Validation of the revised mini nutritional assessment short-forms in nursing homes in Spain

Objective

To contribute to the validation of the revised BMI-MNA-SF and CC- MNA-SF with regard to association and agreement with the full-MNA, considered as gold standard, in nursing homes in Spain.

Design

Prospective analysis.

Setting

Nursing homes.

Participants

Eight hundred ninety five subjects aged 65 or older meeting inclusion criteria.

Measurements

Correlation, diagnostic accuracy and agreement between the revised MNA short forms and the MNA full form.

Results

The MNA-SFs correlated strongly with the full MNA version (Pearson’s correlation coefficient r=0.904; p<0.001). High values of sensitivity, specificity and predictive values were obtained for the BMI- MNA-SF and CC-MNA-SF against the full-MNA when the dichotomized categorizations “malnourished-at risk of malnutrition” vs “well nourished” and “malnourished” vs “at risk of malnutrition-well nourished” were considered (Youden’s index at least 0.695 in all cases). Areas under the ROC curves also reached high values (BMI-SF: 0.950 and CC-SF: 0.923 for the first categorization; BMI-SF: 0.979 and CC-SF: 0.978 for the second one) showing both tests excellent accuracy with the full-MNA. The agreement between the MNA-SFs and the full-MNA was quantified as the percentage of correct classifications. The BMI-MNA-SF classified 83.80% correctly and the CC-MNA-SF classified 78.55% correctly. Significant proportions of subjects were underestimated by both MNA-SFs. Just about 6% of overestimations were found in both cases.

Conclusion

The revised BMI-MNA-SF and CC-MNA-SF are rapid, easy and reliable tools capable to identify malnourished individuals and those who are at risk of malnutrition with minimal misclassifications with potential harm in nursing home residents. Due to the special characteristics of elderly staying in these institutions, the CC-MNA-SF is a good option to replace the BMI-MNA-SF when BMI is not available.     

Use of the Mini Nutritional assessment to detect frailty in hospitalised older people

Objectives

The aims of this study were to: (1) determine the prevalence of undemutrition and frailty in hospitalised elderly patients and (2) evaluate the efficacy of both the Mini-Nutritional Assessment (MNA) screening tool and the MNA short form (MNA-SF) in identifying frailty.

Setting and Participants

A convenient sample of 100 consecutive patients (75.0 % female) admitted to the Geriatric Evaluation and Management Unit (GEMU) at The Queen Elizabeth Hospital in South Australia.

Measurements

Frailty status was determined using Fried??s frailty criteria and nutritional status by the MNA and MNA-SF. Optimal cut-off scores to predict frailty were determined by Youden??s Index, Receiver Operator Curves (ROC) and area under curve (AUC).

Results

Undernutrition was common. Using the MNA, 40.0% of patients were malnourished and 44.0% were at risk of malnutrition. By Fried??s classification, 66.0 % were frail, 30.0 % were pre-frail and 4.0 % robust. The MNA had a specificity of 0.912 and a sensitivity of 0.516 in predicting frailty using the recommended cut-off for malnourishment (< 17). The optimal MNA cut-off for frailty screening was <17.5 with a specificity of 0.912 and sensitivity of 0.591. The MNA-SF predicted frailty with specificity and sensitivity values of 0.794 and 0.636 respectively, using the standard cut-off of < 8. The optimal MNA-SF cut-off score for frailty was < 9, with specificity and sensitivity values of 0.765 and 0.803 respectively and was better than the optimum MNA cut-off in predicting frailty (Youden Index 0.568 vs. 0.503).

Conclusion

The quickly and easily administered MNA-SF appears to be a good tool for predicting both under-nutrition and frailty in elderly hospitalised people. Further studies would show whether the MNA-SF could also detect frailty in other populations of older people.     

Validation of the Mini Nutritional Assessment short-form (MNA®-SF): A practical tool for identification of nutritional status

Objective

To validate a revision of the Mini Nutritional Assessment short-form (MNA®-SF) against the full MNA, a standard tool for nutritional evaluation.

Methods

A literature search identified studies that used the MNA for nutritional screening in geriatric patients. The contacted authors submitted original datasets that were merged into a single database. Various combinations of the questions on the current MNA-SF were tested using this database through combination analysis and ROC based derivation of classification thresholds.

