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研究生:陳雅惠
研究生(外文):Chen,YaHui
論文名稱:以重分類方法評估台灣修訂版簡易營養評估量表預測台灣中老年人死亡風險的改進能力
論文名稱(外文):Using A Reclassification Method To Evaluate The Improvement Of Mini Nutritional Assessment-Taiwan Version In Predicting The Mortality Of Older Taiwanese
指導教授:王俊毅王俊毅引用關係蔡仲弘蔡仲弘引用關係
指導教授(外文):Wang, JiunYiTsai, AlanC
口試委員:張菡馨蔡仲弘王俊毅
口試委員(外文):Chang,HanHsinTsai, AlanCWang, JiunYi
口試日期:2012-06-21
學位類別:碩士
校院名稱:亞洲大學
系所名稱:健康產業管理學系健康管理組
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2012
畢業學年度:100
語文別:中文
論文頁數:57
中文關鍵詞:簡易營養評估量表營養狀態死亡風險重分類改善指標Akaike資訊準則
外文關鍵詞:Mini Nutritional AssessmentNutritional StatusMortalityNet Reclassification ImprovementAkaike's information criterion
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背景:營養不良是老年人常見的健康問題。簡易營養評估量表 (Mini Nutritional Assessment, MNA) 是老人照護上常用的評估工具。目前已有針對台灣族群修訂的簡易營養評估量表台灣修訂一版 (MNA-T1) 及修訂二版 (MNA-T2)。然此二修訂版對台灣族群之有效性仍待評估。

目的:比較二台灣修訂版對台灣族群死亡風險預測的改進能力。

方法:資料來源為1999年及2003年「台灣地區中老年身心社會生活狀況長期追蹤調查」。選取53歲以上中老年人共4,261人為樣本。以重分類改善指標 (Net Reclassification Improvement,NRI) 及Cox迴歸中Akaike資訊準則 (Akaike's information criterion,AIC) 分析台灣修訂一版及台灣修訂二版預測台灣中老年人追蹤4年死亡風險的改進能力。

結果:相對於MNA,MNA-T1與MNA-T2重分類改善幅度分別為0.4% (p=0.726) 和−1% (p=0.454);相對於MNA-T1,MNA-T2的重分類改善幅度則為−1.2% (p=0.052)。Cox迴歸模型僅納入控制變項 (CV) 所得AIC值為8,987.3,而分別加入三版本 (CV+MNA、CV+MNA-T1、CV+MNA-T2) 所得AIC值是8,204.4、8,218.1、8,214.2。表示模型分別加入MNA三個版本後,皆可大幅提高模型與資料的配適程度,唯其差異不大。

結論:MNA-T1、MNA-T2對追蹤4年死亡風險的預測能力並未明顯優於MNA。由於目前對個體營養狀態評估仍未有一黃金標準,本研究僅以死亡率作為參考標準,各修訂版的適切性仍需更多研究來釐清。
Background: Malnutrition is a common problem in geriatric health. The Mini Nutritional Assessment (MNA) has been widely applied in
gerontological care. To normalize the MNA for Taiwan population, the MNA-Taiwan version 1 (MNA-T1) and version 2 (MNA-T2) have been developed. The validity of the two versions requires further investigation.

Objectives: The study aimed to determine the improvement of the two versions in predicting the mortality risk of older Taiwanese.

Methods: We analyzed the 1999 and 2003 data of the “Survey of Health and Living Status of the Elderly in Taiwan (SHLSET)”. A sample of 4,261 subjects with 53 years old or older was recruited. The Net Reclassification Improvement (NRI) and the Cox regression with Akaike's information criterion (AIC) were used to evaluate the improvement of the MNA-T1 and MNA-T2 in predicting the 4-years follow-up mortality risk.

Results: The NRI were 0.004 (p = 0.726) and −0.010 (p = 0.454) if the MNA in the predictive model was replaced by the MNA-T1 and MNA-T2, respectively. The NRI was −0.012 (p = 0.052) if the MNA-T1 in the model was replaced by the MNA-T2. The model fitting index AIC were 8,987.3, 8,204.4, 8,218.1 and 8,214.2 for the Cox regression models with CV (control variables) only, CV + MNA, CV + MNA-T1 and CV + MNA-T2, respectively. It implied that the fitting of the model gets much better if any of the three MNA versions was included in the model. However, there were only small differences among the three versions.

