Beyond malnutrition screening: appropriate methods to guide nutrition care for aged care residents

BackgroundMalnutrition is common in older adults and early and appropriate nutrition intervention can lead to positive quality of life and health outcomes.ObjectiveThe purpose of our study was to determine the concurrent validity of several malnutrition screening tools and anthropometric parameters against validated nutrition assessment tools in the long-term-care setting.Study designThis work was a cross-sectional, observational study.Participants/settingOlder adults (aged >55 years) from two long-term-care facilities were screened.Main outcomesNutrition screening tools used included the Malnutrition Screening Tool (MST), Malnutrition Universal Screening Tool (MUST), Mini Nutritional Assessment-Short Form (MNA-SF), and the Simplified Nutritional Assessment Questionnaire. Nutritional status was assessed by Subjective Global Assessment (SGA), Mini Nutritional Assessment (MNA), body mass index (BMI), corrected arm muscle area, and calf circumference. Residents were rated as either well nourished or malnourished according to each nutrition assessment tool.Statistical analysisA contingency table was used to determine the sensitivity and specificity of the nutrition screening tools and objective measures in detecting patients at risk of malnutrition compared with the SGA and MNA.ResultsOne hundred twenty-seven residents (31.5% men; mean age 82.7±9 years, 57.5% high care) consented. According to SGA, 27.6% (n=31) of residents were malnourished and 13.4% were rated as malnourished by MNA. MST had the best sensitivity and specificity compared with the SGA (sensitivity 88.6%, specificity 93.5%, κ=0.806), followed by MNA-SF (85.7%, 62%, κ=0.377), MUST (68.6%, 96.7%, κ=0.703), and Simplified Nutritional Assessment Questionnaire (45.7%, 77.2%, κ=0.225). Compared with MNA, MNA-SF had the highest sensitivity of 100%, but specificity was 56.4% (κ=0.257). MST compared with MNA had a sensitivity of 94.1%, specificity 80.9% (κ=0.501). The anthropometric screens ranged from κ=0.193 to 0.468 when compared with SGA and MNA.ConclusionsMST, MUST, MNA-SF, and the anthropometric screens corrected arm muscle area and calf circumference have acceptable concurrent validity compared with validated nutrition assessment tools and can be used to triage nutrition care in the long-term-care setting.     

Simplifier le dépistage de la dénutrition du sujet âgé en médecine générale : test de concordance entre un outil simple,le « Malnutrition Universal Screening Tool » (« MUST ») et le « Mini Nutritional Assessment-Short Form » (« MNA-SF »)

ObjectiveThe main goal of this study is to assess how results from two clinical tools, the Mini Nutritional Assessment-Short Form (MNA-SF) and the Malnutrition Universal Screening Tool (MUST), correlate in the framework of nutritional status evaluation of elderly under ambulatory care. Additionally, determinants of nutritional risk have been analyzed.MethodsThe evaluation of a multicentric diagnostic test has been carried out with 81 patients over 70-years-old, while consulting at their general practitioner's office, or at home. For each patient, MUST and MNA-SF scores were calculated and compared with the kappa coefficient. Subjects were classified into two groups according to the absence or presence of nutritional risk. Univariate comparative analyses were realized between MUST and MNA-SF data.ResultsRespectively, MNA-SF and MUST screened 33.3% and 18.5% of the patients at nutritional risk. Consistency between both tools was moderate: κ = 0.438 ± 0.2058. Compared with subjects at nutritional risk, patients with a good nutritional status were younger, took less drugs, their body mass index was higher (for a limit at 23), they were less lonely and tended to have a higher weight.ConclusionsMUST isn’t a satisfying screening tool of elderly malnutrition in ambulatory primary care. Thus, MNA-SF remains the gold standard.     