Results

Twenty-seven datasets (n=6257 participants) were initially processed from which twelve were used in the current analysis on a sample of 2032 study participants (mean age 82.3y) with complete information on all MNA items. The original MNA-SF was a combination of six questions from the full MNA. A revised MNA-SF included calf circumference (CC) substituted for BMI performed equally well. A revised three-category scoring classification for this revised MNA-SF, using BMI and/or CC, had good sensitivity compared to the full MNA.

Conclusion

The newly revised MNA-SF is a valid nutritional screening tool applicable to geriatric health care professionals with the option of using CC when BMI cannot be calculated. This revised MNA-SF increases the applicability of this rapid screening tool in clinical practice through the inclusion of a “malnourished” category.     

Validation of the modified mini nutritional assessment short-forms in different populations of older people in Poland

Objective

To assess the usefulness in different populations of elderly people in Poland of both modified versions of Mini Nutritional Assessment Short-Forms (MNA-SFs) with a three-category scoring classification: one using BMI (MNA-SF-BMI) and another using calf circumference (MNA-SF-CC).

Setting and Participants

A group of 932 community-dwelling subjects from the urban environment, 812 subjects from the rural environment and 859 subjects from an institutional environment (nursing homes).

Measurements

Agreement between both MNA-SFs and the MNA full form. Results: MNA-SF-BMI correctly classified 84.12%, 82.51% and 81.84% of subjects from urban, rural and institutional environment, respectively. For MNA-SF-CC those values were 82.4%, 71.8% and 76.6%, respectively. The sensitivity and specificity of MNA-SF-BMI and MNA-SF-CC against full MNA in screening for “at risk/malnutrition” and “malnutrition” were generally very high, except for relatively lower sensitivity (74.1%) when screening for “malnutrition” with MNA-SF-CC in nursing homes.

Conclusion

Both MNA-SFs can be recommended as screening tools in assessing the nutritional state of the community-dwelling and institutionalised elderly in Poland. The full version of the MNA confirmed the results of MNA-SFs in this group. The “classic” MNA-SF using BMI was found to perform better than the MNA-SF-CC. The MNA-SF-CC should be used only when measuring BMI is not possible. While using MNASF-CC in nursing homes, a higher MNA-SF-CC cut-point of eleven should be rather used in this population to screen for “at risk/malnutrition”.     

Factors associated with deterioration of mini nutritional assessment-short form status of nursing home residents during a 2-year period

Objective

A number of other studies have been conducted to verify the Mini Nutritional Assessment (MNA) or the MNA short form (MNA-SF) as a nutritional assessment/screening tool in various clinical settings or communities. However, there are few longitudinal studies using these tools to analyze which factors affect the incidence of deteriorating nutritional status. We tried to identify the factors associated with deterioration of MNA-SF status of nursing home residents during a 2-year period.

Methods

Participants were 392 people with a mean age of 84.3 in 12 nursing homes in Japan. The factors associated with deterioration in MNA-SF categories during the study period compared to stable/improved MNA-SF categories were identified.

Results

At baseline, 19.9% of the participants were malnourished and 60.2% were at risk of malnutrition, according to the MNA-SF classification. After 2 years, 66.3% participants maintained and 6.1% participants improved their nutritional status according to the MNA-SF classification, while 27.6% showed deterioration in MNA-SF status. Stepwise logistic-regression procedure indicated that basic ADL impairment and hospitalization during the follow-up period were associated with declining MNA-SF status.

Conclusions

Poor basic ADL status and hospitalization during the follow-up period were associated with malnutrition and risk of malnutrition as assessed by MNA-SF of nursing homes residents during a 2-year period.     

Neck circumference is not associated with dysphagia but with undernutrition in elderly individuals requiring long-term care

Objectives

The purpose was to assess the association between neck circumference, dysphagia, and undernutrition in elderly individuals requiring long-term care.

Design

Cross-sectional study.

Setting

Geriatric health services facilities, acute hospitals, and the community.

Participants

Elderly individuals ≥65 years of age with dysphagia or possible dysphagia (N=385).

