The Mini Nutritional Assessment (MNA) review of the literature--What does it tell us?

To review the literature on the MNA to Spring 2006, we searched MEDLINE, Web of Science and Scopus, and did a manual search in J Nutr Health Aging, Clin Nutr, Eur J Clin Nutr and free online available publications. VALIDATION AND VALIDITY: The MNA was validated against two principal criteria, clinical status and comprehensive nutrition assessment using principal component and discriminant analysis. The MNA shortform (MNA-SF) was developed and validated to allow a 2-step screening process. The MNA and MNA-SF are sensitive, specific, and accurate in identifying nutrition risk. NUTRITIONAL SCREENING: The prevalence of malnutrition in community-dwelling elderly (21 studies, n = 14149 elderly) is 2 +/- 0.1% (mean +/- SE, range 0- 8%) and risk of malnutrition is 24 +/- 0.4% (range 8-76%). A similar pattern is seen in out-patient and home care elderly (25 studies, n = 3119 elderly) with prevalence of undernutrition 9 +/- 0.5% (mean +/- SE, range 0-30%) and risk of malnutrition 45 +/- 0.9% (range 8-65%). A high prevalence of undernutrition has been reported in hospitalized and institutionalized elderly patients: prevalence of malnutrition is 23 +/- 0.5% (mean +/- SE, range 1- 74%) in hospitals (35 studies, n = 8596) and 21 +/- 0.5% (mean +/- SE, range 5-71%) in institutions (32 studies, n = 6821 elderly). An even higher prevalence of risk of malnutrition was observed in the same populations, with 46 +/- 0.5% (range 8-63%) and 51 +/- 0.6% (range 27-70%), respectively. In cognitively impaired elderly subjects (10 studies, n = 2051 elderly subjects), detection using the MNA, prevalence of malnutrition was 15 +/- 0.8% (mean +/- SE, range 0-62%), and 44 +/- 1.1% (range 19-87%) of risk of malnutrition. CHARACTERISTICS: The large variability is due to differences in level of dependence and health status among the elderly. In hospital settings, a low MNA score is associated with an increase in mortality, prolonged length of stay and greater likelihood of discharge to nursing homes. Malnutrition is associated with functional and cognitive impairment and difficulties eating. The MNA(R) detects risk of malnutrition before severe change in weight or serum proteins occurs. NUTRITIONAL INTERVENTION: Intervention studies demonstrate that timely intervention can stop weight loss in elderly at risk of malnutrition or undernourished and is associated with improvements in MNA scores. The MNA can also be used as a follow up assessment tool. CONCLUSION: The MNA is a screening and assessment tool with a reliable scale and clearly defined thresholds, usable by health care professionals. It should be included in the geriatric assessment and is proposed in the minimum data set for nutritional interventions.     

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.     

Nutritional status according to the Mini Nutritional Assessment (MNA®) and frailty in community dwelling older persons: A close relationship

Objective

This study investigates the association between MNA results and frailty status in community-dwelling older adults. In addition the relevance of singular MNA items and subscores in this regard was tested.

Design

Cross-sectional study.

Setting

Community-dwelling older adults were recruited in the region of Nürnberg, Germany.

Participants

206 volunteers aged 75 years or older without cognitive impairment (Mini Mental State Examination >24 points), 66.0% female.

Measurements

Frailty was defined according to Fried et al. as presence of three, pre-frailty as presence of one or two of the following criteria: weight loss, exhaustion, low physical activity, low handgrip strength and slow walking speed. Malnutrition (<17 points) and the risk of malnutrition (17–23.5 points) were determined by MNA®.

Results

15.1% of the participants were at risk of malnutrition, no participant was malnourished. 15.5 % were frail, 39.8% pre-frail and 44.7% non-frail. 46.9% of the frail, 12.2% of the pre-frail and 2.2% of the non-frail participants were at risk of malnutrition (p<0.001). Hence, 90% of those at risk of malnutrition were either pre-frail or frail. For the anthropometric, dietary, subjective and functional, but not for the general MNA subscore, frail participants scored significantly lower than pre-frail (p<0.01), and non-frail participants (p<0.01). Twelve of the 18 MNA items were also significantly associated with frailty (p<0.05).