Evaluation of nutritional screening tools for patients scheduled for cardiac surgery

ObjectiveThe aim of this study was to assess the prognostic value of different nutritional screening tools in patients undergoing cardiopulmonary bypass with regard to an adverse clinical course.MethodsThis prospective cohort study analyzed 894 adult patients who underwent cardiopulmonary bypass. Patients were screened using four nutritional screening tools: Nutritional Risk Screening 2002 (NRS-2002), the Malnutrition Universal Screening Tool (MUST), the Mini-Nutritional Assessment (MNA), and the Short Nutritional Assessment Questionnaire (SNAQ). Nutritional status was assessed using the Subjective Global Assessment. In-hospital mortality, postoperative complications, length of stay in the intensive care unit, and length of hospitalization were analyzed.ResultsThe sensitivities of the SNAQ, MUST, and NRS-2002 to detect the malnutrition confirmed by the Subjective Global Assessment were 91.5%, 97.9%, and 38.3%, respectively, and the MNA showed a sensitivity of 81.8% for the elderly. Malnutrition detected by the SNAQ, MUST, and NRS-2002 was associated with postoperative complications (odds ratios [ORs] 1.75, 1.98, and 1.82, respectively) and a stay in the intensive care unit longer than 2 d (ORs 1.46, 1.56, and 2.8). Malnutrition as detected by the SNAQ and MUST was also associated with prolonged hospitalization (ORs 1.49 and 1.59). According to multivariate logistic regression analysis, postoperative complications were independently predicted by the European System for Cardiac Operative Risk Evaluation (OR 1.1, P < 0.0001), cardiopulmonary bypass time (OR 1.01, P < 0.0001), and malnutrition identified by the MUST (OR 1.2, P = 0.01).ConclusionThe MUST independently predicts postoperative complications. The SNAQ and MUST have comparable accuracy in detecting malnutrition. Whether preoperative nutritional therapy would improve the outcome in malnourished patients needs to be studied.     

Comparison of nutritional risk screening tools for predicting clinical outcomes in hospitalized patients

ObjectiveInternational nutritional screening tools are recommended for screening hospitalized patients for nutritional risk, but no tool has been specifically evaluated in the Brazilian population. The aim of this study was to identify the most appropriate nutritional screening tool for predicting unfavorable clinical outcomes in patients admitted to a Brazilian public university hospital.MethodsThe Nutritional Risk Screening 2002 (NRS 2002), Mini-Nutritional Assessment–Short Form (MNA-SF), and Malnutrition Universal Screening Tool (MUST) were administered to 705 patients within 48 h of hospital admission. Tool performance in predicting complications, very long length of hospital stay (LOS), and death was analyzed using receiver operating characteristic curves.ResultsNRS 2002, MUST, and MNA-SF identified nutritional risk in 27.9%, 39.6%, and 73.2% of the patients, respectively. NRS 2002 (complications: 0.6531; very long LOS: 0.6508; death: 0.7948) and MNA-SF (complications: 0.6495; very long LOS: 0.6197; death: 0.7583) had largest areas under the ROC curve compared to MUST (complications: 0.6036; very long LOS: 0.6109; death: 0.6363). For elderly patients, NRS 2002 was not significantly different than MNA-SF (P > 0.05) for predicting outcomes.ConclusionConsidering current criteria for nutritional risk, NRS 2002 and MNA-SF have similar performance to predict outcomes but NRS 2002 seems to provide a best yield.     

Comparing Assessment Tools as Candidates for Personalized Nutritional Evaluation of Senior Citizens in a Nursing Home

