Anthropometric and nutritional assessment in Italian elderly subjects

The aims of this anthropometric study on 486 non-institutionalized subjects aged 60 and over were to assess the body mass index (BMI), to evaluate possible sex and age-linked differences of BMI and to find whether there were any correlations with systolic and diastolic blood pressure. To this end, the subjects were divided into three age groups: A: 60-69 years, B: 70-79 years and C: > or =80 years old. The results showed a high prevalence (74%) of overweight or clearly obese subjects (BMI >25.1 for men and BMI > 23.9 for women) (70% male and 77% female). Both the BMI and diastolic blood pressure showed a decreasing trend in the three age groups and were significantly correlated in the total population (p < 0.001). A dietary investigation using a 24-hour recall method, repeated on three separate days, was carried out on a subsample of 90 subjects, selected at random from the total population. They underwent in-depth anthropometric assessment (BMI, four skinfolds, mid-arm, waist and hip circumferences, midarm muscle and fat areas, body fat percent). The trend of the anthropometric assessment reflected that of the total population. Total energy intake in both sexes did not significantly differ from the Italian RDA (Recommended Dietary Allowance). As regards the three macronutrients, no significant differences in protein and carbohydrate intakes were found between the sexes. However, in the females, fat intake was over the Italian DRA (30%) and below it in the males. Calcium intake was lower than the Italian RDA (1,000 mg/day) in most males (77%) and females (89%). However, iron and vitamin intakes were adequate in most subjects. As regards age-linked differences, there were non significant changes in the percentage of energy intake from proteins of the males whereas this decreased with age and was significantly different (p < 0.05) in the females. No significant differences were found in the percentage of energy intake from carbohydrates and fats.     

Predicting the value of the mini nutritional assessment (MNA) as an indicator of functional ability in older Iranian adults (Kahrizak elderly study)

Objective  

We aimed to investigate the appropriateness of the Mini Nutritional Assessment (MNA) in predicting functional ability in older adults.     

Anthropometric measurements as indicators of nutritional status of the elderly

This review contains details on anthropometric measurements required for assessment of nutritional status in the elderly. These measurements provide indicators of fat tissue content or body composition and evaluate trends in nutritional status. Anthropometric measurements in the elderly are similar to these in other groups of population but they have to be adopted according to changes in constitution and posture of elderly and disabled people. The following measurements are presented: stature, weight, skinfold thickness and mid upper-arm, waist and hip circumferences. Derived measurements and indices of nutritional status are also discussed.     

Feasibility and reliability of the mini nutritional assessment (MNA) in older adults with intellectual disabilities

Objective

Feasibility and reliability of the Mini Nutritional Assessment (MNA) in older adults with intellectual disabilities (ID).

Design

Instrument development.

Setting

Three care providers for people with ID.

Participants

48 persons aged 50 years and over with borderline to profound ID and their professional caregivers.

Measurements

The MNA was performed by means of interviews with participants (N = 12) and caregivers (N = 48) and physical assessments of participants (N = 47). Aspects of feasibility: completion of interview, difficulty of answering interview items, duration of interview and completion of physical assessment. Aspects of reliability: inter-observer reliability between caregivers and between participants and caregivers, test-retest reliability and internal consistency. For inter-observer and test-retest reliability, intraclass correlation coefficients (ICC) were calculated, and for internal consistency Chronbach??s alpha.

Results

All participants and caregivers completed the interview part. For 7 out of 12 personally interviewed participants and none of the caregivers, at least 3 out of 15 questions were difficult to answer. Mean duration of the interview was 7 minutes in participants and 4 minutes in caregivers. Physical assessment was successfully performed in 40 participants (85.1%). In the remaining 7 participants (14.9%) missing values were retrieved from the medical records. ICCs (95% confidence interval) for test-retest and inter-observer reliability between caregivers were good, 0.85 (0.72?C0.92) and 0.86 (0.74?C0.92) respectively, but ICC for inter-observer reliability between caregivers and persons with ID was low, 0.03 (?0.51 ?0.59). Internal consistency was 0.61.

