untitled

Size: px

Start display at page:

Download "untitled"

형범 전
5 years ago
Views:

1 Original Article J Clin Nutr 2014;6(1):24-29 ISSN Mini Nutritional Assessment-Short Form 을이용한노인입원환자의영양불량유병률조사 : A Cross-sectional, Multi-center Study 이호선 1, 강주희 2, 김은미 3, 김원경 4 1 세브란스병원영양팀, 2 분당제생병원영양과, 3 삼성서울병원영양팀, 4 보라매병원영양팀 Prevalence of Malnutrition in Hospitalized Elderly Korean Patients Based on Mini Nutritional Assessment-Short Form Hosun Lee 1, Ju Hee Kang 2, Eunmee Kim 3, Won Gyoung Kim 4 1 Department of Clinical Nutrition, Severance Hospital, Yonsei University Health System, Seoul, 2 Department of Clinical Nutrition, Bundang Jesaeng Hospital, Seongnam, 3 Department of Dietetics, Samsung Medical Center, 4 Department of Nutrition, Boramae Medical Center, Seoul, Korea Purpose: To determine the prevalence of malnutrition in hospitalized elderly Korean patients using Mini Nutritional Assessment-Short Form (MNA-SF) in Korea. Methods: A cross-sectional, multi-center study was performed. We enrolled 300 patients aged 65 years from 10 hospitals. We collected subjects general characteristics, including age, sex, height, weight, and diagnosis. Patients nutritional status was assessed using MNA-SF within 48 hours since hospital admission. Results: The subjects were 74.2±6.3 years old, and 155 patients were male (51.7%). Cancer was the most common diagnosis (26.3%), followed by musculoskeletal (11.3%), neuromuscular (10.3%), pulmonary (9.0%), and cardiovascular disease (8.7%). The length of hospital stay was 8.7±5.9 days. According to MNA-SF, 99 patients (33.0%) were at risk of malnutrition, and 51 patients (17.0%) were malnourished. MNA-SF score showed negative correlations with age (r= 0.259, P) and hospital stay (r= 0.168, P=0.006). Patients in the malnourished or at risk of malnutrition groups were more likely to be admitted to and stayed longer in the intensive care unit (ICU) than those of normal nutritional status (8.7% vs. 17.3%, P=0.026; 1.6±1.0 days vs. 3.7±3.2 days, P=0.033). The patients who were malnourished or at risk of malnutrition were hospitalized significantly longer than those of normal nutritional status (9.8±6.2 vs. 7.7.±5.4 days, P=0.004). After adjusting for age and ICU admission, nutritional status by MNA-SF was the only risk factor for prolonged hospitalization (β=1.384, P=0.005). Conclusion: About half of hospitalized elderly patients were at risk of malnutrition or malnutrition status at admission, and nutritional status was the only risk factor for longer hospital stay. Thus, more attention should be paid to the nutritional care of elderly patients to improve clinical outcomes. Key Words: Aged, Malnutrition, Hospitalization, Length of stay Received Jan 18, 2014; Revised Mar 11, 2014; Accepted Mar 11, 2014 Correspondence to Hosun Lee Department of Clinical Nutrition, Severance Hospital, Yonsei University Health System, 50-1, Yonsei-ro, Seodaemun-gu, Seoul , Korea Tel: , Fax: , hslee0730@yuhs.ac Conflict of interest: None. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 서론 노인을대상으로한연구에서영양불량발생률은 40% 77% 로높게보고되고있다. 노인은활동량이감소하고, 식욕이저하되며, 만성질환을동반한경우가많아영양불량위험이높다. 1 병원에입원한노인환자는젊은연령대의환자에비해영양불량위험이높으며, 2 이는이환율과재원기간, 사망률, 퇴원후재 c 2014, The Korean Society for Parenteral and Enteral Nutrition. All Rights Reserved.