Nutrition is an important health issue for seniors. In nursing homes, simple, inexpensive, fast, and validated tools to assess nutritional risk/status are indispensable. A multisurvey cross-sectional study with a convenient sample was created, comparing five nutritional screening/assessment tools and the time required for each, in order to identify the most useful instrument for a nursing home setting. Nutrition risk/status was evaluated using the following tools: Subjective Global Assessment (SGA), Mini Nutritional Assessment Short Form (MNA-SF), Malnutrition Universal Screening Tool (MUST), Nutritional Risk Screening 2002 (NRS 2002), and calf girth (CG). The time spent completing each tool was recorded. Eighty-three subjects were included. MNA-SF and CG were the screening tools that ranked highest with regards to malnutrition identification. CG failed to identify nutritional risk/malnutrition in seniors with lower limb edema. CG was the fastest tool while SGA was the slowest. This was the first study comparing non-invasive nutritional tools with time expended as a consideration in the implementation. CG is responsive, fast, and reliable in elders without edema. MNA-SF was more efficient at detecting malnutrition cases in the elderly population. Both MNA-SF and CG are considered the most suitable for the nursing home setting.     

Validity of Nutritional Screening Tools for Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis

ObjectivesThe aim of this systematic review was to summarize the validity of nutritional screening tools to detect the risk of malnutrition in community-dwelling older adults.DesignA systematic review and meta-analysis. The protocol for this systematic review was registered in the PROSPERO database (CRD42017072703).Setting and participantsA literature search was performed in PubMed, EMBASE, CINAHL, and Cochrane using the combined terms “malnutrition,” “aged,” “community-dwelling,” and “screening.” The time frame of the literature reviewed was from January 1, 2001, to May 18, 2018. Older community-dwellers were defined as follows: individuals with a mean/median age of >65 years who were community-dwellers or attended hospital outpatient clinics and day hospitals. All nutritional screening tools that were validated in community-dwelling older adults against a reference standard to detect the risk of malnutrition, or with malnutrition, were included.MeasuresMeta-analyses were performed on the diagnostic accuracy of identified nutritional screening tools validated against the Mini Nutritional Assessment-Long Form (MNA-LF). The symmetric hierarchical summary receiver operating characteristic models were used to estimate test performance.ResultsOf 7713 articles, 35 articles were included in the systematic review, and 9 articles were included in the meta-analysis. Seventeen nutritional screening tools and 10 reference standards were identified. The meta-analyses showed average sensitivities and specificities of 0.95 (95% confidence interval [CI] 0.75–0.99) and 0.95 (95% CI 0.85–0.99) for the Mini Nutritional Assessment-Short Form (MNA-SF; cutoff point ≤11), 0.85 (95% CI 0.80–0.89) and 0.87 (95% CI 0.86–0.89) for the MNA-SF-V1 (MNA-SF using body mass index, cutoff point ≤11), 0.85 (95% CI 0.77–0.89) and 0.84 (95% CI 0.79–0.87) for the MNA-SF-V2 (MNA-SF using calf circumference instead of body mass, cutoff point ≤11), respectively, using MNA-LF as the reference standard.Conclusions and ImplicationsThe MNA-SF, MNA-SF-V1, and MNA-SF-V2 showed good sensitivity and specificity to detect community-dwelling older adults at risk of malnutrition validated against the MNA-LF. Clinicians should consider the use of the cutoff point ≤11 on the MNA-SF, MNA-SF-V1, and MNA-SF-V2 to identify community-dwelling older adults at risk of malnutrition.     

Identifying Geriatric Patients at Risk for Malnutrition: A Quality Improvement Project

Abstract

Malnourishment leads to poor outcomes in the geriatric surgical population and national guidelines recommend preoperative nutrition screening. However, care practices do not reflect current recommendations. As a quality-improvement project, a validated nutritional screening tool, the Mini Nutritional Assessment-Short Form (MNA-SF), was implemented in the preoperative clinic of a large academic health center to identify patients at-risk for malnutrition prior to elective surgery. Patients were screened during the nursing intake process and categorized as no nutritional risk; at-risk for malnourishment; or severely malnourished. During the four-week screening period, 413 patients met inclusion criteria with 67.8% (n?=?280) screened. No nutritional risk was identified in 77.5% (n?=?215) of patients, 18.2% (n?=?51) were at-risk, and 4.3% (n?=?12) were malnourished. This project will inform and guide a prehabilitation plan for nutrition optimization to improve healthcare quality, outcomes, and costs in the geriatric surgical population.     