Conclusion

The MNA is feasible and reliable for older people with ID. Interview data can be reliably obtained through caregivers, but not through people with ID.     

主客观营养评价指标在老年麻风患者中的应用

目的调查麻风患者的营养状况,探讨营养评价方法的可行性。方法采用主观全面营养评定（SGA）和客观指标对60例长期住院晚期老年麻风患者进行营养状态评估。结果SGA评估结果显示,60例患者中,有22例（36．7％）患者存在营养不足,其中5例（8．3％）为严重营养不足。三头肌皮褶厚度（TSF）、前白蛋白（PALB）、上臂肌围（MAMC）、血红蛋白（Hb）和血清白蛋白（ALB）与SGA评价一致性的Kappa值分别为0．619、0．571、0．476、0．454和0．419。除身高和胆固醇外,性别、麻风型别、住院时间和麻风畸残度与所有营养指标无关。年龄和溃疡程度与患者体重指数、TSF、Hb、ALB和PALB明显相关（P〈0．01）。SGA对被筛选客观指标敏感性和特异性不一,TSF和溃疡对SGA的影响最大。结论麻风患者营养风险性不高。客观指标不适合单独应用于老年晚期麻风患者,应结合SGA进行综合评价。     

The use of the Mini-Nutritional Assessment (MNA) tool in elderly orthopaedic patients

OBJECTIVE: To assess the use of the Mini-Nutritional Assessment (MNA) in elderly orthopaedic patients. DESIGN: An observation study assessing the nutritional status of female orthopaedic patients. SETTING: The orthopaedic wards of the Royal Surrey County Hospital. SUBJECTS: Forty-nine female patients aged 60-103 y; dietary records were obtained for 41 subjects and 36 subjects gave a blood sample for biochemical analysis. MAJOR OUTCOME METHODS: MNA questionnaire, anthropometry, plasma albumin, transferrin, C-reactive protein (CRP) levels and dietary analyses. RESULTS: The group as a whole had low mean values for body weight, albumin and transferrin and high CRP levels. In addition, the group had mean energy intakes well below the estimated average requirement (EAR) and mean intakes of vitamin D, magnesium, potassium, selenium and non-starch polysaccharides (NSP) were below the lower reference nutrient intakes (LRNI). The MNA screening section categorized 69% of the patients as requiring a full assessment (scored 11 or below), but for the purposes of the study the MNA was completed on all patients. The MNA assessment categorized 16% of the group as 'malnourished' (scored<17 points), 47% as 'at risk' (scored 17.5-23.5) and 37% as 'well nourished' (scored>23.5). Significant differences were found between the malnourished and well nourished groups for body weight (P<0.001), body mass index (BMI) (P<0.001), demiquet (P<0.001) and mindex (P<0. 001). Mean values for energy and nutrient intakes showed a clear stepwise increase across the three groups for all nutrients except sodium, with significant differences for protein (P<0.05), carbohydrate (P<0.05), riboflavin (P<0.05) niacin (P<0.05), pyridoxine (P<0.05), folate (P<0.05), calcium (P<0.05), selenium (P<0.05), iron (P<0.05) and NSP (P<0.05) intakes. Stepwise multiple regression analysis indicated that anthropometric assessments were the most predictive factors in the total MNA score. The sensitivity and specificity of the MNA was assessed in comparison with albumin levels, energy intake and mindex. The sensitivity of the MNA classification of those scoring less than 17 points in comparison with albumin levels, energy intake and mindex varied from 27 to 57% and the specificity was 66-100%. This was compared with the sensitivity and specificity of using a score of less than 23.5 on the MNA to predict malnourished individuals. Using this cut-off the sensitivity ranged from 75 to 100%, but the specificity declined to between 37 and 50%. CONCLUSIONS: The results suggest that the MNA is a useful diagnostic tool in the identification of elderly patients at risk from malnutrition and those who are malnourished in this hospital setting. SPONSORSHIP: Nestlé Clinical Nutrition, Croydon, Surrey.     

Validation of the photography method for nutritional intake assessment in hospitalized elderly subjects

Objective

The aim of the present study was to validate the photographic indirect method as an accurate and specific tool to assess nutritional intake in a cohort of elderly hospitalized patients.