Conclusions: The result shows that the mortality-predictive ability of the MNA-T1 and the MNA-T2 did not significantly superior to the original MNA. Beacuse there is no “gold standard” for identifying subjects with malnutrition, we just take mortality as an external reference in this study. More studies may be required to confirm the validity of the modified versions.

中文摘要
英文摘要
目錄i
表目錄ii
圖目錄iii

第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 5
第二章 文獻回顧 6
第一節 簡易營養評估量表 6
第二節 簡易營養評估量表台灣修訂版 9
第三節 重分類改善指標 13
第三章 研究方法 16
第一節 研究架構 16
第二節 研究資料來源與研究對象 17
第三節 研究變項定義與測量 20
第四節 資料處理與分析 24
第四章 研究結果 27
第一節 基本資料分析 27
第二節 重分類改善指標 29
第三節 模型配適度 34
第五章 討論與結論 35
第一節 討論 35
第二節 結論 39
參考文獻 40
中文文獻 40
英文文獻 41

表一、MNA、MNA-T1與MNA-T2修訂比較 48
表二、MNA與1999年面訪調查問卷題項對照情形 49
表三、1999年人口學資料、健康狀態及健康行為基本資料 51
表四、1999年營養狀態及其追蹤4年 (2003) 死亡率 53
表五、2003年MNA-T1相對MNA死亡風險預測改善幅度 54
表六、2003年MNA-T2相對MNA死亡風險預測改善幅度 55
表七、2003年MNA-T2相對MNA-T1死亡風險預測改善幅度 56
表八、1999年MNA、MNA-T1與MNA-T2之模型配適 57

圖一、研究架構 16





中文文獻
王月萍、林聖宗、沈盈貝、郭金琼、林大成、楊季清、王子慶 (2012)。迷你營養評估量表應用於老人營養狀況調查−以高雄市某老人公寓為例。大仁學報,40,1-24。
吳幸娟、吳佳娟、金惠民、胡淑惠、陳惠欣、張樂綺、蔡秀玲 (2010)。營養評估。台中市:華格那。
李庚霖、區雅倫、陳淑惠、翁儷禎 (2009)。「臺灣地區中老年身心社會生活狀況長期追蹤調查」短版CES-D量表之心理計量特性。中華心理衛生學刊,22 (4),384-410。
蔡秀玲、張素琼、郭静香 (2005)。迷你營養評估量表應用於護理之家老人營養狀況評估。中華民國營養學會雜誌,30,135-145。
戰臨茜、高森永、金惠民、李美璇 (2002)。北臺灣社區與機構中老人的營養狀況及其預測因子。中華民國營養學會雜誌,27,147-158。
簡怡雯、黃美智、廖芳萱、陳嘉君、謝明哲 (2005)。住院病人營養評估新模式之建立。台灣營養學會雜誌,28,200-209。