Measurements

Neck circumference, the Dysphagia Severity Scale (DSS) and the Mini Nutritional Assessment Short Form (MNA-SF).

Results

Participants included 130 males and 255 females with a mean age (± standard deviation) of 83 ± 8.0 years. Sixty-six were in acute hospitals, 195 were in geriatric health services facilities, and 124 were community-dwelling. The mean neck circumference in males and females was 37.1 ± 3.0 cm and 33.3 ± 3.3 cm, respectively. Based on the DSS, 81 participants were within normal limits, 137 had dysphagia without aspiration, and 167 had dysphagia with aspiration. The MNA-SF revealed that 173 were malnourished, 172 were at risk of malnutrition, and 40 had a normal nutritional status. Neck circumference was not significantly correlated with the DSS (r=?0.080) but was significantly correlated with the MNA-SF (r=0.183) in the Spearman rank correlation analysis. In the logistic regression, neck circumference was not independently associated with the DSS after adjusting for the MNA-SF, the Barthel Index, age, sex, setting, and cerebrovascular disorders. However, the multiple regression analysis showed that neck circumference had an independent effect on the MNA-SF after adjusting for the Barthel Index, age, sex, setting and cerebrovascular disorders.

Conclusions

Neck circumference is not associated with dysphagia but with undernutrition in elderly individuals requiring long-term care.

     

Nutritional risk,nutritional status and incident disability in older adults. The FRADEA Study

Objectives

To analyze if body mass index (BMI) and waist circumference (WC) as measures of nutritional status, and the Mini Nutritional Assessment Short Form (MNA-SF) as a nutritional risk measure are associated with increased risk of incident disability in basic activities of daily living (BADL) in a population based cohort of Spanish older adults.

Design

Concurrent cohort study.

Setting

Albacete City, Spain.

Participants

678 subjects over age 70 from the FRADEA Study (Frailty and Dependence in Albacete).

Measurements

BMI, WC and MNA-SF were recorded at the basal visit of the FRADEA Study. Incident disability in BADL was defined as loss of the ability to perform bathing, grooming, dressing, toilet use, or feeding from basal to follow-up visit, using the Barthel index. The association between nutritional status and nutritional risk with incident BADL disability was determined by Kaplan-Meier analysis and logistic regression adjusted for age, sex, basal function, comorbidity, cognitive decline, depression risk and frailty status.

Results

Each point less of MNA-SF (OR 1.17, 95%CI 1.04–1.31) and MNA-SF<14 (OR 2.33, 95%CI 1.39–3.89), but not MNA-SF<12 (OR 1.47, 95%CI 0.89–2.42) had a greater adjusted risk of incident disability in BADL. Neither BMI (OR 1.02, 95%CI 0.97–1.06) nor WC (OR 1.01, 95%CI 0.99–1.03) were associated. Weight loss (OR 1.75, 95%CI 1.08–2.83) and mobility impairment (OR 3.35, 95%CI 1.67–6.73) remained as adjusted predictors of incident BADL disability, while anorexia almost reached the significance (OR 1.65, 95%CI 0.94–2.87).

Conclusion

Nutritional risk measured with the MNA-SF is associated with incident disability in BADL in older adults, while nutritional status measured with BMI or WC is not.     

The diagnostic accuracy of the revised mini nutritional assessment short form for older people living in the community and in nursing homes

Objective

The aim of this study was to determine the diagnostic accuracy of the CC-SF, which was developed to use calf circumference (CC) instead of BMI in the MNA-SF, for elderly people living in the community and in nursing homes. It also aimed separately to determine the correlation of CC-SF and BMI-SF with the full MNA.

Study Design and Methods

The study included 640 elderly people living in their community and 243 elderly people living in nursing homes. Accuracy was assessed by determining the sensitivity and selectivity of the nutritional assessments. The correlations between the MNA-SFs and the full MNA were analyzed.