Design

this is a prospective observational study.

Setting

hospital (geriatric acute ward and transitional care of IRCCSS AUO San Martino Hospital, Genoa, Italy).

Participants

255 consecutive elderly hospitalized patients. Measurements: assessment of malnutrition by: Mini nutritional assessment (MNA) and abbreviated Comprehensive geriatric assessment (CIRS; Barthel index, SPMSE). The direct method (Gold standard): food dish weight (before lunch) and residual (after lunch) food dish weight and estimation of the percentage of eaten food and of residual food for each dish. The percentages of food intake and residual food were calculated according to the following formula: intake %= initial weight of the dishes- residual food weight)/ initial weight dish x100. The unit of variable was the percentage. The indirect photographic method with extrapolation of the lunch food intake by photographic method confronting initial meal and residual meal (25% quartile food dish estimation).

Results

The results showed a significant correlation between the direct method (weighing residual food) and the indirect photographic method(n=255; r=0.9735; p<0.001) as well as a significant positive correlation between the indirect photographic method and the food caloric estimation calculated by the direct method (n=255; r= 0.6489, p<0.001). Intraclass coefficient (ICC), showed a highly significant degree of agreement between the gold standard and the indirect photographic method (ICC: 0.69; p<0.0001). Additionally, the results showed a good inter rater agreement of the indirect photographic method (kappa-statistic measure of interrater agreement: (Z=13.04; p<0.001); agreement 70.29% e Kappa=0.5965) and a good specificity of the indirect method as it was independent on the single food item.

Conclusions

The study originally provided the validation of the indirect photographic method for the assessment of nutritional intake in a vast cohort of hospitalized elderly subjects. The present results moved a step forward in the appropriate assessment of nutrition intake in frail elderly, providing an easy to use tool that may be incorporate in routine clinical practice for early and targeted therapeutic interventions.

     

Validation of a modified-multidimensional prognostic index (m-MPI) including the mini nutritional assessment short-form (MNA-SF) for the prediction of one-year mortality in hospitalized elderly patients

Background  

The mortality prediction represents a key factor in the managing of elderly hospitalized patients. Since in older subjects mortality results from a combination of biological, functional, nutritional, psychological and environmental factors, a Multidimensional Prognostic Index (MPI) that predict short- and long-term mortality based on a standardized comprehensive geriatric assessment (CGA) has recently been developed and validated.     

Anthropometric measurement error and the assessment of nutritional status

Anthropometry involves the external measurement of morphological traits of human beings. It has a widespread and important place in nutritional assessment, and while the literature on anthropometric measurement and its interpretation is enormous, the extent to which measurement error can influence both measurement and interpretation of nutritional status is little considered. In this article, different types of anthropometric measurement error are reviewed, ways of estimating measurement error are critically evaluated, guidelines for acceptable error presented, and ways in which measures of error can be used to improve the interpretation of anthropometric nutritional status discussed. Possible errors are of two sorts; those that are associated with: (1) repeated measures giving the same value (unreliability, imprecision, undependability); and (2) measurements departing from true values (inaccuracy, bias). Imprecision is due largely to observer error, and is the most commonly used measure of anthropometric measurement error. This can be estimated by carrying out repeated anthropometric measures on the same subjects and calculating one or more of the following: technical error of measurement (TEM); percentage TEM, coefficient of reliability (R), and intraclass correlation coefficient. The first three of these measures are mathematically interrelated. Targets for training in anthropometry are at present far from perfect, and further work is needed in developing appropriate protocols for nutritional anthropometry training. Acceptable levels of measurement error are difficult to ascertain because TEM is age dependent, and the value is also related to the anthropometric characteristics of the group of population under investigation. R > 0.95 should be sought where possible, and reference values of maximum acceptable TEM at set levels of R using published data from the combined National Health and Nutrition Examination Surveys I and II (Frisancho, 1990) are given. There is a clear hierarchy in the precision of different nutritional anthropometric measures, with weight and height being most precise. Waist and hip circumference show strong between-observer differences, and should, where possible, be carried out by one observer. Skinfolds can be associated with such large measurement error that interpretation is problematic. Ways are described in which measurement error can be used to assess the probability that differences in anthropometric measures across time within individuals are due to factors other than imprecision. Anthropometry is an important tool for nutritional assessment, and the techniques reported here should allow increased precision of measurement, and improved interpretation of anthropometric data.     