2 Prevalence of Malnutrition in Hospitalized Elderly Korean Patients 활치료기간연장과삶의질저하의원인이될수있다. 3 영양불량위험이있는환자를조기에발견하여영양중재를시행하는것이중요하며, 국내의료기관평가와국제병원인증기준에서는 24시간이내모든입원환자를대상으로영양검색을시행하도록하고있다. 영양위험혹은영양불량환자의비율은사용된영양검색도구나기준, 대상군의특성에따라달라질수있다. 4 Mini Nutritional Assessment (MNA) 는노인의영양검색을위해개발되었으며, 유럽정맥경장영양학회에서노인을대상으로할때사용하도록권고한바있다. MNA는비교적간단하고, 검증된영양검색도구로, 10 15분이내수행가능하지만일부급성환자치료병원에서는시간적인문제로널리사용되지못하는한계가있었다. 5,6 따라서, 시간적인부담을줄이기위해 MNA 결과대비높은민감도와특이도를갖는 6개의질문으로구성된 Mini Nutritional Assessment-Short Form (MNA-SF) 이개발되었으며, 6,7 요양기관이나병원등에서사망률증가, 삶의질저하, 입원기간과회복기간증가와관련있는것으로보고되었다. 8 우리나라에서도노인의영양불량률에대한연구가보고된바있으나 9-11 병원입원환자를대상으로한연구는많지않으며, 12 대부분단일기관연구였다. 따라서, 본연구에서는다기관단면연구를통해한국노인입원환자에서영양불량유병률을조사하고, 이것이재원기간등의임상경과와관련있는지알아보고자했다. 대상및방법 1. 연구대상 2013년 5월부터 6월까지서울, 경기도에소재하고있는상급종합병원과종합병원중연구참여에동의한 10개병원에입원한 65세이상노인환자를대상으로했다. 입원 24시간이내퇴원혹은사망한환자는대상에서제외했다. 각병원영양사에게연구의목적및조사방법에대해교육하고, 5월 1일부터입원한순서에따라 30명까지, 총 300명의자료를수집했다. 자료입력을위해마련된엑셀파일에자료를입력하도록했다. 환자의개인정보보호를위해병원별로 30개씩의증례번호를부여하고, 환자이름은영문이니셜로입력하여환자식별가능한정보는수집하지않았다. 2. 연구방법대상자의입원 48시간이내에 MNA-SF를이용하여영양상태를평가하고, 의무기록을통해연령, 성별, 진단명, 영양평가당시의식사처방과정맥을통한영양공급현황을조사했다. 식사처방은금식, 경장영양, 유동식, 치료식, 일반식으로구분하 여기록했고, 정맥을통한영양공급은중심정맥영양, 말초정맥영양, 덱스트로즈나아미노산수액, 지질유화액처방여부를기록했다. 진단명은뇌신경계, 눈 / 귀 / 코 / 목, 심장혈관계, 호흡계, 간담췌장, 소화기, 신장, 비뇨생식계, 내분비계, 근골격계, 혈액및골수, 종양, 감염성, 그리고기타의 14개영역으로나누어조사했다. 대상환자의입원 31일째퇴원기록지를통해퇴원경과, 입원기간, 중환자실치료여부와중환자실재원기간을기록했다. 퇴원경과는완쾌 / 경쾌, 호전안됨 / 진단뿐, 가망없는퇴원, 48시간이후사망으로구분하여조사했다. MNA-SF 는노인환자의영양검색을위해개발된도구로 6개의질문으로이루어져있다. 즉, 3개월간의식사섭취량변화 (0 2 점 ), 3개월간의체중변화 (0 3점), 거동능력 (0 2점), 3개월간의스트레스유무 (0 또는 2점 ), 신경정신과적문제 (0 2점), 체질량지수 (0 3점) 의 6가지항목이다. 총점 14점으로, 12 14점은정상, 8 11점은영양불량위험있음, 0 7점은영양불량으로판정된다. Nestle Nutrition Institute ( com) 에서 MNA-SF 한국어판과사용자지침서를내려받아자료조사에참여하는임상영양사들에게전달하고, 조사방법및자료입력방법에대해설명했다. 3. 통계분석연속형자료는평균과표준편차로표시했다. 대상자를 MNA- SF 점수 12점이상인정상군과 12점미만인영양불량또는위험군의두군으로분류하여연령, 체질량지수, 중환자실치료기간, 병원입원기간을 Student t-test를이용해비교했다. 두군간의중환자실입원환자비율은 chi-square test를이용하여비교했다. 연령, 중환자실입실여부를통제하고도 MNA-SF를통한영양검색결과가병원입원기간에영향을주는의미있는변수인지분석하기위해 MNA-SF 결과 ( 정상군 vs. 영양불량혹은위험군 ), 중환자실입실여부, 연령을독립변수로하여다중회귀분석을시행했다. 통계분석결과는유의수준 0.05 미만인경우유의적인것으로해석했으며, 통계분석은 IBM SPSS Statistics 20.0 (IBM Co., Armonk, NY, USA) 을이용했다. 결과 1. 환자군의특성대상자의평균연령은 74.2±6.3세 (65 94세) 였고, body mass index (BMI) 는 23.2±3.5 kg/m 2 ( kg/m 2 ) 이었다. 남자가 155명 (51.7%) 이었으며, 평균재원기간은 8.7±5.9 일 (2 31일) 이었다. 종양환자가 26.3% 로가장많았고, 근골격계 (11.3%), 뇌ㆍ신경계 (10.3%), 호흡기계 (9.0%) 순이었다. 입 Volume 6, Number 1, April