Conclusions

These results underline the close association between frailty syndrome and nutritional status in older persons. A profound understanding of the interdependency of these two geriatric concepts will represent the basis for successful treatment strategies.     

Use of Upper-Arm Anthropometry as Measure of Body-Composition and Nutritional Assessment in Children and Adolescents (6–20 Years) of Assam,Northeast India

Background

Upper-arm muscle area (UMA), upper-arm fat area (UFA), arm-fat index (AFI), upper-arm fat estimate (UFE) and upper-arm muscle estimate (UME) was introduced for the assessment of body-composition. This cross-sectional study assessed age-sex specific upper-arm composition and nutritional status among children and adolescents.

Methods

The present cross-sectional study was conducted among 1545 (770 boys; 775 girls) Sonowal Kacharis of Dibrugarh District, Assam, Northeast-India, using multi-stage stratified random sampling method. The anthropometric measurements of height, weight, triceps and mid-upper-arm circumference were recorded. The upper-arm composition was assessed using standard equations. Nutritional status was assessed using standard classification of upper-arm muscle-area by height (UAMAH) and thinness (low BMI-for-age).

Results

Age and sex-specific muscularity were found significantly greater among boys than girls (p<0.01), while adiposity was significantly greater among girls (p<0.01), particularly when they approached to puberty. The overall prevalence of low and below-average UAMAH was found to be 16.38% and 22.65% respectively. The overall prevalence of thinness was 23.69% (26.36% boys, 21.03% girls) (p>0.05).

Conclusion

Body-composition and nutritional status of these children and adolescents were found markedly unsatisfactory using upper-arm composition, UAMAH and thinness. The combination of upper-arm composition and conventional anthropometric measures appear to be useful for body-composition and nutritional status assessment.     

mini-PAT (Peer Assessment Tool): A Valid Component of a National Assessment Programme in the UK?

Purpose To design, implement and evaluate a multisource feedback instrument to assess Foundation trainees across the UK. Methods mini-PAT (Peer Assessment Tool) was modified from SPRAT (Sheffield Peer Review Assessment Tool), an established multisource feedback (360°) instrument to assess more senior doctors, as part of a blueprinting exercise of instruments suitable for assessment in Foundation programmes (first 2 years postgraduation). mini-PAT’s content validity was assured by a mapping exercise against the Foundation Curriculum. Trainees’ clinical performance was then assessed using 16 questions rated against a six-point scale on two occasions in the pilot period. Responses were analysed to determine internal structure, potential sources of bias and measurement characteristics. Results Six hundred and ninety-three mini-PAT assessments were undertaken for 553 trainees across 12 Deaneries in England, Wales and Northern Ireland. Two hundred and nineteen trainees were F1s or PRHOs and 334 were F2s. Trainees identified 5544 assessors of whom 67% responded. The mean score for F2 trainees was 4.61 (SD = 0.43) and for F1s was 4.44 (SD = 0.56). An independent t test showed that the mean scores of these 2 groups were significantly different (t = −4.59, df 390, p < 0.001). 43 F1s (19.6%) and 19 F2s (5.6%) were assessed as being below expectations for F2 completion. The factor analysis produced 2 main factors, one concerned clinical performance, the other humanistic qualities. Seventy-four percent of F2 trainees could have been assessed by as few as 8 assessors (95% CI ±0.6) as they either scored an overall mean of 4.4 or above or 3.6 and below. Fifty-three percent of F1 trainees could have been assessed by as few as 8 assessors (95% CI ±0.5) as they scored an overall mean of 4.5 or above or 3.5 and below. The hierarchical regression when controlling for the grade of trainee showed that bias related to the length of the working relationship, occupation of the assessor and the working environment explained 7% of the variation in mean scores when controlling for the year of the Foundation Programme (R squared change = 0.06, F change = 8.5, significant F change <0.001). Conclusions As part of an assessment programme, mini-PAT appears to provide a valid way of collating colleague opinions to help reliably assess Foundation trainees.     