Anthropometric assessment of nutritional depletion after surgery injury

Triceps skinfold (TS), arm muscle circumference (AMC) and body weight (BW) were studied prospectively in 20 adults, admitted to elective operations on the digestive tract, in order to evaluate these anthropometric parameters in planned surgical procedures performed in non-critically ill, non-stressed patients. Mean duration of the preoperative period was 19.2 days (range 1--38), and of the postoperative period, 14.1 days (range 6--31). Mean changes for BW were, respectively, -0.2% and -2.5%, AMC decreased -0.5% before operation and -3.4% afterwards, and TS was reduced to -1.9% in the preoperative phase, and to -8.4% postoperatively. These results are consistent with minimal anthropometric changes during the presurgical stay, with more striking decreases after operative injury. Postoperative findings were further examined in relationship to degree of surgical trauma and length of postoperative hospitalization. After the arbitrary selection of a 10% reduction as the limit for significant decrease in any of the analysed parameters, the percentage of impaired measurements was determined in the sub-groups of medium and large operations, two consecutive procedures, as well as postoperative stay of 6 to 14 days, 15 to 21 days, and over 3 wks. Decreased parameters comprised 6.0% (2/33) of the observations after moderate surgical manipulation, 27.7% (5/18) after serious trauma, and 66.6% (6/9) after two operations. Simarilarly they represented 2.7% (1/36) of the findings in patients discharged within 2 weeks, 33.3% (4/12) in those staying between 2--3 weeks, and 66.6% (8/12) in the cases remaining for longer periods. Despite the limited sensitivity of anthropometric parameters in the detection of acute moderate changes in body constitution, they were useful in separating the patients undergoing medium surgical injury from those subjected to more severe metabolic stress, when only changes greater than 10% of initial value were considered.     

住院患者营养风险筛查的调查和分析

目的 应用NRS2002方法对住院患者营养风险进行筛查,并调查实际应用营养支持率情况.方法 采用定点连续抽样,选取3家大、中、小医院新住院患者共2309例,测定体重、身高,询问近3个月体重变化情况,近1周饮食情况,依照NRS2002评分系统进行评分.BMI＜18.5 kg/m2或sA1b＜30 g/L为存在营养不良.NRS2002≥3分为存在营养风险.结果 大医院营养风险发生率高于中、小医院.结论 各级医院住院患者中均存在一定比例营养不良及营养风险,营养支持没有得到足够重视.     

Mini Nutritional Assessment (MNA) and nutritional risk in elderly. A proposal of nutritional surveillance system for the Department of Public Health

Objective of the study is to present an intervention model to evaluate nutritional risk of institutionalised elderly, suitably with the aims and resources of the Hygiene of Nutrition Services, and to individuate predictive variables of nutritional vulnerability. 237 subjects from the residential homes of ASL RMB were involved in the study; to each subject was administered: a) the Mini Nutritional Assessment (MNA); b) a questionnaire for the analysis of the risk factors. Multivariate logistic regression analysis was performed to evaluate the influence of the risk factors on nutritional status. On the basis of BMI the prevalence of malnutrition is 6.5% and the prevalence of overweight and obesity is respectively 41.6% and 22.9%; on the basis of MNA, 5.1% of the subjects is malnourished and 60.3% at risk for malnutrition. The absence of chewing difficulties (OR 2.94; I.C. 1.46-5.91) and the habit to eat all foods served at meals (OR 2.83; I.C. 1.46-5.91) are associated with a good nutritional status. The age > or = 90 years is a risk factor for malnutrition at the limit of statistical significance (OR 0.44; I.C. 0.14-1.00). Carrying out the MNA resulted easy and quick, confirming the hypothesis for feasibility of this protocol in the Hygiene of Nutrition Services. The results highlight an high nutritional risk of the elderly nursing home residents and the importance of planning programs of nutritional surveillance with particular attention on masticatory function impairments, meal intake and on the oldest subjects among the elderly as a group greatly vulnerable. We believe that these areas are very important in defining public health intervention programs.     

