基于营养状况指标构建简易模型对北京地区老年体检人群认知功能损害的预测价值

李海静; 朱峰; 刘慧娟; 关锐

doi:10.16766/j.cnki.issn.1674-4152.003317

基于营养状况指标构建简易模型对北京地区老年体检人群认知功能损害的预测价值

doi: 10.16766/j.cnki.issn.1674-4152.003317

首都医科大学附属北京康复医院劳模健康管理中心, 北京 100144

基金项目:

北京首都卫生发展科研专项项目 2022-4-9085

详细信息

通讯作者:
关锐，E-mail: rain_315@yeah.net

中图分类号: R151.42 R592
计量
- 文章访问数: 170
- HTML全文浏览量: 36
- PDF下载量: 40
- 被引次数: 0
出版历程
- 收稿日期: 2023-11-01
- 网络出版日期: 2024-03-09

Predictive value of a simple model based on nutritional status indicators for cognitive impairment in elderly people undergoing physical examination in Beijing area

Model Worker Health Management Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing 100144, China

摘要

摘要: 目的营养状况与认知功能的关系是研究热点，本研究建立基于营养状况指标的简易模型并分析对北京地区老年体检人群认知功能损害(CI)的预测价值。方法选取2022年2月—2023年4月首都医科大学附属北京康复医院劳模健康管理中心的670名老年体检者，采用蒙特利尔认知评估量表(MoCA)分为认知障碍组(MoCA＜26分，CI组)和无认知障碍组(n-CI组)，比较2组一般资料、微型营养评估量表(MNA)和血清白蛋白(ALB)指标，分析营养状况指标与受检者CI发生的关系。结果 670名受检者CI发生率为9.10%(61/670)，MoCA评分为(22.78±3.15)分。CI组受教育程度、MNA评分[(18.47±3.57) 分vs. (23.92±3.95) 分]、血清ALB[(30.25±3.86) g/L vs. (38.70±4.26) g/L]均低于n-CI组(P＜0.05)。随着MNA评分、血清ALB水平逐渐下降，CI发生率明显升高(P＜0.05)。MoCA评分与MNA评分、血清ALB均呈正相关关系(P＜0.05)。较低的MNA评分、血清ALB均为老年体检人群CI发生的独立危险因素(P＜0.05)。基于MNA评分、血清ALB构建简易模型筛查CI发生的AUC为0.891，均高于单独预测(P＜0.05)。结论营养状况与老年CI密切相关，基于MNA评分、血清ALB构建简易模型对北京地区老年体检人群CI发生的筛查预测价值显著。
- 体检 /
- 老年 /
- 认知功能 /
- 营养状况 /
- 简易预测模型
Abstract: Objective The relationship between nutritional status and cognitive function is a research focus. This study established a simple model based on nutritional status indicators and analyzed the predictive value of cognitive function impairment in elderly people in Beijing. Methods From February 2022 to April 2023, 670 elderly physical examination subjects in the Health Management Center of Model Workers, Beijing Rehabilitation Hospital Affiliated to Capital Medical University were selected and divided into cognitive impairment (CI) group (MoCA < 26) and no cognitive impairment (n-CI) group by using the Montreal cognitive assessment (MoCA). The two groups were compared with the general data, the miniature nutrition assessment scale (MNA) and serum albumin (ALB) indexes, and the relationship between the nutritional status indexes and CI occurrence was analyzed. Results The incidence of CI in 670 subjects was 9.10% (61/670) and MoCA score was (22.78±3.15) points. Education level, MNA score [(18.47±3.57) points vs. (23.92±3.95) points] and serum ALB [(30.25±3.86) g/L vs. (38.70±4.26) g/L] in CI group were lower than those in n-CI group (P < 0.05). With the decrease of MNA score and serum ALB level, the incidence of CI was significantly increased (P < 0.05). MoCA score was significantly positively correlated with MNA score and serum ALB (P < 0.05). Lower MNA score and serum ALB were independent risk factors for CI in the elderly population (P < 0.05). The AUC of the simple model based on MNA score and serum ALB was 0.891, which was higher than that predicted by alone (P < 0.05). Conclusion Nutritional status is closely related to CI in the elderly. The simple model built based on MNA score and serum ALB has significant value in predicting CI occurrence in the elderly population in Beijing area.
- Physical examination /
- Old age /
- Cognitive function /
- Nutritional status /
- Simple prediction model

HTML全文

图 1 营养状况指标筛查北京地区老年体检人群CI发生的ROC曲线

Figure 1. ROC curve of CI occurrence in elderly people screened by nutritional status indicators in Beijing area

