老年人的营养状况、去脂体重指数与功能依赖：一项横断面路径分析
Nutritional Status, Fat-Free Mass Index, and Functional Dependency in Older Adults: A Cross-Sectional Path Analysis.
文献信息
| PMID | 42757386 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Hacer Alataş |
| 作者单位 | Department of Nutrition and Dietetics, Faculty of Health Sciences, Malatya Turgut Ozal University, Malatya, Türkiye. |
| 期刊 | Clinical interventions in aging |
| SCI 分区 | Q2 |
| IF | 4.5 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 本研究旨在探讨老年人营养状况、身体成分与功能依赖之间的横断面关联，并采用观测变量路径分析评估去脂体重指数（FFMI）是否在统计学上对营养状况与功能状态之间的间接关联有所贡献。
方法： 这项回顾性横断面研究纳入了165名年龄≥65岁、居住在土耳其伊斯坦布尔长期照护中心的成年人，其中51.5%为女性。营养状况采用微型营养评定（MNA）评估，功能状态采用Barthel指数评估，身体成分采用多频生物电阻抗分析（InBody S10）评估。同时评估了握力、步速、吞咽困难和肌少症。进行了多变量回归、受试者工作特征（ROC）和观测变量路径分析。
结果： 总体而言，44.2%的参与者存在营养不良，32.7%处于营养不良风险，70.3%存在功能依赖。较高的MNA评分（OR=0.66，95% CI：0.57-0.77）、FFMI（OR=0.84，95% CI：0.72-0.98）、握力（OR=0.73，95% CI：0.61-0.88）和步速（OR=0.64，95% CI：0.45-0.91）与功能依赖的较低几率相关，而吞咽困难（OR=8.27，95% CI：2.23-30.65）和肌少症（OR=3.90，95% CI：1.43-10.63）与较高的几率相关。MNA评分对功能依赖显示出极好的判别能力（AUC=0.894）。路径分析显示，MNA评分与Barthel指数评分之间存在强的正向直接关联（β=0.882，p<0.001），并通过FFMI存在一个小的负向间接关联（β=-0.023，bootstrap 95% CI：-0.053至-0.002）。直接关联与间接关联方向相反，符合统计学抑制模式，而非传统的中介关系。
结论： 营养状况差、FFMI低、肌肉力量下降、步速减慢、吞咽困难和肌少症与老年人的功能依赖相关。尽管FFMI对营养状况与功能状态之间关联的统计分解有所贡献，但观察到的间接关联较小且与直接关联方向相反。这些发现应被解释为同时存在的横断面关系，而非中介、时间顺序或因果关系的证据。需要纵向研究来阐明其时间顺序和临床意义。
英文摘要
OBJECTIVE: This study aimed to investigate the cross-sectional associations among nutritional status, body composition, and functional dependency in older adults and to evaluate whether fat-free mass index (FFMI) statistically contributed to the indirect association between nutritional and functional status using observed-variable path analysis.
METHODS: This retrospective cross-sectional study included 165 adults aged ≥65 years residing in long-term care centers in Istanbul, Türkiye, of whom 51.5% were women. Nutritional status was assessed using the Mini Nutritional Assessment (MNA), functional status using the Barthel Index, and body composition using multifrequency bioelectrical impedance analysis (InBody S10). Handgrip strength, gait speed, dysphagia, and sarcopenia were also evaluated. Multivariable regression, receiver operating characteristic (ROC), and observed-variable path analyses were performed.
RESULTS: Overall, 44.2% of participants were malnourished, 32.7% were at risk of malnutrition, and 70.3% were functionally dependent. Higher MNA scores (OR=0.66, 95% CI: 0.57-0.77), FFMI (OR=0.84, 95% CI: 0.72-0.98), handgrip strength (OR=0.73, 95% CI: 0.61-0.88), and gait speed (OR=0.64, 95% CI: 0.45-0.91) were associated with lower odds of functional dependency, whereas dysphagia (OR=8.27, 95% CI: 2.23-30.65) and sarcopenia (OR=3.90, 95% CI: 1.43-10.63) were associated with higher odds. The MNA score showed excellent discriminatory ability for functional dependency (AUC=0.894). Path analysis showed a strong positive direct association between MNA and Barthel Index scores (β=0.882, p<0.001) and a small negative indirect association through FFMI (β=-0.023, bootstrap 95% CI: -0.053 to -0.002). The opposing directions of the direct and indirect associations were consistent with a statistical suppression pattern rather than a conventional mediating relationship.
CONCLUSION: Poor nutritional status, low FFMI, reduced muscle strength, slower gait speed, dysphagia, and sarcopenia were associated with functional dependency in older adults. Although FFMI contributed to the statistical decomposition of the association between nutritional and functional status, the observed indirect association was small and opposite in direction to the direct association. These findings should be interpreted as concurrent cross-sectional relationships rather than evidence of mediation, temporal ordering, or causality. Longitudinal studies are needed to clarify their temporal and clinical significance.