Results

The correlation between MNA-SFs and full MNAs was strong, significant and almost identical both in the community and in nursing homes (r=0.86–0.88; p<0.001). The observed agreement between the BMI-SF and the full MNA was 82.2% in the community and 77.8% in the nursing homes. There was a substantial agreement by kappa values in the comparison of community and nursing homes (the Kappa value of the BMI-SF was 0.63 in the community and 0.62 in the nursing homes, and the kappa value of the CC-SF was 0.62 in the community and 0.63 in the nursing homes). When compared to the full MNA the MNA-SFs tended to underestimate nutritional status. Both MNA-SFs had similarly high sensitivity and selectivity, both in the community and nursing homes. (when dichotomized as “malnourished-at risk of malnutrition” versus “well nourished” and “malnourished” versus “at risk of malnutrition-well nourished”) (over 80%).

Conclusion

In cases where BMI cannot be determined, the CC-SF is a good substitute for the BMI-SF.     

Mini Nutritional Assessment short-form: Validation in five Latin American cities. SABE study

Objectives

To validate the short-form of the MNA (MNA-SF) and the cut-off point of 31 cm for calf circumference (CC) in older people in Latin America.

Methods

A cross-sectional study was conducted with 5,722 community-dwelling older subjects (range: 60-102 years) in Latin America’s five main cities: Sao Paulo (Brazil), Santiago (Chile), Havana (Cuba), Mexico DF (Mexico) and Montevideo (Uruguay). All participants underwent an interview, which included anthropometric measurements, completing the MNA and obtaining socio-demographic, nutrition and health information. The short-form of the MNA consists of only six questions from the original 18. It has two versions: one using body mass index (BMI) and the second using CC as a surrogate. Cohen’s Kappa was calculated to assess the agreement between the MNA and the MNA-SF; diagnostic tests were performed, and Receiver-operating characteristic (ROC) curves were developed. Criterion-related validity was assessed in the Chilean sample.

Results

Both version of the MNA-SF showed high sensitivity and specificity with the MNA, showing good accuracy (0.88), although higher values were estimated for malnutrition and risk of malnutrition in the total sample by sex. The cut-off point of 31 cm for CC showed high sensitivity (74.6-94.4%), specificity (72.6-100%) and good area under the ROC curve (0.87-0.95) when compared with BMI. There was good agreement between MNA and both version of MNA-SF for identifying persons with malnutrition or a risk of malnutrition in the five cities (Kappa coefficient: 0.6193-0.7852).

Conclusion

Both versions of the MNA-SF are population-screening tools of easy and fast application, with good accuracy for assessing malnutrition and risk of malnutrition in Latin American older people.

     

Malnutrition: A highly predictive risk factor of short-term mortality in elderly presenting to the emergency department

Objectives

To identify independent risk factors of mortality among elderly patients in the 3 months after their visit (T3) to an emergency department (ED).

Design

Prospective cohort study.

Setting

University hospital ED in an urban setting in France.

Participants

One hundred seventy-three patients aged 75 and older were admitted to the ED over two weeks (18.7% of the 924 ED visits). Of these, 164 patients (94.8%) were included in our study, and 157 (95.7%) of them were followed three months after their ED visit.

Measurements

During the inclusion period (T0), a standardized questionnaire was used to collect data on socio-demographic and environmental characteristics, ED visit circumstances, medical conditions and geriatric assessment including functional and nutritional status. Three months after the ED visits (T3), patients or their caregivers were interviewed to collect data on vital status, and ED return or hospitalization.

Results

Among the 157 patients followed at T3, 14.6% had died, 19.9% had repeated ED visits, and 63.1% had been hospitalized. The two independent predictive factors for mortality within the 3 months after ED visit were: malnutrition screened by the Mini Nutritional Assessment short-form (MNA-SF) (OR=20.2; 95% CI: 5.74–71.35; p<.001) and the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) score (OR=1.1; 95% CI: 1.01–1.22; p=.024).

Conclusion

Malnutrition is the strongest independent risk factor predicting short-term mortality in elderly patients visiting the ED, and it was easily detected by MNA-SF and supported from the ED visit.     

Nutritional screening strategy in nonagenarians: The value of the MNA-SF (Mini Nutritional Assessment short form) in NutriAction

Objectives

To identify older subjects at risk of malnutrition using the most appropriate tool available for the specific setting and to evaluate the Mini Nutritional Assessment short form (MNA-SF) in a sample of nonagenarians.

