充剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88172, encryptionId=ee8e881e23f, topicName=营养补充剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4a4d285, createdName=日月, createdTime=Fri Sep 30 10:57:00 CST 2016, time=2016-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=66131, encodeId=4c4266131d9, content=很好,, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Feb 28 11:56:00 CST 2016, time=2016-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=66132, encodeId=84d36613262, content=有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Feb 28 11:56:00 CST 2016, time=2016-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=65213, encodeId=4b3565213e8, content=自己恢复最好, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib260FNcic8ThYZTmbW36JHpvHcnIog7VbWIQjibo1kwuH9obXRJJtqHn1hYHHLG0DpIMIBVFPhBBpQOJWDk1rbib2Y/0, createdBy=d27274268, createdName=sillywu, createdTime=Tue Feb 23 06:56:00 CST 2016, time=2016-02-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=65201, encodeId=f330652011f, content=good, beContent=null, objectType=article, channel=null, level=null, likeNumber=121, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuK9CDibOwszLoEBg36ZXqzB5NDasNV9GTfFDmBicM1V8hUS4OtTicG3IiaFIKq4wqD23LUxORRJXqjVs/0, createdBy=00e81647535, createdName=I come, createdTime=Mon Feb 22 22:57:00 CST 2016, time=2016-02-22, status=1, ipAttribution=)]
    2016-02-23 sillywu

    自己恢复最好

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=2059016, encodeId=70e3205901666, content=<a href='/topic/show?id=ee8e881e23f' target=_blank style='color:#2F92EE;'>#营养补充剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88172, encryptionId=ee8e881e23f, topicName=营养补充剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4a4d285, createdName=日月, createdTime=Fri Sep 30 10:57:00 CST 2016, time=2016-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=66131, encodeId=4c4266131d9, content=很好,, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Feb 28 11:56:00 CST 2016, time=2016-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=66132, encodeId=84d36613262, content=有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Feb 28 11:56:00 CST 2016, time=2016-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=65213, encodeId=4b3565213e8, content=自己恢复最好, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib260FNcic8ThYZTmbW36JHpvHcnIog7VbWIQjibo1kwuH9obXRJJtqHn1hYHHLG0DpIMIBVFPhBBpQOJWDk1rbib2Y/0, createdBy=d27274268, createdName=sillywu, createdTime=Tue Feb 23 06:56:00 CST 2016, time=2016-02-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=65201, encodeId=f330652011f, content=good, beContent=null, objectType=article, channel=null, level=null, likeNumber=121, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuK9CDibOwszLoEBg36ZXqzB5NDasNV9GTfFDmBicM1V8hUS4OtTicG3IiaFIKq4wqD23LUxORRJXqjVs/0, createdBy=00e81647535, createdName=I come, createdTime=Mon Feb 22 22:57:00 CST 2016, time=2016-02-22, status=1, ipAttribution=)]
    2016-02-22 I come

    good

    0

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