英文文獻
Ahmed, T., & Haboubi, N. (2010). Assessment and management of nutrition in older people and its importance to health. Clin Interv Aging, 5, 207-216.
Akaike, H. (1973). Maximum likelihood identification of Gaussian autoregressive moving average models. Biometrika, 60(2), 255-265.
Amirkalali, B., Sharifi, F., Fakhrzadeh, H., Mirarefin, M., Ghaderpanahi, M., & Larijani, B. (2010). Evaluation of the Mini Nutritional Assessment in the elderly, Tehran, Iran. Public Health Nutr, 13(9), 1373-1379.
Beck, A. M., Ovesen, L., & Osler, M. (1999). The 'Mini Nutritional Assessment' (MNA) and the 'Determine Your Nutritional Health' Checklist (NSI Checklist) as predictors of morbidity and mortality in an elderly Danish population. Br J Nutr, 81(1), 31-36.
Berner, Y. N. (2003). Assessment tools for nutritional status in the elderly. Isr Med Assoc J, 5(5), 365-367.
Bleda, M. J., Bolibar, I., Pares, R., & Salva, A. (2002). Reliability of the mini nutritional assessment (MNA) in institutionalized elderly people. J Nutr Health Aging, 6(2), 134-137.
Chen, C. C., Schilling, L. S., & Lyder, C. H. (2001). A concept analysis of malnutrition in the elderly. J Adv Nurs, 36(1), 131-142.
Cohendy, R., Gros, T., Arnaud-Battandier, F., Tran, G., Plaze, J. M., & Eledjam, J. (1999). Preoperative nutritional evaluation of elderly patients: the Mini Nutritional Assessment as a practical tool. Clin Nutr, 18(6), 345-348.
Duprez, D. A., Jacobs, D. R., Jr., Lutsey, P. L., Bluemke, D. A., Brumback, L. C., Polak, J. F., & et al. (2011). Association of small artery elasticity with incident cardiovascular disease in older adults: the multi-ethnic study of atherosclerosis. Am J Epidemiol, 174(5), 528-536.
Elia, M., Zellipour, L., & Stratton, R. J. (2005). To screen or not to screen for adult malnutrition? Clin Nutr, 24(6), 867-884.
Guigoz Y., Vellas B., & Garry P.J. (1994). Mini Nutritional Assessment: a practical assessment tool or grading the nutritional state of elderly patients. Facts Res Gerontol, 4 (suppl 2), 15-59.
Guigoz, Y., & Vellas, B. (1999). The Mini Nutritional Assessment (MNA) for grading the nutritional state of elderly patients: presentation of the MNA, history and validation. Nestle Nutr Workshop Ser Clin Perform Programme, 1, 3-11.
Guigoz, Y., Lauque, S., & Vellas, B. J. (2002). Identifying the elderly at risk for malnutrition. The Mini Nutritional Assessment. Clin Geriatr Med, 18(4), 737-757.
Kohout, F. J., Berkman, L. F., Evans, D. A., & Cornoni-Huntley, J. (1993). Two shorter forms of the CES-D (Center for Epidemiological Studies Depression) depression symptoms index. J Aging Health, 5(2), 179-193.
Kuzuya, M., Kanda, S., Koike, T., Suzuki, Y., Satake, S., & Iguchi, A. (2005). Evaluation of Mini-Nutritional Assessment for Japanese frail elderly. Nutrition, 21(4), 498-503.
McNemar Q. (1947). Note on the sampling error of thee differences between correlated proportions or percentages. Psychometrika, 12, 153-157.
Mijac, D. D., Jankovic, G. L., Jorga, J., & Krstic, M. N. (2010). Nutritional status in patients with active inflammatory bowel disease: prevalence of malnutrition and methods for routine nutritional assessment. Eur J Intern Med, 21(4), 315-319.
Omran, M. L., & Morley, J. E. (2000a). Assessment of protein energy malnutrition in older persons, part I: History, examination, body composition, and screening tools. Nutrition, 16(1), 50-63.
Omran, M. L., & Morley, J. E. (2000b). Assessment of protein energy malnutrition in older persons, Part II: Laboratory evaluation. Nutrition, 16(2), 131-140.
Pencina, M. J., D'Agostino, R. B., Sr., D'Agostino, R. B., Jr., & Vasan, R. S. (2008). Evaluating the added predictive ability of a new marker: From area under the ROC curve to reclassification and beyond. Stat Med, 27(2), 157-172.
Pencina, M. J., D'Agostino, R. B., Sr., & Steyerberg, E. W. (2011). Extensions of net reclassification improvement calculations to measure usefulness of new biomarkers. Stat Med, 30(1), 11-21.
Pfeiffer E. (1975). A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr, 23(10), 433-441.
Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Appl. Psychol. Meas., 1(3), 385-401.
Saka, B., Kaya, O., Ozturk, G. B., Erten, N., & Karan, M. A. (2010). Malnutrition in the elderly and its relationship with other geriatric syndromes. Clin Nutr, 29(6), 745-748.