Design

Questionnaire based national screening week for the risk and prevalence of malnutrition in older people (NutriAction).

Setting

Older people in the community (CD) and in nursing homes (NH).

Participants

General practices (n=70) and Nursing Homes (n=70).

Measurements

Questionnaire based on items from validated screening instruments: the MNA-SF, the Short Nutritional Assessment Questionnaire (SNAQ) and additional clinically relevant parameters (mobility, independence, social isolation and co-morbidities).

Results

In total 5,334 people were screened of which 16% were aged over 90 years. In this age group, 66% of the screened individuals were at risk of malnutrition (MNA ≤ 11), and women were affected significantly more than men (p<0.001). Actual malnutrition was present in 22% (BMI <20), 20% (SNAQ) and 25% (clinical evaluation). The MNA appeared to be very sensitive but had a low specificity as well in the nonagenarians (98% and 44%) as in the younger old (97% and 52%). The SNAQ was not a sensitive tool for detecting malnutrition in this study population (25%). Although clinical impression had a low sensitivity (60–61%) it has a good specificity (86% in 90+ and 91% below 90yr).

Conclusion

The overall risk of and the prevalence of malnutrition is common in older people. The prevalence is higher in women, in nursing homes and in older age groups. The MNA-SF followed by a clinical subjective evaluation seems to be the preferred strategy for detecting malnutrition in nonagenarians.     

Mini nutritional assessment short-form (MNA-SF) predicts institutionalisation in an intermediate post-acute care setting

Objectives

The aim of the study was to investigate whether nutritional status as measured by the Mini Nutritional Assessment Short-Form (MNA-SF) predicts level of care of the discharge destination after post-acute care in a nursing home.

Design

Cohort study.

Setting

Post-acute intermediate care nursing home, 19-bed unit with increased multidisciplinary staff.

Participants

Patients ≥70 years in post-acute care (N=900) following an acute admission to the hospital.

Measurements

The predictive value of nutritional status, as measured by the MNA-SF, on discharge destination was analysed by means of a multinomial logistic regression model with the MNA-SF as the independent variable, discharge destination as the dependent variable and age and living situation as co-variates. The participants were grouped into three categories according to their discharge destination: home, other institution or readmitted to the hospital.

Results

A higher score on the MNA-SF significantly predicted a reduced risk of discharge to institution (adjusted OR=0.90 (95% CI=0.84;0.97), p=0.003).

Conclusion

Nutritional status, as measured by the MNA-SF, predicted discharge destination from an intermediate care nursing home following acute hospitalisation. The findings underscore the value of nutritional assessment as part of overall clinical assessment and care planning prior to discharge. The findings may also imply that interventions to improve nutritional status could increase patients’ ability to return home, as opposed to further institutionalisation, after hospitalisation.

     

Is it possible using handgrip strength instead of body mass index in MNA-SF test to assess the nutritional status of geriatric patients?

Introduction

In Mini-Nutritional Assessment-Short Form (MNA-SF) test, a practical and reliable alternative parameter is still necessary for patients with difficult body mass index evaluation. We aimed to show whether or not handgrip strength may be used instead of body mass index (BMI) in MNA-SF test.

Materials and Methods

MNA-SF test scores, calf circumferences (CC), handgrip strength (HGS), and BMI of 191 patients were evaluated. The first one of calculated MNA-SF tests was with BMI, the second one with CC, and the last one with HGS. Zero point was given if CC was <31 cm and 3 points were given if CC was ≥31 cm. Zero, 1, 2, and 3 points were given if the loss of HGS when compared to expected HGS were ≥%60, from ≥%30 to <%60, from ≥%10 to <%30, and <%10 or greater than expected HGS, respectively. MNA-SF scores and nutritional status according to these three measures were compared.

Results

Mean age and median MNA-SF scores of the patients were 75±7.6 years and 12 points (min-max: 0-14) respectively. There were strongly positive correlations between MNA-SF scores with BMI and CC, with BMI and HGS, and with CC and HGS (r=0.938 p<0.001, r=0.938 p<0.001, r=0.914 p<0.001, respectively). Substantial agreement in nutritional status of the patients were seen between MNA-SF groups with BMI and CC, with CC and HGS, and with BMI and HGS (kappa: 0.795 p<0.001, kappa: 0.709 p<0.001, and kappa: 0.760 p<0.001, respectively).