Screening for malnutrition among nursing home residents — a comparative analysis of the Mini Nutritional Assessment, the Nutritional Risk Screening, and the Malnutrition Universal Screening Tool

Background

The European Society for Clinical Nutrition and Metabolism (ESPEN) has recommended the Mini Nutritional Assessment (MNA®), the Nutritional Risk Screening 2002 (NRS), and the Malnutrition Universal Screening Tool (MUST) for nutritional screening in various settings and age groups. While in recent years all three tools have been applied to nursing home residents, there is still no consensus on the most appropriate screening tool in this specific setting.

Aim

The present study aims at comparing the MNA, the NRS, and the MUST with regard to applicability, categorization of nutritional status, and predictive value in the nursing home setting.

Method

MNA, NRS, and MUST were performed on 200 residents from two municipal nursing homes in Nuremberg, Germany. Follow-up data on infection, hospitalization, and mortality were collected after six and again after twelve months.

Results

Among 200 residents (mean age 85.5 ±7.8 years) the MNA could be completed in 188 (94.0%) and the NRS and MUST in 198 (99.0%) residents. The prevalence of ‘malnutrition’ according to the MNA was 15.4%. The prevalence of ‘risk of malnutrition’ (NRS) and ‘high risk of malnutrition’ (MUST), respectively, was 8.6% for both tools. The individual categorization of nutritional status showed poor agreement between NRS and MUST on the one hand and MNA on the other. For all tools a significant association between nutritional status and mortality was demonstrated during follow-up as classification in ‘malnourished’, respectively ‘high risk of malnutrition’ or ‘nutritional risk’, was significantly associated with increased hazard ratios. However, the MNA showed the best predictive value for survival among well-nourished residents.

Conclusion

The evaluation of nutritional status in nursing home residents by MNA, NRS, and MUST shows significant differences. This observation may be of clinical relevance as nutritional intervention is usually based on screening results. As the items of the MNA reflect particularities of the nursing home population, this tool currently appears to be the most suitable one in this setting.     

Vitamin B12 and folic acid levels are not related to length of stay in elderly inpatients

ObjectiveWe designed this study, to evaluate the interaction (relation) between vitamin B12 and folic acid levels and length of hospital stay in elderly inpatients.MethodsIn this cross-sectional study, the Mini Nutritional Assessment–Short Form (MNA-SF) test was used to evaluate nutritional status of 615 (239 men, 376 female; mean age 72.89 ± 8.93 y) inpatients of a university hospital. Length of stay and blood samples in elderly inpatients were evaluated.ResultsOnly 33.8% of the patients were classified as having an adequate nutritional status; 44.3% had a risk of malnutrition, and 21.8% were classified as malnourished. Low MNA-SF score was related to length of stay, but vitamin B12 and folic acid were not related to risk of malnutrition and length of stay.ConclusionMNA-SF score is associated with length of stay; however, vitamin B12 level, per se, is not associated with length of hospital stay in elderly inpatients.     

Suitability of the short-form Mini nutritional assessment in free-living elderly people in the northwest of Spain

Objective  

To evaluate the Mini Nutritional Assessment (MNA) test and the short-form MNA (MNA-SF) as screening tools for malnutrition risk and malnutrition in the free-living elderly of northwestern Spain.     

An observational study of screening for malnutrition in elderly people living in sheltered accommodation.

