Nutritional (High Protein) Perihabilitation in Older Veterans Undergoing Surgery

接受手术的老年退伍军人的营养（高蛋白）康复训练

• 批准号: 9292730
• 负责人: Kathryn N Starr
• 金额: --
• 依托单位: DURHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-05-01 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9292730
• 关键词: Address; Adherence; Admission activity; Adoption; Albumins; Area; Assessment tool; Biological Markers; Body Weight decreased; Caring; Client satisfaction; Clinic; Clinical; Clinical Trials; Counseling; Development; Diagnosis; Dietary Intervention; Dietary intake; Early identification; Early treatment; Education; Elderly; Fostering; Foundations; Frail Elderly; Frail Older Adults; Future; Goals; Health; Health Care Costs; Health Care Research; Hospitalization; Hospitals; Inflammation; Interleukin-6; Intervention; Intervention Trial; Length; Length of Stay; Life; Link; Location; Malnutrition; Medical center; Mentorship; Nutritional; Nutritional Support; Nutritional status; Operative Surgical Procedures; Outcome; Outcome Measure; Participant; Patients; Perioperative; Physical Function; Physical activity; Population; Postoperative Complications; Postoperative Period; Preparation; Prevalence; Prospective Studies; Prospective cohort study; Proteins; Quality of life; Randomized; Recruitment Activity; Rehabilitation Research; Reporting; Research; Research Proposals; Research Support; Risk; Scientist; Severities; Standardization; Supplementation; Surgical complication; TNF gene; Techniques; Testing; Treatment Protocols; Veterans; Work; arm; base; career; design; experience; hospital readmission; improved; improved outcome; interest; multidisciplinary; novel; nutrition; pilot trial; primary outcome; programs; protein intake; screening; secondary outcome; skills; stressor; tool; week trial

Post-surgical complications are most common in older adults. While a number of factors contribute, one key determinant is malnourishment. Malnutrition – particularly low protein intake – is seen in up to 86% of older adults at hospital admission; however, the prevalence of malnutrition in older Veterans is unknown. Malnutrition and post-surgical complications are linked through two critical observations: 1) malnutrition dramatically reduces the ability of older adults to overcome postsurgical health stressors, and 2) nutritional status is likely to deteriorate further during hospitalization and after discharge. Despite convincing evidence that perioperative nutrition interventions can improve surgical outcomes, such interventions have not been developed and implemented for our Veterans. Thus, there is a critical need to initiate the required steps to identify and reduce malnutrition in older Veterans who are anticipating surgery. The overall objectives of the proposed research are: 1) to validate screening and assessment tools to quickly and accurately identify perioperative malnutrition in Veterans, and 2) to pilot test a “perihabilitation” intervention of protein enhanced supplementation to identify its feasibility, fidelity, and acceptability, and 3) to determine the effect size of physical function in preparation for a larger clinical trial. The Perioperative Optimization of Senior Health Program (VAPOSH), a new interdisciplinary program at the Durham VAMC, offers a unique opportunity to develop and pilot test approaches for addressing perioperative malnutrition. Demonstration of the functional impact of perioperative protein supplementation for malnourished older Veterans will support this research proposal seeking to identify and treat perioperative malnutrition and improve postoperative outcomes in older Veterans. The Aims of this project are: 1) to select the appropriate nutrition screening and assessment tools for VAPOSH Veterans and employ them to characterize malnutrition prevalence and severity and establish cut-off values associated with malnutrition, 2) to conduct a pilot randomized controlled 6-week trial of enhanced protein supplementation in a population of malnourished Veterans undergoing elective surgery; 2.1) use a pilot trial to evaluate the feasibility, fidelity, and acceptability of a perioperative protein- enhanced intervention compared to an educational control; and 2.2) to determine the effect size for planned future studies of enhanced protein supplementation in malnourished Veterans, with physical function as the primary outcome of interest. Aim1 encompasses an observational, prospective study that screens and evaluates 75 VAPOSH patients undergoing elective surgery 1) to report the prevalence of being malnourished or at risk of being malnourished in VAPOSH patients, 2) determine the criterion validity of the Nutrition Risk Screener-2002 and Patient Generated-Subjective Global Assessment tools, and 3) identify cut-off value associated with malnutrition. Aims 2.1 and 2.2 will pilot test a “perihabilitation” intervention in malnourished older Veterans undergoing elective surgery to assess 1) the feasibility, fidelity and acceptability of a higher protein supplement before and after surgery and 2) the effects of a higher protein supplement on the primary outcome measure, physical function and secondary outcomes of interest. Malnourished VAPOSH Veterans will be randomly assigned to either an education (nutritional counseling) control arm or high-protein perihabilitation arm. Participants in the high-protein arm will be provided with high quality protein supplements that will bring their protein intakes to at least 30 grams for each of the 3 meals per day. The successful completion of these aims will provide important findings that will support the development of novel and much needed approaches to intervene for malnutrition in Veterans before, during and after surgery.