An algorithm for the clinical assessment of nutritional status in hospitalized patients

Upon admission to hospital, 30-50 % of patients either are or become malnourished. There is no generally accepted definition of malnutrition or guidelines on the best way to establish nutritional status. We consider it self-evident that the nursing staff have an important role in screening patients at risk of malnutrition on admission and thereafter at regular times. This is why we developed the nursing nutritional screening form (NNSF). The NNSF was tested by nurses, dietitians and clinicians, in pairs, to establish the extent of agreement in two phases on sixty-nine and forty patients. Later, the form was used in practice by nursing staff on five wards (334 patients). Based on the results of the NNSF, patients were referred to a dietitian. The dietitian established whether the patient was indeed at risk, or was actually malnourished, using a complete nutritional history. The degree of concurrence within pairs was reasonable to good. The same applied to the concurrence between nursing staff and dietitians, but concurrence between clinicians and nursing staff was less. In total, 334 patients were screened and sixty-nine of them were referred to the dietitian. It was established that 86 % of the referred patients were potentially at risk of malnutrition or were malnourished. Without the NNSF, 39 % (n 27) of the patients referred to the dietitian would not have been referred, or would have been referred much later. The NNSF makes it possible for nurses to detect malnourished patients or patients at risk of malnutrition at an early stage of their hospitalization.     

肥胖指标在青少年高血压病预测中的价值

目的评价体重指数（BMI）、腰围／身高比值（WHtR）、腰围（WC）及腰臀比（WHR）在预测青少年高血压病中的价值。方法通过分层整群随机抽样,共抽取12—18岁青少年3953例（男1947例,女2006例）。据血压水平分为正常对照组（3724例）和高血压组（229例）。测量身高、体重、腰围、收缩压（SBP）、舒张压（DBP）水平。结果高血压组BMI、WC、WHtR、WHR、SBP及DBP均明显高于正常对照组,差异有统计学意义（P〈0．05）。校正年龄、性别后,4个指标（BMI、WHtR、WC及WHR）均与SBP和DBP呈正相关,BMI与SBP和DBP的偏相关分析r’最大（r’分别为0．3228和0．2358）（P〈0．05）。4个指标预测高血压的受试者工作特性曲线下面积以BMI最大,分别为男性0．715（95％C10．659～0．771）和女性0．702（95％C10．646～0．757）。以SBP和DBP为因变量,以性别、年龄、BMI、腰围、WHtR和WHR为自变量,行多元线性回归,BMI均第一个被引入方程。结论BMI是预测青少年高血压病的有效指标。     

肥胖指标在青少年高血压病预测中的价值

目的评价体重指数（BMI）、腰围／身高比值（WHtR）、腰围（WC）及腰臀比（WHR）在预测青少年高血压病中的价值。方法通过分层整群随机抽样,共抽取12～18岁青少年3953例（男1947例,女2006例）。据血压水平分为正常对照组（3724例）和高血压组（229例）。测量身高、体重、腰围、收缩压（SBP）、舒张压（DBP）水平。结果高血压组BMI、WC、WHtR、WHR、SBP及DBP均明显高于正常对照组,差异有统计学意义（P〈0．05）。校正年龄、性别后,4个指标（BMI、WHtR、WC及WHR）均与SBP和DBP呈正相关,BMI与SBP和DBP的偏相关分析r’最大（r’分别为0．3228和0．2358）（P〈0．05）。4个指标预测高血压的受试者工作特性曲线下面积以BMI最大,分别为男性0．715（95％CI0．659～0．771）和女性0．702（95％CI0．646—0．757）。以SBP和DBP为因变量,以性别、年龄、BMI、腰围、WHtR和WHR为自变量,行多元线性回归,BMI均第一个被引入方程。结论BMI是预测青少年高血压病的有效指标。