BACKGROUND: Elderly people are particularly at risk of malnutrition. There is no consensus regarding the optimal malnutrition screening test for elderly people and little is known about the prevalence of malnutrition in elderly people living in sheltered housing. METHOD: An observational study comparing sensitivity, specificity and positive and negative predictive values of the following screening measures in elderly people living in sheltered accommodation: body mass index, mid-arm circumference, albumin, haemoglobin, lymphocyte count, cholesterol and the Malnutrition Universal Screening Tool (MUST) and Mini Nutritional Assessment (MNA). A dietitian assessment was used as the gold standard to establish whether there was a risk of malnutrition. RESULTS: Of 100 people recruited (31 male and 69 female with average age 79.3 years) ten were categorized at risk by the dietitian assessment. The MUST score was the most sensitive and specific screening measure (100% and 98% respectively) with a negative predictive value of 1. The sensitivity and specificity of the other measures were: MNA 80% and 90%, mid-arm circumference 70% and 99%, BMI 60% and 90%, albumin 30% and 77%, haemoglobin 50% and 61%, lymphocyte count 20% and 86%, low cholesterol 30% and 90%. CONCLUSIONS: Ten per cent of elderly people in sheltered housing are at risk of malnutrition. The MUST screening tool is a sensitive and specific method of identifying those requiring further nutritional assessment.     

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.     

Diagnostic Performance and Accuracy of the MNA-SF against GLIM Criteria in Community-Dwelling Older Adults from Poland

Up to 28% of elderly residents in Europe are at risk of malnutrition. As uniform diagnostic criteria for malnutrition have not been formulated, in autumn 2018, the Global Leadership Initiative on Malnutrition (GLIM) presented a consensus on its diagnosis. According to the consensus, the diagnosis of malnutrition requires a positive screening test result for the risk of malnutrition, and the presence of at least one etiologic and one phenotypic criterion. This study aimed to assess the diagnostic performance and accuracy of the Mini Nutritional Assessment—Short Form (MNA-SF) against GLIM criteria. The analysis involved 273 community-dwelling volunteers aged ≥ 60 years. All participants were screened for malnutrition with the MNA-SF questionnaire. Next, the GLIM phenotypic and etiologic criteria were assessed in all subjects. Based on the presence of at least one phenotypic and one etiologic criterion, malnutrition was diagnosed in more than one-third of participants (n = 103, 37.7%). According to the MNA-SF, only 7.3% of subjects had malnutrition, and 28.2% were at risk of malnutrition. The agreement between the MNA-SF score and the GLIM criteria were observed in only 22.3% of the population. The sensitivity and specificity of MNA-SF against the GLIM criteria were fair (59.2% and 78.8%, respectively). The area under the curve (AUC) was 0.77, indicating the fair ability of MNA-SF to diagnose malnutrition. Based on the present study results, the best solution may be an optional replacement of the screening tool in the first step of the GLIM algorithm with clinical suspicion of malnutrition.     

Validity, reliability and acceptability of the Imperial Nutritional Screening System (INSYST): a tool that does not require the body mass index

Background: Nutritional screening tools are central to identifying malnourished patients, but their efficacy is often reduced as a result of difficulties in obtaining height for body mass index (BMI) calculations. The present study aimed to evaluate the validity, reliability and acceptability of the Imperial Nutritional Screening System (INSYST); a tool that does not require the BMI. Methods: Patients were screened by the researcher within 72 h of admission using INSYST I & II, Malnutrition Universal Screening Tool (MUST) and Mini Nutritional Assessment (MNA), including taking height and weight. Routine INSYST data, completed by nursing staff, were subsequently collected. At risk and malnourished patients were combined for statistical analysis. Inter‐tool and inter‐rater agreement (kappa, κ) was evaluated. Sensitivity and specificity were calculated. Nurses were timed using INSYST. Acceptability, including ease and speed of use, was evaluated. Results: Kappa (agreement) scores (all P < 0.001) were substantial for INSYST I versus MUST and MNA (κ = 0.73 and κ = 0.76, respectively) and moderate for INSYST II (both κ = 0.53). The sensitivity of INSYST I and II was high (95–100%), whereas specificity was lower (65–83%). The agreement between dietitian and nurse for INSYST I was substantial κ = 0.77 and that for INSYST II was fair κ = 0.39 (both P ≤ 0.001). There was little disagreement for INSYST I, although nurses tended to underestimate malnutrition risk when using INSYST II. INSYST I took a median of 60 s to complete, INSYST II took 102 s and weighing took 100 s, giving a total time of approximately 5 min. Likert scales showed that the majority of nurses scored INSYST as being fast and easy to use. Conclusions: INSYST has shown promising levels of concurrent validity (versus MUST and MNA), inter‐rater reliability and acceptability, suggesting that BMI (and therefore height) is unnecessary for identifying malnourished patients.     