Synthesis, antitumor and antimicrobial activities of 4-(4-chlorophenyl)-3-cyano-2-(β-O-glycosyloxy)-6-(thien-2-yl)-nicotinonitrile

4-(4-Chlorophenyl)-3-cyano-6-(thien-2-yl)-1H-pyridin-2-one (2) was obtained by reaction of 2-acetyl thiophene with 4-chlorobenzaldehyde and ethyl cyanoacetate in presence of ammonium acetate or by the reaction of α,β-unsaturated compound 1 with ethyl cyanoacetate in the presence of ammonium acetate. 4-(4-Chlorophenyl)-2-(2′,3′,4′,6′-tetra-O-acetyl-β-d-gluco/galactopyranosyloxy)-6-(thien-2-yl)nicotinonitrile (5a and 5b), riboside 11, xyloside 12 and lactoside 16 were prepared by the reaction of 2 with glycosyl/galactosyl/xylosyl/lactosyl bromide and peracetylated xylose/ribose under the conventional and microwave irradiation methods. The reaction has regioselectively gave the O-glycosides and not the N-glycosides. The glycosides 5a,b, riboside 11, xyloside 12 and lactoside 16 were deacetylated in the presence of Et₃N/MeOH and few drops of water to give 7a,b, 13, 14 and 17. The structure of the new synthesized compounds was confirmed by using IR, ¹H, ¹³C NMR spectra and microanalysis. Selected members of these compounds were screened for antitumor and antibacterial activity.     

Quantitation of [5-14CH3]-(2R, 4'R, 8'R)-α-tocopherol in humans

Half-lives of α-tocopherol in plasma have been reported as 2-3 d, whereas the Elgin Study required >2 y to deplete α-tocopherol, so gaps exist in our quantitative understanding of human α-tocopherol metabolism. Therefore, 6 men and 6 women aged 27 ± 6 y (mean ± SD) ingested 1.81 nmol, 3.70 kBq of [5-(14)CH(3)]-(2R, 4'R, 8'R)-α-tocopherol. The levels of (14)C in blood plasma and washed RBC were monitored frequently from 0 to 460 d while the levels of (14)C in urine and feces were monitored from 0 to 21 d. Total fecal elimination (fecal + metabolic fecal) was 23.24 ± 5.81% of the (14)C dose, so feces over urine was the major route of elimination of the ingested [5-(14)CH(3)]-(2R, 4'R, 8'R)-α-tocopherol, consistent with prior estimates. The half-life of α-tocopherol varied in plasma and RBC according to the duration of study. The minute dose coupled with frequent monitoring over 460 d and 21 d for blood, urine, and feces ensured the [5-(14)CH(3)]-(2R, 4'R, 8'R)-α-tocopherol (the tracer) had the chance to fully mix with the endogenous [5-(14)CH(3)]-(2R, 4'R, 8'R)-α-tocopherol (the tracee). The (14)C levels in neither plasma nor RBC had returned to baseline by d 460, indicating that the t(1/2) of [5-CH(3)]-(2R, 4'R, 8'R)-α-tocopherol in human blood was longer than prior estimates.     

