共病与日常生活能力在老年衰弱患者营养状况和认知功能关系中的链式中介效应OA
Chain Mediating Effect of Comorbidity and Activities of Daily Living on the Association Between Nutritional Status and Cognitive Function in Frail Elderly Patients
目的:探讨老年衰弱患者共病和日常生活活动能力(Activities of Daily Living,ADL)在营养状况与认知功能关联中的链式中介作用.方法:采用便利抽样法,选取2021年1月—2024年9月某三甲医院364例老年衰弱患者为研究对象;采用一般资料调查表、Fried衰弱评估量表、简易微型营养评定量表(MNA-SF)、查尔森共病指数量表(CCI)、Barthel指数、简易认知状态评估量表(Mini-Cog)收集相关资料.通过Spearman相关分析探讨各变量间的相关性,运用PROCESS宏程序检验共病、ADL在营养状况与认知功能间的链式中介效应.结果:衰弱前期组与衰弱组在年龄、居住方式及近1年跌倒史比较,差异有统计学意义(P<0.05).营养状况(MNA-SF)评分为 12.00(10.00,13.00),共病(CCI)评分为 8.20±2.37,ADL(BI)评分为82.50(60.00,95.00),认知功能(Mini-Cog)评分为3.00(2.00,5.00).营养风险评分与共病评分、ADL 评分、认知功能评分均呈负相关(r=-0.227,P<0.01;r=-0.358,P<0.01;r=-0.232,P<0.01);共病评分与 ADL评分呈负相关(r=-0.461,P<0.01),与认知功能评分呈正相关(r=0.203,P<0.01);ADL评分与认知功能评分呈正相关(r=0.357,P<0.01).中介效应模型分析显示:营养状况(MNA-SF)评分与认知功能(Mini-Cog)的总效应关联显著(β=0.122,P<0.01),直接效应关联显著(β=0.073,P<0.05);在共病和 ADL的链式中介模型中,路径 1"营养→共病→认知功能"无中介效应,路径2"营养→ADL→认知功能"的间接效应值为0.048,占总效应的40.16％,路径3"营养→共病→ADL→认知功能"的间接效应值为0.002,占总效应的1.63％.结论:共病和ADL在老年衰弱患者营养状况与认知功能之间起链式中介作用.建议医务人员重视衰弱患者的营养筛查与支持,加强日常生活功能锻炼与共病管理,延缓或改善认知功能下降,提高老年衰弱患者的生活质量.
[Objective]To explore the chain mediating role of comorbidity and Activities of Daily Living(ADL)in the association between nutritional status and cognitive function among frail elderly patients.[Method]Using convenience sampling,364 frail elderly patients admitted to a tertiary hospital between January 2021 and September 2024 were enrolled.Data were collected using a general information questionnaire,the Fried Frailty Phenotype(FP)scale,the Short-Form Mini Nutritional Assessment(MNA-SF),the Charlson Comorbidity Index(CCI),the Barthel Index(BI),and the Mini-Cog scale.Spearman correlation analysis was employed to examine relationships between variables.The PROCESS macro was used to test the chain mediating effects of comorbidity and ADL on the association between nutritional status and cognitive function.[Result]The frail group exhibited significantly higher age,more solitary living arrangements,and higher prevalence of falls in the past year compared to the pre-frail group(P<0.05).Nutritional status(MNA-SF)was 12.00(10.00,13.00);Comorbidity(CCI)was 8.20±2.37;ADL(Barthel Index)was 82.50(60.00,95.00);Cognitive function(Mini-Cog)was 3.00(2.00,5.00).MNA-SF score was negatively correlated with CCI(r=-0.227,P<0.01),BI(r=-0.358,P<0.01),and Mini-Cog scores(r=-0.232,P<0.01).CCI score was negatively correlated with BI(r=-0.461,P<0.01)but positively correlated with Mini-Cog(r=0.203,P<0.01).BI score was positively correlated with Mini-Cog(r=0.357,P<0.01).Mediation analysis revealed a significant total effect of MNA-SF on Mini-Cog(β=0.122,P<0.01),with a significant direct effect(β=0.073,P<0.05).In the chain mediation model:Path 1(Nutrition→Comorbidity→Cognitive Function):No significant mediation effect.Path 2(Nutrition→ADL→Cognitive Function):Indirect effect was 0.048(40.16％of total effect).Path 3(Nutrition→Comorbidity→ADL→Cognitive Function):Indirect effect was 0.002(1.63％of total effect).[Conclusion]Comorbidity and ADL exhibit a chain mediating effect on the relationship between nutritional status and cognitive function in frail elderly patients.Healthcare professionals should prioritize nutritional screening and support,enhance functional exercise for daily living,and improve comorbidity management to delay or mitigate cognitive decline,thereby improving the quality of life for frail elderly patients.
胡洁琼;石小天;王斗;孙颖;张炜
首都医科大学附属北京友谊医院医保内科/老年医学科,北京 100050首都医科大学附属北京友谊医院医保内科/老年医学科,北京 100050首都医科大学附属北京友谊医院医保内科/老年医学科,北京 100050首都医科大学附属北京友谊医院医保内科/老年医学科,北京 100050首都医科大学附属北京友谊医院医保内科/老年医学科,北京 100050
衰弱营养共病日常生活活动能力认知功能中介效应
frailtynutritioncomorbidityactivities of daily living(ADL)cognitive functionmediation effect
《中国食物与营养》 2026 (9)
56-67,12
科技创新2030-"新一代人工智能"重大项目(项目编号:2021ZD0111002)京友谊医院科研启动基金资助项目(项目编号:yyqdkt2019-63).
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