下载: 全尺寸图片幻灯片

表 1 CI组与n-CI组老年体检人群相关资料比较

Table 1. Data comparison between CI group and n-CI group

组别	例数	男性/女性(例)	年龄(x±s，岁)	城市/农村(例)	吸烟史[例(%)]	饮酒史[例(%)]	在婚/其他[例(%)]	≥2种/≤1种基础疾病(例)	小学及以下/初中/高中及以上(例)	MNA量表评分(x±s，分)	血清ALB(x±s, g/L)
CI组	61	39/22	68.12±6.17	29/32	20(32.79)	24(39.34)	40(65.57)	15/46	12/22/27	18.47±3.57	30.25±3.86
n-CI组	609	370/239	66.93±6.03	360/249	159(26.11)	190(31.20)	435(71.43)	99/510	87/210/312	23.92±3.95	38.70±4.26
统计量		0.236^a	1.466^b	2.249^a	1.263^a	1.692^a	0.921^a	2.727^a	6.838^a	10.359^b	14.618^b
P值		0.627	0.143	0.134	0.261	0.193	0.337	0.099	0.033	＜0.001	＜0.001
注：^a为χ²值，^b为t值。

下载: 导出CSV

表 2 不同营养状况体检人群的CI发生率

Table 2. Comparison of CI incidence among people with different nutritional status

MNA评分(分)	例数	CI[例(%)]	血清ALB(g/L)	例数	CI[例(%)]
≥24	387	36(9.30)	≥35	400	41(10.25)
17~23	159	30(18.87)	28-34	162	37(22.84)
＜17	124	61(49.19)	≤27	108	56(51.85)
合计	670	127(18.96)	合计	670	134(20.00)

下载: 导出CSV

表 3 老年体检人群MoCA评分与MNA评分、血清ALB的相关性

Table 3. Correlation between MoCA score, MNA score and serum ALB in elderly people undergoing physical examination

组别	例数	MNA评分		血清ALB
组别	例数	r值	P值	r值	P值
CI组	61	0.742	＜0.001	0.754	＜0.001
n-CI组	609	0.713	＜0.001	0.708	＜0.001
总受检者	670	0.726	＜0.001	0.720	＜0.001

下载: 导出CSV

表 4 北京地区670例老年体检人群CI发生的多因素logistic分析

Table 4. Multivariate logistic analysis of CI occurrence in 670 elderly people in Beijing

变量	B	SE	Waldχ²	P值	OR值	95% CI
受教育程度	-0.337	0.150	5.048	＜0.001	0.714	0.483~0.936
MNA评分	0.608	0.238	6.526	＜0.001	1.837	1.257~3.771
血清ALB	0.704	0.271	6.748	＜0.001	2.021	1.383~5.027

下载: 导出CSV

表 5 营养状况指标筛查北京地区老年体检人群CI发生的ROC曲线分析

Table 5. ROC curve analysis of CI occurrence in the elderly population screened by nutritional status indicators in Beijing area

变量	截断值	AUC(95% CI)	SE	P值
MNA评分	19.35分	0.812(0.714~0.910)	0.054	＜0.001
血清ALB	33.01 g/L	0.770(0.650~0.888)	0.060	＜0.001
简易模型		0.891(0.806~0.977)	0.044	＜0.001

下载: 导出CSV

参考文献(16)