Assessment of dietary vitamin A intake (retinol, α-carotene, β-carotene, β-cryptoxanthin) and its sources in the National Survey of Dietary Intake in Spain (2009–2010)

Abstract

Grape seed oil (GSO) is reported to improve oxidative stress and lipid profile. However, the ameliorating effect of GSO on inflammation and insulin resistance has not being noticed so far. We aimed to examine the effects of GSO consumption on inflammation and insulin resistance in overweight or obese females. The subjects (n?=?44) were randomly assigned into intervention group as “GSO” (consuming 15% of energy from GSO) and control group as sunflower oil “SFO” (consuming 15% of energy from SFO) through a weight loss diet for 8 weeks. Anthropometric measurements, dietary recall and fasting serum glucose, insulin, high sensitive C-reactive protein (hs-CRP) and tumor necrosis factor-alpha (TNF-α) were assessed before and after the intervention. Homeostatic model assessment of insulin resistance (HOMA-IR) scores, hs-CRP and TNF-α decreased in the GSO group. The hs-CRP was lower in GSO than the SFO group (p?<?0.03). GSO consumption seems to improve inflammatory condition and insulin resistance in overweight/obese women.     

Tocopherol metabolites 2, 5, 7, 8-tetramethyl-2-(2'-carboxyethyl)-6-hydroxychroman (α-CEHC) and 2, 7, 8-trimethyl-2-(2'-carboxyethyl)-6-hydroxychroman (γ-CEHC) in human serum after a single dose of natural vitamin E

Summary Backgroundα- and γ-Tocopherol are vitamin E compounds in human blood and tissues. α-CEHC (2,5,7,8-tetramethyl-2-(2'-carboxyethyl)-6-hydroxychroman) and γ-CEHC (2,7,8-trimethyl-2-(2'-carboxyethyl)-6-hydroxychroman) have been identified as water-soluble metabolites which are excreted with the urine in humans. Aim of the study To assess over-time changes of serum levels of α- and γ-CEHC in humans after a single dose of vitamin E from a natural source. Methods Twenty-one healthy subjects ingested a single dose of vitamin E (306 mg of RRR-α-tocopherol and 1.77 mg of γ-tocopherol). Blood was collected before (baseline) and 2, 6, 12, 24, 35, 50, and 74 h after ingestion. Serum was separated and levels of α- and γ-tocopherol and α- and γ-CEHC were determined by HPLC. Results After vitamin E ingestion, a statistically significant increase was observed for α-tocopherol and α-CEHC. Maximum serum levels for both compounds were measured 12 h after application (33.3 ± 11.1 μmol α-toco-pherol /L and 42.4 ± 18.3 nmol α-CEHC /L); baseline values were reached again after 72 h. While γ-tocopherol levels decreased during the study period, an increase in the metabolite γ-CEHC was observed. The optical isomer formed in the metabolism of RRR-α-tocopherol was assigned as S-α-CEHC. Conclusionsα-CEHC levels increase after administration of a single dose of natural vitamin E in humans. The appearance of the metabolite in blood parallels that of the parent compound. The γ-tocopherol analog appears to be metabolized more efficiently than α-tocopherol. Received: 14 November 2001, Accepted: 5 April 2002     

Comparative genomic analysis of genogroup 1 (Wa-like) rotaviruses circulating in the USA, 2006–2009

Group A rotaviruses (RVA) are double stranded RNA viruses that are a significant cause of acute pediatric gastroenteritis. Beginning in 2006 and 2008, respectively, two vaccines, Rotarix™ and RotaTeq®, have been approved for use in the USA for prevention of RVA disease. The effects of possible vaccine pressure on currently circulating strains in the USA and their genome constellations are still under investigation. In this study we report 33 complete RVA genomes (ORF regions) collected in multiple cities across USA during 2006–2009, including 8 collected from children with verified receipt of 3 doses of rotavirus vaccine. The strains included 16 G1P[8], 10 G3P[8], and 7 G9P[8]. All 33 strains had a Wa like backbone with the consensus genotype constellation of G(1/3/9)-P[8]-I1-R1-C1-M1-A1-N1-T1-E1-H1. From maximum likelihood based phylogenetic analyses, we identified 3–7 allelic constellations grouped mostly by respective G types, suggesting a possible allelic segregation based on the VP7 gene of RVA, primarily for the G3 and G9 strains. The vaccine failure strains showed similar grouping for all genes in G9 strains and most genes of G3 strains suggesting that these constellations were necessary to evade vaccine-derived immune protection. Substitutions in the antigenic region of VP7 and VP4 genes were also observed for the vaccine failure strains which could possibly explain how these strains escape vaccine induced immune response. This study helps elucidate how RVA strains are currently evolving in the population post vaccine introduction and supports the need for continued RVA surveillance.     