3 Hosun Lee, et al. Table 1. General characteristic Variable Age (y) Gender Male:female Body mass index (kg/m 2 ) Admission process Scheduled admission Emergent admission Diagnosis Oncology Musculoskeletal Neurologic Pulmonary Cardiovascular Hepatobiliary Gastrointestinal Others Outcomes at discharge Resolved/improved Not improved Dead Length of stay (d) Intensive care unit admission Yes No Length of stay in ICU (d) Value 74.2± :145 (51.7:48.3) 23.2± (73.0) 81 (27.0) 79 (26.3) 34 (11.3) 31 (10.3) 27 (9.0) 26 (8.7) 26 (8.7) 18 (6.0) 59 (19.7) 244 (91.7) 16 (6.0) 6 (2.3) 8.7± (87.0) 39 (13.0) 3.0±2.9 Values are presented as mean±standard deviation or number (%). ICU = intensive care unit. 원 31일째 266명 (88.7%) 의환자는퇴원한상태였으나 34명 (11.3%) 은입원중이었다. 퇴원한환자중 244명 (91.7%) 은완쾌또는호전된상태로퇴원했고, 16명 (6.0%) 은호전없이퇴원했으며, 6명 (2.3%) 은사망했다 (Table 1). 2. 영양공급방법식사처방은일반식 115명 (38.3%), 치료식 97명 (32.3%), 금식 72명 (24.0%), 경장영양 12명 (4.0%), 유동식 4명 (1.3%) 의순이었다. 대상자의 96명 (32%) 이정맥영양공급을받고있었으며, 이중중심정맥영양 18명 (6.0%), 말초정맥영양 40명 (13.3%), 아미노산이나덱스트로즈, 지방유화액등단일영양소공급중인환자가 36명 (12.0%) 이었다 (Table 2). 금식환자의 52.8% 는정맥영양공급이이루어지고있었고, 경구식사처방이있는환자의 11.5% 만이정맥영양으로영양공급이이루어지고있어금식환자에서정맥영양처방비율이유의적으로높았다 (P< ). 3. 영양평가결과 MNA-SF 를이용한영양평가결과, MNA-SF 점수는 10.7±2.9 점이었으며, 영양불량군 51명 (17.0%), 영양불량위험군 99명 (33.0%), 정상군 150명 (50.0%) 이었다 (Fig. 1). 3개월간식사량변화가없었다고답한환자가 63.0%, 조금줄었다고답한환자는 20.7%, 많이줄었다고답한환자는 16.3% 였다. 3개월간 Table 2. Comparison between the two groups according to nutritional status based on Mini Nutritional Assessment-Short Form Variable All (n=300) Normal (n=150) Risk at malnutrition or malnutrition (n=150) P-value Age (y) BMI (kg/m 2 ) MNA score Diet order NPO Enteral Oral PN order No IV Single nutrient PPN TPN ICU admission ICU stay (d) Hospital stay (d) 74.2± ± ± (24.0) 12 (4.0) 216 (72.0) 206 (68.7) 36 (12.0) 40 (13.3) 18 (6.0) 39 (13.0) 3.0± ± ± ± ± (18.5) 2 (1.3) 121 (80.1) 119 (78.8) 15 (9.9) 11 (7.3) 6 (4.0) 13 (8.7) 1.6± ± ± ± ± (29.5) 10 (6.7) 95 (63.8) 87 (58.4) 21 (14.1) 29 (19.5) 12 (8.1) 26 (17.3) 3.7± ± Values are presented as mean±standard deviation or number (%). BMI = body mass index; MNA = Mini Nutritional Assessment; NPO = nil per os; PN = pareanteral nutrition; IV = intravenous; PPN = peripheral parenteral nutrition; TPN = total parenteral nutrition; ICU = intensive care unit. 26 Journal of Clinical Nutrition