Evaluation of malnutrition status and related risk factors in geriatric outpatient clinic

BACKGROUND/OBJECTIVESMalnutrition risk and malnutrition among the elderly is a public health concern. In combating this health-related problem, it is critically important to evaluate the risk factors in a multidimensional way and to apply appropriate nutrition intervention based on the results.SUBJECTS/METHODSA cross-sectional study was conducted on 215 elderly patients (32.6% male, 67.4% female) in a geriatric outpatient clinic of a hospital in Turkey. Nutritional questionnaires that incorporated the 24-h recall method were applied to determine general characteristics of patients, their health status, nutritional habits, and daily energy and nutrient intakes. Mini Nutritional Assessment was used to determine nutritional status. Relevant anthropometric measurements were obtained.RESULTSThe subjects'' mean age was 76.1 ± 7.0 years, and the prevalence of malnutrition (n = 7) and risk of malnutrition (n = 53) among the 215 subjects was 3.2% and 24.7%, respectively. Patients with malnutrition or risk of malnutrition were found to be single, have a depression diagnosis, in an older age group, have less appetite, more tooth loss, have more frequent swallowing/chewing difficulty, and have more frequent meal skipping. In addition, mean daily energy, carbohydrate, fat, fiber, vitamin E, vitamin B1, vitamin B2, vitamin B6, vitamin C, folates, potassium, magnesium, phosphorus, iron intake, and water consumption were found to be statistically significantly low in subjects with malnutrition or risk of malnutrition. After performing regression analysis to determine confounding factors, malnutrition risk was significantly associated with marital status, loss of teeth, appetite status, and depression.CONCLUSIONSRoutine nutritional screening and assessment of the elderly should be performed. If nutritional deficiencies cannot be diagnosed early and treated, self-sufficiency in the elderly may deteriorate, resulting in increased institutionalization.     

Ability of different screening tools to predict positive effect on nutritional intervention among the elderly in primary health care

ObjectiveRoutine identification of nutritional risk screening is paramount as the first stage in nutritional treatment of the elderly. The major focus of former validation studies of screening tools has been on the ability to predict undernutrition. The aim of this study was to validate Mini Nutritional Assessment–Short Form (MNA–SF), the Malnutrition Universal Screening Tool (MUST), the Nutritional Risk Screening 2002 (NRS–2002), Body Mass Index (BMI) <24, and the Eating Validation Scheme (EVS), using published randomized controlled trials of nutritional intervention among old people in primary health care, in order to evaluate whether they were capable of distinguishing those with a positive benefit from those that showed no benefit of nutritional intervention.MethodsThe methods used were a literature search; classification of participants with respect to nutritional risk according to the different nutritional screening tools; and validation (i.e., evaluation of whether the different tools were capable of distinguishing those with a positive benefit from those that showed no benefit of nutritional intervention by assessing the positive [PPV] and negative [NPV] predictive values).ResultsMNA–SF, NRS–2002, BMI <24 and EVS had the highest PPV (0.75) and EVS the highest NPV (0.74) with regard to function—the primary clinical outcome.ConclusionOverall EVS seemed most capable of distinguishing those clients and residents with a positive benefit from those that showed no benefit of nutritional intervention. The findings should be confirmed in further validation and intervention studies.     