Conclusions

HGS might be considered instead of BMI in MNA-SF test to assess nutritional status of geriatric patients.

     

Physical function mitigates the adverse effects of being thin On mortality in a free-living older Taiwanese cohort

Objectives

To examine the significance of underweight and physical function as well as their interaction on mortality in the aged.

Design

Prospective cohort.

Setting

The Elderly Nutrition and Health Survey in Taiwan during 1999?C2000.

Participants

Total of 1435 representative free-living elders (739 men and 696 women).

Measurements

Body composition was assessed by various anthropometrics. Physical function score (PF, ranged 0?C100) was derived from the SF-36?. Death by December 31, 2006 was the outcome measure.

Results

After 7.9 (median: 7.0) years follow-up, 381 (223 men, 158 women) of 1435 eligible participants had died. Those with the lowest PF (<45) had 3.43 (hazards ratio (HR), 95% confidence interval (CI) = 2.20?C5.36) times the all-cause mortality risk of the highest PF (??58). Interactions for PF and BMI (P =0.02) and for PF and wrist circumference (P =0.09) on death were found after controlling for potential confounders. Jointly, compared to normal-BMI-highest-PF, the greatest HR for death occurred where BMI <18.5 kg/m2 was combined with the lowest-PF after covariate adjustments (HR = 8.67, 95% CI = 3.77?C20.0). Similarly, the lowest arm muscle circumference (MAMC)-PF had a HR of 5.22 compared to mid-MAMC-highest-PF. However, percent and absolute body fat, estimated by bioelectrical impedance, was comparable to non-sarcopenic individuals.

Conclusion

Thin elderly Taiwanese with sarcopenia, and less skeleton, are at the most risk of death, especially if physical function is limited.     

Dietary protein and beef consumption predict for markers of muscle mass and nutrition status in older adults

Objective

To determine the relationship of beef and protein intake to nutrition status, body composition, strength, and biochemical measures of vitamin and mineral status, inflammation and blood lipids in older adults.

Design

Cross-sectional observational study.

Setting

State of Ohio, U.S A.

Participants

142 adults ages 60?C88.

Measurements

Subjects completed a Diet History Questionnaire, and questionnaires related to nutrition status and activity. Subjects also underwent measurements of body composition and strength, and a subset took part in a blood draw for biochemical measurements.

Results

Beef intake (g/d) was positively correlated to muscle mass measured by mid-arm muscle area (R=0.128, p=0.030). From multiple linear regression analysis, a loz/d (??28g/d) increase in beef consumption predicts for a 2.3cm² increase in mid-arm muscle area. Beef intake was negatively correlated to total (R=?0.179, p=0.035) and HDL (R=?0.247, p=0.004) cholesterol, and there was no association between beef and LDL-cholesterol, triglycerides, liver enzymes, or inflammatory markers. Protein intake (% of total energy) was positively correlated to nutrition status measured by the Mini Nutrition Assessment (R=0.196, p=0.020), and calf circumference (R=0.190, p=0.024), and these correlations remained when potential confounders were accounted for in multiple linear regression models. Protein intake was also positively correlated with BMI when analyzed with multiple linear regression.

Conclusions

Beef intake was positively associated with mid-arm muscle area, and protein intake was positively associated with nutrition status, calf circumference, and BMI in older adults. Consuming lean cuts of beef in moderation may be a healthy way in which older adults can increase protein intake, preserve muscle mass and improve nutrition status.     

Intention as an indicator for subjective need: A new pathway in need assessment

Background

The current analyses focus on the need for services from the perspective of individuals considering preventive measures. A new approach imported from social and health psychology is used for assessing subjective need. This indicator is used for predicting actual health behaviour under field conditions and simultaneously other relevant background variables are taken into account.

Methods

A mail survey was conducted prior to the start of a coaching program for teachers. A sample of n = 949 respondents were queried about mental distress and their intention to participate in the program. This intention to participate and actual attendance were taken as outcome variables in logistic regression analyses adjusted for relevant background variables.