4 Prevalence of Malnutrition in Hospitalized Elderly Korean Patients Table 3. Correlation among Mini Nutritional Assessment score, age, length of intensive care unit (ICU) stay and hospital stay Age Hospital stay ICU stay Mini-Nutritional Assessment-Short Form P-value Fig. 1. Distribution of nutritional status. 체중감소는 3 kg 이상감소한환자가 18.0%, 1 3 kg 감소한환자가 11.7%, 모르겠다고답한환자가 11.7%, 변화없었던환자가 58.7% 였다. 활동량은침대나의자에서만생활가능한환자가 7.7%, 집안에서만활동가능한환자가 18.7% 였고, 73.7% 의환자는활동제약이없다고했다. 최근 3개월간정신적스트레스나급성질환을앓았던환자는 26.7% 였고, 신경정신과적문제로중증치매나우울증을진단받은환자가 4.3%, 경증치매를진단받은환자가 9.3% 였다. 체질량지수는 19 kg/m 2 미만이 10.3%, kg/m 2 은 16.3%, kg/m 2 은 19.3%, 23 kg/m 2 이상은 54% 였다. 4. 영양위험도에따른두군간의비교 MNA-SF 점수를기준으로 12점이상인정상군과 11점이하인영양불량위험군의두군으로나누어임상경과에차이가있는지분석했다 (Table 2). 나이는영양위험군이정상군에비해유의적으로많았고 (75.7±7.0 vs. 72.8±5.2, P), BMI는낮았다 (21.8±3.5 kg/m 2 vs. 24.6±2.9 kg/m 2, P). 두군간의식사처방을비교한 chi-square test에서정상군에서경구식사섭취비율이높고, 금식처방비율이낮았으나 (P=0.002), 영양위험군의 63.8% 는경구식사가가능한환자였다. 병원재원기간은영양불량위험군이정상군에비해의미있게길었다 (9.8±6.2일 vs. 7.7±5.4일, P=0.004). 영양불량위험군환자는정상군에비해더많은환자가중환자실에서치료를받았으며 (17.3% vs. 8.7%, P=0.026), 중환자실치료기간도길었다 (3.7±3.2일 vs. 1.6±1.0일, P=0.033). 5. 입원기간에영향을주는요인분석 MNA-SF 점수는연령 (r= 0.259, P) 과병원입원기간 (r= 0.168, P=0.006), 중환자실재원일수 (r= 0.363, P=0.021) 와음의상관관계를보였다 (Table 3). MNA-SF를통한영양검색결과와병원입원기간의상관관계를분석하기위해 MNA-SF와상관관계가있는것으로분석된연령과중환자실입실여부및 MNA-SF 에의한영양상태를독립변수로하여다중회귀분석을시행했다 (Table 4). MNA-SF에의한영양 Volume 6, Number 1, April 2014 Table 4. Multivariate analysis of factors associated with length of hospital stay Variable β±se P-value Nutritional status by MNA-SF Age ICU admission 1.384± ± ± Data from multiple linear regression analysis. In this analysis, nutritional status is categorized into two groups; mornal vs. risk of malnutrition or malnutrition. SE = standard error; MNA-SF = Mini Nutritional Assessment- Short Form; ICU, intensive care unit. 평가결과만입원기간에영향을주는유의한변수로분석되었으며, 영양불량혹은위험군은정상군에비해연령과중환자실입원여부를통제한상태에서입원기간이 1.38배긴것으로분석되었다 (β=1.384, P=0.005). 고 찰 65세이상노인입원환자를대상으로, 입원 48시간이내 MNA-SF를이용해영양검색을시행한결과, 50% 가영양불량또는영양불량위험이있는것으로평가되었다. 노인환자를대상으로한외국연구들의영양불량률은 40% 70% 로보고되었다. 2,3 국내에서도노인의영양상태를평가한연구들이있었는데, 영양불량군의비율은대상군의연령분포와조사기관에따라차이가있었다. 즉, 건강검진수검자를대상으로한연구에서는영양불량상태인대상은없었고, 영양불량위험군만 12% 로평가되어비율이낮았으나 13 뇌졸중후재활치료중인환자 14 와파킨슨병으로외래를방문한환자 9 등신경계질환환자는통원치료중인환자라도영양불량또는영양불량위험군이 80% 이상으로높게보고되었다. 본연구대상과유사하게 65세이상입원환자를대상으로했던단일기관연구에서는 63% 의환자가영양불량또는영양불량위험군으로선별되어본연구보다높았으며, 12 60세이상노인환자 312명을대상으로포괄적노인평가의일환으로 MNA를이용한영양평가를수행했던다기관연구에서는 45.9% 의환자가영양불량또는영양불량위험환자로평가되어 15 본연구결과와유사한결과를보여외국의 27