Assessment of dietary lutein,zeaxanthin and lycopene intakes and sources in the Spanish survey of dietary intake (2009–2010)

We assessed the intake and major dietary sources of lutein, zeaxanthin and lycopene (non-provitamin A carotenoids) in Spain using food consumption data from the Spanish National Dietary Intake Survey (2009–2010). Three-day diaries and one 24-h recall were used to collect dietary data and a software application that includes HPLC data was used. Average intake of those carotenoids was 4290.8?μg/d (67.1% total carotenoid intake), mainly from vegetables (3414.0?μg/d), followed by fruits (393.5?μg/d), oils/fats (204.0?μg/d) and eggs/egg products (170.0?μg/d). Main sources of lutein and zeaxanthin were vegetables (62.9% total diet, 1235.2?μg/person/d). Lycopene intake was 3055.6?μg/d (71.2% of non-provitamin A carotenoids), mainly from tomato and by-products (86.3%) and watermelon. Red- and orange-colored fruits and vegetables were the major contributors of non-provitamin carotenoids (3219.0?μg/person/d). Balanced diets should favor fruits and vegetables over other dietary sources (oils, eggs, processed foods) that contain components to be consumed with moderation.     

Clinical evaluation of efficacy and adverse effects in the (European) registration of drugs: what does it mean for the doctor and patient?

The clinical criteria for admission of new drugs to the European common market have become more stringent in recent years. Increasingly often, the manufacturer is required to demonstrate that the new drug offers a clinically visible and relevant benefit to the patient. Efficacy and adverse effects should not only be studied by comparative trials with placebo, the registration authorities also expect the drug to be compared with the standard treatment already available. Such trials should prove that the balance between efficacy and adverse effects of the drug is better than that of placebo and at least as good as the standard treatment, as regards not only statistical significance but also clinical relevance. Therefore, Dutch and European assessment reports and product information may be increasingly useful to prescribers, patients and insurers in determining the role and therapeutic value of new drugs within the existing therapeutic possibilities concerning certain diseases.     

Food consumed does not account for the higher prevalence of obesity among stunted adults in a very-low-income population in the Northeast of Brazil (Maceió, Alagoas)

OBJECTIVE: To study the food pattern of stunted and nonstunted, obese and nonobese individuals in a very-low-income population. DESIGN: A household survey. SETTING: Slum set up by the 'Homeless Movement', city of Maceió (Alagoas), Brazil. SUBJECTS AND METHODS: A total of 532 adults classified by sex, stature (Z -2s.d. of the NCHS curves), and body mass index (BMI) were compared using the following variables: waist circumference, waist-hip circumference ratio (W/H), percentage body fat (skinfold thickness and bioelectrical impedance), and food intake (24-h recall). RESULTS: The prevalence of stunting was 22.6%. In all, 30% of the stunted subjects were overweight or obese, compared with 23% for the nonstunted individuals (P<0.05). In women, logistic regression analysis showed a strong association among weight, abdominal fat, and stunting (r=0.81). No significant differences were observed in the values of W/H or in the qualitative menu of the different categories. Energy intake was below the RDA figures (about 63%). There was similarity among the groups regarding the proportion of macronutrients, except for the fact that stunted obese women ingested less fat and protein than nonstunted obese women. Stunted obese individuals consumed less energy (5962 kJ) than the population as a whole (6213 kJ), an amount far lower than their average needs, which were calculated on the basis of their shorter stature (8109 kJ). CONCLUSION: The observed energy consumption seems compatible with the panorama of undernutrition present in the population, but it does not explain the high prevalence of obesity detected.