Results

Intention and participation in the coaching program three months later were associated with an unadjusted OR of 90.1 (95% CI: 39.2 - 207.0) for male teachers. For female teachers the crude effect was OR = 80.0 (95% CI: 45.7 - 140.1). The positive predictive value (PPV) was 96.4% among males and 94.5% among females. Adjusting for covariates results in higher values. Among female, but not among male teachers, the participation depended on psychological distress as assessed by the General Health Questionnaire (GHQ).

Conclusions

There is strong evidence for using subjective need as an additional component in assessing the need for services and for predicting actual health behaviour. But it needs to be confined to intended behaviour which is under behavioural control.     

Nutritional status in chronically-ill elderly patients. Is it related to quality of life?

Objective

The aim of this study is to assess the quality of life in chronically-ill elderly patients and its relationship with parameters concerning the patients’ nutritional status.

Design

A cross-sectional study.

Setting

Primary health-care centres in Jaen, Spain.

Participants

A total of 168 chronically-ill elderly outpatients aged from 65 to 89 years.

Measurements

Quality of life was measured using the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire. A nutritional assessment was undertaken including socio-demographic variables, anthropometric measurements (body-mass index and calf circumference), functional evaluation (Barthel index and Folstein mini-mental status test) and a dietetic questionnaire. The mini-nutritional assessment test was used as an assessment tool to detect nutritional risk.

Results

Quality of life in chronically-ill elderly subjects, as determined by the WHOQOL-BREF questionnaire, which diminishes with age, is independent of anthropometric parameters and a statistically significant difference was found between gender, socio-demographic characteristics, functional capacity, nutritional status and the kind of chronic disease (p<0.05).

Conclusion

The relationship between the quality of life with the patients’ socio-demographic characteristics, functional capacity and nutritional status underlines the importance of taking these factors into account in the management of chronically ill patients, especially women.     

Secular trends in the association between nativity/length of US residence with body mass index and waist circumference among Mexican-Americans, 1988–2008

Objectives

We investigated whether associations between nativity/length of US residence and body mass index (BMI) and waist circumference (WC) varied over the past two decades.

Methods

Mexican-Americans aged 20–64 years from the National Health and Nutrition Survey (NHANES) III (1988–1994), and NHANES (1999–2008). Sex-stratified multivariable linear regression models further adjusted for age, education, and NHANES period.

Results

We found no evidence of secular variation in the nativity/length of US residence gradient for men or women. Foreign-born Mexican-Americans, irrespective of residence length, had lower mean BMI and WC than their US-born counterparts. However among women, education modified secular trends in nativity differentials: notably, in less-educated women, nativity gradients widened over time due to alarming increases in BMI among the US-born and little increase in the foreign-born.

Conclusions

Associations between nativity/length of US residence and BMI/WC did not vary over this 20-year period, but we noted important modifications by education in women. Understanding these trends is important for identifying vulnerable subpopulations among Mexican-Americans and for the development of effective health promotion strategies in this fast-growing segment of the population.     

Assessment of diagnostics tools for sarcopenia severity using the item response theory (IRT)

Objective

To use the item response theory (IRT) methods to examine the degree to which the four selected tools reflect sarcopenia and to arrange them according to their ability to estimate sarcopenia severity.

Design

A cross-sectional study aimed at verifying the possibilities of using diagnostic tools for sarcopenia.

Setting and Participants

The study included residents living in an assisted living unit at the Senior Centre in Blansko (South Moravia, Czech Republic) (n=77). Sarcopenia was estimated according to the proposals of the European Working Group on Sarcopenia in Older People (EWGSOP) using calf circumference, the EWGSOP algorithm, hand grip strength, and the Short Physical Performance Battery (SPPB).

Results

The results from the IRT model showed that these four methods indicate strong unidimensionality so that they measure the same latent variable. The methods ranked according to the discrimination level ranging from high to low discrimination where the calf circumference was the most discriminatory (Hi = 0.86) and the SPPB together with hand grip strength were the least discriminatory (both Hi = 0.44).

Conclusion

We are recommending to identify mild sarcopenia by SPPB or hand grip strength, moderate sarcopenia by the EWGSOP algorithm and severe sarcopenia by the calf circumference.