5 Hosun Lee, et al. 경우와마찬가지로노인입원환자에서영양불량률이높은것을알수있었다. 본연구에서영양불량혹은영양불량위험환자는정상군에비해병원입원기간이유의적으로길었고, 중환자실치료받은환자의비율이높고, 중환자실치료기간도유의적으로길었다. Rasheed와 Woods 16 는 MNA-SF로영양불량이나영양불량위험군으로선별된환자는정상영양상태인환자에비해입원기간이유의적으로길었고, 사망률도높았다고했다. 60세이상노인환자 615명을대상으로한연구에서도영양상태가나빠질수록병원입원기간이유의적으로증가되었고, MNA 점수와재원기간이유의적인음의상관관계를보였다고하여본연구와유사한결과를보고했다. 17 MNA-SF 결과에따른사망률과재원기간을비교한국내의단일기관연구에서도영양불량군의입원기간이유의적으로길었음을보고했다 세이상내과입원환자의일상생활수행능력에영향을주는요인을분석한국내연구에서영양불량은일상생활수행능력과유의적인상관관계가있었고, 일상생활수행의존군의장기재원환자와사망환자비율이일상행활수행비의존군에비해유의적으로높아영양불량이간접적으로병원입원기간과사망률증가에기여할수있음을보여주었다. 18 그러나, MNA-SF 평가결과와사망률과의관련성에대한연구결과는일관되지않다. MNA-SF 점수가사망률을예측하는강력한지표였다고보고하는일부연구와는달리, 8 Vischer 등 19 은 75세이상노인환자 444명을대상으로 MNA-SF를이용한영양검색에서영양불량위험또는영양불량으로검색된환자와정상영양상태인환자간에 4년생존율은유의적인차이를보이지않았고, 누적동반질환점수와 BMI가유의적인상관성을보였다고했다. 이연구는 75세이상을대상으로해평균연령이 85.3±6.7세였고, 퇴원 4년후에 51% 의환자가사망했는데, 이때는평균연령이 90세에가까워영양상태보다는만성질환의악화가사망여부에더기여했을것으로생각된다. 따라서, 노인입원환자의영양상태와임상적인경과에대한분석에서는연령과질병의중증도에대한고려가필요하다. 본연구에서는입원중사망률이 2.3% (7명) 로낮아영양상태에따른사망률비교분석은시행하지않았다. 입원기간분석시에중증도에의한임상경과의차이를보정하고자중환자실입실여부를 MNA-SF 검색결과및연령과함께독립변수로하여다중회귀분석을수행했으며이중 MNA-SF 평가결과에서영양불량또는영양불량위험군인지여부만이재원기간에대한의미있는지표로선택되었다. 대상환자의입원시식사처방조사결과, 70% 이상의환자가경구섭취가가능한환자였으며, 약 30% 의환자는금식또는경장영양이처방되어영양집중지원의대상이될수있을것으로 나타났다. 약 20% 의환자에서정맥을통한영양공급이이루어지고있었는데, 금식환자중약 53% 가정맥영양처방이있었지만식사처방이있는환자에서는 11.5% 가정맥영양처방이있어금식환자에서의처방비율이유의적으로높았다. 영양상태에따른두군간의비교에서는정상군의정맥영양처방비율이적었으나영양불량, 영양불량위험, 정상군의세군간을비교했을때는영양불량군에서의정맥영양처방이가장낮아서영양상태보다는금식여부가정맥영양처방결정에영향을주는것으로생각되었다. 한대학병원의정맥영양처방적정성을평가한연구에서정맥영양처방건중 40% 가적응증이아닌환자에게처방되었다고했으며, 20 소화기암수술환자의정맥영양처방을비교한국내연구에서도영양위험군과정상군의정맥영양처방현황에차이가없다고했다. 21 따라서, 영양검색을통해영양적위험이있거나영양불량으로선별된환자의경우, 전반적인영양상태및원인에대한평가, 식사를통한영양소섭취량의적정성평가결과에기초해서필요한환자에게적절한영양집중지원처방이이루어질수있는체계가필요하겠다. 본연구의제한점은대상병원이모두수도권에있어지역적인제한이있었고, 상급종합병원과종합병원을대상으로한연구이므로, 이를한국노인입원환자전체의결과로보기는어렵다는점이다. 또한병원별대상환자수가 30명으로적어서병원규모나진단과중증도에따른분석이이루어지지못한제한점이있다. 그럼에도불구하고, 본연구는국내노인입원환자의영양불량정도와그에따른임상경과의차이를분석함으로써향후영양불량이있는노인입원환자에대한영양중재및영양집중지원전략수립의근거자료로의미가있을것으로생각된다. 결론 본연구결과를통해국내수도권지역의종합병원이상의의료기관에입원한노인환자중 50% 에이르는환자가입원당시이미영양불량상태이거나영양불량위험상태였고, 이는병원입원기간과중환자실치료비율및중환자실치료기간의증가에기여할수있다는것을알수있었다. 향후입원초기에영양불량또는위험군으로선별된노인환자를대상으로영양평가및적절한방법으로영양소섭취량을증가시킴으로써환자의영양상태와임상경과개선에기여할수있는지에대한연구가필요할것으로생각되었다. ACKNOWLEDGMENTS 바쁘신중에도자료수집에참여해주신선생님들께진심으로 28 Journal of Clinical Nutrition