手术后并发症在老年人中最常见。虽然许多因素造成了 关键确定器是营养不良的。在多达86％ 老年人入院；但是，老年退伍军人的营养不良的患病率尚不清楚。 营养不良和手术后并发症通过两个关键观察有联系：1）营养不良 大大降低了老年人克服术后健康压力源的能力，2）营养 状态可能会在住院期间和出院后进一步确定。尽管有令人信服的证据 定期营养干预措施可以改善手术结果，这种干预措施尚未 为我们的退伍军人开发和实施。那是迫切需要启动所需步骤 识别并减少预期手术的老年退伍军人的营养不良。总体目标 拟议的研究是：1）验证筛选和评估工具以快速准确地识别 退伍军人的围围院和2）试点测试蛋白质的“杂型”干预措施 增强补充以确定其可行性，忠诚和可接受性，以及3）确定效果 身体功能的大小为更大的临床试验做准备。高级围手术期优化 Durham VAMC的新跨学科计划Health Program（Vaposh）提供了独特的 开发和试点测试方法来解决定期营养不良的机会。演示 周期性蛋白质补充营养不良的老年退伍军人的功能影响将支持 该研究提案旨在识别和治疗周期性营养不良并改善术后 老年退伍军人的结果。该项目的目的是：1）选择适当的营养筛查和 Vaposh退伍军人和员工的评估工具，以表征营养不良的患病率和严重性 并建立与营养不良相关的截止值，2）进行飞行员随机控制的6周 在接受选修课的营养不良的退伍军人人群中补充蛋白质补充的试验 外科手术; 2.1）使用试验试验来评估周期性蛋白质的可行性，保真度和可接受性 与教育控制相比，干预的增强； 2.2）确定计划的效果大小 未来对营养不良的退伍军人补充蛋白质补充的研究，身体机能是 兴趣的主要结果。 AIM1涵盖了一项观察性的前瞻性研究，该研究筛选和评估75 Vaposh 接受选修外科的患者1）报告营养不良或有可能存在的风险 在Vaposh患者中营养不良，2）确定营养风险筛选器2002的标准有效性 和患者生成的主体全球评估工具，以及3）确定与 营养不良。 AIMS 2.1和2.2将对营养不良的年龄进行试验测试“围日临床”干预措施 接受选修手术的退伍军人评估1）较高蛋白质的可行性，保真度和可接受性 手术前后补充剂和2）较高蛋白补充剂对原发性的影响 结果测量，身体机能和感兴趣的次要结果。营养不良的Vaposh退伍军人 将随机分配给教育（营养咨询）控制臂或高蛋白 围院臂。高蛋白组的参与者将配备高质量的蛋白质 每天3顿饭中的每一顿饭都会将其蛋白质摄入量至少30克。 这些目标的成功完成将提供重要的发现，以支持 开发新颖和急需的方法来干预退伍军人的营养不良 手术后。