[1]	DOMINGUEZ L J, VERONESE N, VERNUCCIO L, et al. Nutrition, physical activity, and other lifestyle factors in the prevention of cognitive decline and dementia[J]. Nutrients, 2021, 13(11): 4080. doi: 10.3390/nu13114080
[2]	MUTH A K, PARK S Q. The impact of dietary macronutrient intake on cognitive function and the brai][J]. Clin Nutr, 2021, 40(6): 3999-4010. doi: 10.1016/j.clnu.2021.04.043
[3]	王伟, 谭淑慧, 张斌, 等. 加强基层医务工作者对痴呆的识别与诊治是中国痴呆防控的关键[J]. 中国全科医学, 2021, 24(6): 637-642. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202106007.htm WANG W, TAN S H, ZHANG B, et al. Strengthening primary healthcare workers' identification, diagnosis and treatment of dementia is the key to the prevention and control of dementia in china[J]. Chinese General Practice, 2021, 24(6): 637-642. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202106007.htm
[4]	熊屹立, 于宝乙, 刘声悦, 等. 中国痴呆症疾病负担研究及未来预测分析[J]. 现代预防医学, 2023, 50(3): 402-407. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF202303004.htm XIONG L L, YU B Y, LIU S Y, ET AL. Study on the burden of dementia in China and its future prediction[J]. Modern Preventive Medicine, 2023, 50(3): 402-407. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF202303004.htm
[5]	DAVIS D H, CREAVIN S T, YIP J L, et al. Montreal cognitive assessment for the detection of dementia[J]. Cochrane Database Syst Rev, 2021, 7(7): CD010775. DOI: 10.1002/14651858.CD010775.
[6]	JIA X, WANG Z, HUANG F, et al. A comparison of the mini-mental state examination (mmse) with the montreal cognitive assessment (moca) for mild cognitive impairment screening in chinese middle-aged and older population: a cross-sectional study[J]. BMC Psychiatry, 2021, 21(1): 485. doi: 10.1186/s12888-021-03495-6
[7]	王丽娟, 刘欣, 鲁翠红, 等. AD8联合MOCA量表对中老年体检人群认知功能障碍筛查分析[J]. 中国医学创新, 2020, 17(7): 29-33. doi: 10.3969/j.issn.1674-4985.2020.07.007 WANG L J, LIU X, LU C H, et al. Application of ad8 combined and moca in detecting cognitive impairment in some middle-aged and elderly people undergoing physical examination[J]. Medical Innovation of China, 2020, 17(7): 29-33. doi: 10.3969/j.issn.1674-4985.2020.07.007
[8]	ÓBREASAIL M, SMITH M D, TENISON E, et al. Parkinson's disease: the nutrition perspective[J]. Proc Nutr Soc, 2022, 81(1): 12-26. doi: 10.1017/S0029665121003645
[9]	BIANCHI V E, HERRERA P F, LAURA R. Effect of nutrition on neurodegenerative diseases: a systematic review[J]. Nutr Neurosci, 2021, 24(10): 810-834. doi: 10.1080/1028415X.2019.1681088
[10]	韩敏, 秦瑶, 葛晓燕, 等. 营养状态和认知功能对PD患者日常生活能力的作用机制探索: 基于中介效应和调节效应[J]. 现代预防医学, 2021, 48(21): 4001-4005, 4011. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF202121033.htm HAN M, QIN Y, GE X Y, et al. The mechanism of nutritional status and cognitive function on the ability of daily living in PD patients: based on mediating effect and modulating effect[J]. Modern Preventive Medicine, 2021, 48(21): 4001-4005, 4011. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF202121033.htm
[11]	ŚLIWIŃSKA S, JEZIOREK M. The role of nutrition in Alzheimer's disease[J]. Rocz Panstw Zakl Hig, 2021, 72(1): 29-39.
[12]	林伟权, 孙敏英, 刘览, 等. 广州市社区老年人慢性病共病与营养状况相关性研究[J]. 中华全科医学, 2022, 20(11): 1870-1873. doi: 10.16766/j.cnki.issn.1674-4152.002723 LIN W Q, SUN M Y, LIU LAN, et al. Study on the relationship between multimorbidity and nutritional status among the community-dwelling elderly people in Guangzhou[J]. Chinese Journal of General Practice, 2022, 20(11): 1870-1873. doi: 10.16766/j.cnki.issn.1674-4152.002723
[13]	吴茜. 轻度认知功能障碍病人营养状态及营养干预研究进展[J]. 护理研究, 2020, 34(20): 3652-3655. doi: 10.12102/j.issn.1009-6493.2020.20.016 WU Q. Research progress on nutritional status and nutritional intervention in patients with mild cognitive impairment[J]. Chinese Nursing Research, 2020, 34(20): 3652-3655. doi: 10.12102/j.issn.1009-6493.2020.20.016
[14]	熊敏, 余红璐, 夏丹豪, 等. 突触功能障碍参与阿尔茨海默病发病的研究进展[J]. 卒中与神经疾病, 2022, 29(6): 578-581. doi: 10.3969/j.issn.1007-0478.2022.06.019 XIONG M, YU H L, XIA D H, et al. Research progress of synaptic dysfunction involved in the pathogenesis of Alzheimer's disease[J]. Stroke and Nervous Diseases, 2022, 29(6): 578-581. doi: 10.3969/j.issn.1007-0478.2022.06.019
[15]	MELZER T M, MANOSSO L M, YAU S Y, et al. In pursuit of healthy aging: effects of nutrition on brain function[J]. Int J Mol Sci, 2021, 22(9): 5026. doi: 10.3390/ijms22095026
[16]	崔佳瞿, 陈启仪, 李宁. 肠道微生物群-肠-脑轴在神经精神系统疾病中的研究进展[J]. 上海医药, 2023, 44(1): 14-18. https://www.cnki.com.cn/Article/CJFDTOTAL-SYIY202301004.htm CUI J Q, CHEN Q Y, LI N. Research progress of gut microbiota-gut-brain axis in neuropsychiatric disorders[J]. Shanghai Medical & Pharmaceutical Journal, 2023, 44(1): 14-18. https://www.cnki.com.cn/Article/CJFDTOTAL-SYIY202301004.htm