6 Prevalence of Malnutrition in Hospitalized Elderly Korean Patients 감사드립니다. 권미라 ( 보라매병원영양팀 ), 김민경 ( 분당서울대병원영양팀 ), 김우정 ( 강남세브란스병원영양팀 ), 이정주 ( 강동경희대병원영양팀 ), 이정화 ( 경희대병원영양팀 ), 이지선 ( 서울성모병원영양팀 ), 임정현 ( 서울대병원영양팀 ). REFERENCES 1. Durán Alert P, Milá Villarroel R, Formiga F, Virgili Casas N, Vilarasau Farré C. Assessing risk screening methods of malnutrition in geriatric patients: Mini Nutritional Assessment (MNA) versus Geriatric Nutritional Risk Index (GNRI). Nutr Hosp 2012;27(2): Bienia R, Ratcliff S, Barbour GL, Kummer M. Malnutrition in the hospitalized geriatric patient. J Am Geriatr Soc 1982;30(7): Covinsky KE, Martin GE, Beyth RJ, Justice AC, Sehgal AR, Landefeld CS. The relationship between clinical assessments of nutritional status and adverse outcomes in older hospitalized medical patients. J Am Geriatr Soc 1999;47(5): Holst M, Yifter-Lindgren E, Surowiak M, Nielsen K, Mowe M, Carlsson M, et al. Nutritional screening and risk factors in elderly hospitalized patients: association to clinical outcome? Scand J Caring Sci 2013;27(4): Bauer JM, Kaiser MJ, Anthony P, Guigoz Y, Sieber CC. The Mini Nutritional Assessment--its history, today's practice, and future perspectives. Nutr Clin Pract 2008;23(4): Rubenstein LZ, Harker JO, Salvà A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: developing the shortform mini-nutritional assessment (MNA-SF). J Gerontol A Biol Sci Med Sci 2001;56(6):M Kaiser MJ, Bauer JM, Ramsch C, Uter W, Guigoz Y, Cederholm T, et al; MNA-International Group. Validation of the Mini Nutritional Assessment short-form (MNA-SF): a practical tool for identification of nutritional status. J Nutr Health Aging 2009;13(9): Gentile S, Lacroix O, Durand AC, Cretel E, Alazia M, Sambuc R, et al. Malnutrition: a highly predictive risk factor of short-term mortality in elderly presenting to the emergency department. J Nutr Health Aging 2013;17(4): Yun JH, Lim HJ, Woo MH, Ahn TB, Choue R. Study on the qualities of diet and life in Parkinson's disease patients according to their nutritional status. Korean J Nutr 2012;45(3): Yoon MO, Moon HK, Kim SY, Kim BH. Nutritional assessment and management in long-term care insurance's home visit care service. Korean J Community Nutr 2013;18(2): Yoon