Tsai, A. C., Chang, T. L., Yang, T. W., Chang-Lee, S. N., & Tsay, S. F. (2010b). A modified mini nutritional assessment without BMI predicts nutritional status of community-living elderly in Taiwan. J Nutr Health Aging, 14(3), 183-189.
Tsai, A. C., Chou, Y. T., Chang, T. L., Chang-Lee, S. N., & Tsay, S. F. (2009a). A modified Mini Nutritional Assessment without BMI can effectively assess the nutritional status of neuropsychiatric patients. J Clin Nurs, 18(13), 1916-1922.
Tsai, A. C., Ho, C. S., & Chang, M. C. (2007). Population-specific anthropometric cut-points improve the functionality of the Mini Nutritional Assessment (MNA) in elderly Taiwanese. Asia Pac J Clin Nutr, 16(4), 656-662.
Tsai, A. C., Ho, C. S., & Chang, M. C. (2008a). Assessing the prevalence of malnutrition with the Mini Nutritional Assessment (MNA) in a nationally representative sample of elderly Taiwanese. J Nutr Health Aging, 12(4), 239-243.
Tsai, A. C., Hsu, W. C., Chan, S. C., & Chang, T. L. (2011a). Usefulness of the mini nutritional assessment in predicting the nutritional status of patients with liver cancer in Taiwan. Nutr Cancer, 63(3), 334-341.
Tsai, A. C., & Ku, P. Y. (2008). Population-specific Mini Nutritional Assessment effectively predicts the nutritional state and follow-up mortality of institutionalized elderly Taiwanese regardless of cognitive status. Br J Nutr, 100(1), 152-158.
Tsai, A. C., Ku, P. Y., & Tsai, J. D. (2008b). Population-specific anthropometric cutoff standards improve the functionality of the Mini Nutritional Assessment without BMI in institutionalized elderly in Taiwan. J Nutr Health Aging, 12(10), 696-700.
Tsai, A. C., Lu, S. J., & Chang, T. L. (2009b). Modified Mininutritional Assessment can effectively assess the nutritional status of patients on hemodialysis. J Ren Nutr, 19(5), 380-388.
Tsai, A. C., & Shih, C. L. (2009). A population-specific Mini-Nutritional Assessment can effectively grade the nutritional status of stroke rehabilitation patients in. Taiwan. J Clin Nurs, 18(1), 82-88.
Tsai, A. C., Yang, S. F., & Wang, J. Y. (2010a). Validation of population-specific Mini-Nutritional Assessment with its long-term mortality-predicting ability: results of a population-based longitudinal 4-year study in Taiwan. Br J Nutr, 104(1), 93-99.
Tsai, H. J., Tsai, A. C., Hung, S. Y., & Chang, M. Y. (2011b). Comparing the predictive ability of population-specific Mini-Nutritional Assessment with Subjective Global Assessment for Taiwanese patients with hemodialysis: A cross-sectional study. Int J Nurs Stud, 48, 326-332.
Van Nes, M. C., Herrmann, F. R., Gold, G., Michel, J. P., & Rizzoli, R. (2001). Does the mini nutritional assessment predict hospitalization outcomes in older people? Age Ageing, 30(3), 221-226.
Vellas, B., Guigoz, Y., Baumgartner, M., Garry, P. J., Lauque, S., & Albarede, J. L. (2000). Relationships between nutritional markers and the mini-nutritional assessment in 155 older persons. J Am Geriatr Soc, 48(10), 1300-1309.
Vellas, B., Guigoz, Y., Garry, P. J., Nourhashemi, F., Bennahum, D., Lauque, S., & Albarede, J. L. (1999). The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition, 15(2), 116-122.
Vellas, B. J., Hunt, W. C., Romero, L. J., Koehler, K. M., Baumgartner, R. N., & Garry, P. J. (1997). Changes in nutritional status and patterns of morbidity among free-living elderly persons: a 10-year longitudinal study. Nutrition, 13(6), 515-519.
Vellas, B., Lauque, S., Andrieu, S., Nourhashemi, F., Rolland, Y., Baumgartner, R., & Garry, P. (2001). Nutrition assessment in the elderly. Curr Opin Clin Nutr Metab Care, 4(1), 5-8.
Vellas, B., Villars, H., Abellan, G., Soto, M. E., Rolland, Y., Guigoz, Y., & et al. (2006). Overview of the MNA--Its history and challenges. J Nutr Health Aging, 10(6), 456-463; discussion 463-455.
Vetta, F., Ronzoni, S., Taglieri, G., & Bollea, M. R. (1999). The impact of malnutrition on the quality of life in the elderly. Clin Nutr, 18(5), 259-267.
Visvanathan, R., Newbury, J. W., & Chapman, I. (2004). Malnutrition in older people--screening and management strategies. Aust Fam Physician, 33(10), 799-805.
Wang, T. J., Gona, P., Larson, M. G., Tofler, G. H., Levy, D., Newton-Cheh, C., & et al. (2006). Multiple biomarkers for the prediction of first major cardiovascular events and death. N Engl J Med, 355(25), 2631-2639.

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