L’évaluation nutritionnelle chez le sujet âgé en 2008

Malnutrition is frequent in elderly patients and results from multifactorial mechanisms, including age-related metabolic alterations, reduction of food intake and intercurrent diseases, especially inflammatory processes, that compromise nutritional status. Nutritional evaluation must be systematically and repeatedly performed and based primarily on clinical parameters such as weight, body mass index, weight loss, anthropometric measurements and dietetic history eventually combined in scores such as the mini-nutritional assessment (MNA). Fat-free mass evaluated by bioimpedance analysis has a prognostic value. Hypoalbuminemia is indicative of bad prognosis and may be combined with weight loss in the geriatric nutritional risk index (GNRI) to assess the nutritional risk. The determination of plasma transthyretin (prealbumin) is especially useful to assess acute malnutrition state and the response to nutritional support. Routine determination of the above criteria may be facilitated by the spreading of simple integrated tools and a better education of health professionals to the screening and active treatment of malnutrition in the elderly.     

Relationship between Nutritional Screening Tools and GLIM in Complicated IBD Requiring Surgery

Background: Accurate identification of malnutrition and preoperative nutritional care in Inflammatory Bowel Disease (IBD) surgery is mandatory. There is no validated nutritional screening tool for IBD patients. We developed a novel nutritional screening tool for IBD patients requiring surgery and compared it with other tools. Methods: we included 62 consecutive patients scheduled for elective surgery. The IBD Nutritional Screening tool (NS-IBD) was developed to screen patients for further comprehensive assessment. NRS-2002, MUST, MST, MIRT, SaskIBD-NR are compared with the new test. All screening tests were subsequently related to new GLIM criteria. Results: according to GLIM criteria, 25 (40%) IBD patients were malnourished (15 CD and 10 UC, 33% vs. 63%, p = 0.036). Stage 1 malnutrition was reported in ten patients, while stage 2 was detected in 15 patients. The comparison of each nutritional risk tool with GLIM criteria showed sensitivity of 0.52, 0.6, 0.6, 0.84, 0.84 and 0.92 for SASKIBD-NR, MUST, MST, NRS-2002, MIRT, and the new NS-IBD, respectively. Conclusions: in IBD, currently adopted nutritional screening tools are characterized by a low sensitivity when malnutrition diagnosis is performed with recent GLIM criteria. Our proposed tool to detect malnutrition performed the best in detecting patients that may require nutritional assessment and preoperative intervention.     

Poor nutritional habits are predictors of poor outcome in very old hospitalized patients

BACKGROUND: Malnutrition is prevalent in elderly populations. Recommended methods of nutritional screening are often too complicated and time-consuming for routine application in frail, very old, hospitalized patients. OBJECTIVE: Our aims were to identify risk factors for development of malnutrition in very old hospitalized patients and to evaluate the total Mini Nutritional Assessment (MNA) score and MNA subscores as predictors of in-hospital and long-term mortality. DESIGN: A prospective cohort study of patients aged > or =75 y was conducted in a geriatric hospital. Assessment included demographic, clinical, and laboratory data and cognitive, functional, and nutritional status. Follow-up was conducted for < or =2.7 y. RESULTS: Of the 414 patients studied, only 73 (17.6%) were well-nourished. Low serum albumin and phosphorus concentrations, dementia, and cerebrovascular accident (CVA) were significant risk factors for malnutrition. Survival was significantly lower in malnourished patients and patients at risk of malnutrition than in well-nourished patients (P < 0.0001). Low MNA-3 subscores (dietary habits) were significantly correlated with laboratory indexes of malnutrition and were significantly lower in patients with infections, malignancy, pressure ulcers, dementia, recent orthopedic surgery, and CVA. Multivariate analysis showed that a low MNA-3 score was an independent predictor of mortality; scores <7.5 increased the risk of death 2.05-fold. CONCLUSIONS: The prevalence of malnutrition was high in elderly hospitalized patients. Dietary habits were significant predictors of poor hospitalization outcome. A questionnaire on dietary habits can serve as a useful tool in assessing nutritional status and prognosis in elderly patients.