MO, Moon HK, Jeon JY, Sohn CM. Nutritional management by dietitian at elderly nursing homes in Gyeonggi-do. J Korean Diet Assoc 2013;19(4): Chung SH, Sohn CM. nutritional status of hospitalized geriatric patients using by the mini nutritional assessment. Korean J Community Nutr 2005;10(5): Lee HO, Lee JS, Shin JW, Lee GJ. Nutrition assessment of older subjects in a health care center by MNA (Mini Nutritional Assessment). J Korean Diet Assoc 2010;16(2): Kim EJ, Yoon YH, Kim WH, Lee KL, Park JM. The clinical significance of the mini-nutritional assessment and the scored patient-generated subjective global assessment in elderly patients with stroke. Ann Rehabil Med 2013;37(1): Cho CY, Lee SH, Hong SH, Kim DH, Park JS, Ahn YW, et al. The multi-center study of the comprehensive geriatric assessment in the Korean elderly. J Korean Acad Fam Med 2001;22(9): Rasheed S, Woods RT. Predictive validity of 'Malnutrition Universal Screening Tool' ('MUST') and Short Form Mini Nutritional Assessment (MNA-SF) in terms of survival and length of hospital stay. ESPEN J 2013;8(2):e Soysal P, Isik AT, Uğur A, Kazancioglu R, Ergun F, Babacan Yildiz G. Vitamin B12 and folic acid levels are not related to length of stay in elderly inpatients. Nutrition 2013;29(5): Park MS, Chung SH, Seo YW, Kim EY, Kim HY, Lee HJ, et al. Influencing factors of activity of daily living in patients admitted to the acute elderly care unit. J Korean Geriatr Soc 2007;11(2): Vischer UM, Frangos E, Graf C, Gold G, Weiss L, Herrmann FR, et al. The prognostic significance of malnutrition as assessed by the Mini Nutritional Assessment (MNA) in older hospitalized patients with a heavy disease burden. Clin Nutr 2012;31(1): DeLegge MH, Basel MD, Bannister C, Budak AR. Parenteral nutrition (PN) use for adult hospitalized patients: a study of usage in a tertiary medical center. Nutr Clin Pract 2007;22(2): Lee H, Kim CB. Prevalence of patients at nutritional risk among those who underwent gastrointestinal surgery for cancer. J Korean Soc Parent Enter Nutr 2007;1(1):23-7. Volume 6, Number 1, April

386-390.hwp

386-390.hwp 386 HANYANG MEDICAL REVIEWS Vol. 29 No. 4, 2009 우리나라 미숙아의 통계와 의료비용 Statistics and Medical Cost of Preterm in Korea 윤혜선 을지대학교 노원을지병원 소아청소년과학교실 Hye Sun Yoon, M.D., Ph.D., Department of Pediatrics, Nowon