总体主观评价法和微型营养评价精法在老年肿瘤患者、营养评估中的比较

目的研究总体主观评价法（PG—SGA）和微型营养评价精法（MNA—SF）在老年肿瘤患者营养评估方面的差异,为临床营养评价提供科学依据。方法108例老年肿瘤患者分别应用MNA—SF和PG—SGA进行营养评估,将2种评估方法的结果进行比较。结果MNA—SF法评价42例营养正常的患者中,PG—SGA评分为A级12例,B级30例,没有评为C级者;MNA—SF法评价66例营养不良的患者中,PG—SGA评分为A级2例,B级60例,C级4例,PG—SGA对老年肿瘤营养不良的检出率（87．0％）高于MNA—SF（61．1％）;2种方法的评估结果间差异有统计学意义（P〈0．05）。结论PG-SGA更适合用于老年肿瘤患者进行营养评估,并可为临床治疗提供指导性意见。     

三种营养筛查工具在外科术前患者中的应用

目的采用营养风险筛查2002（NRS2002）、营养不良筛查工具（MUST）和微型营养评定简表（MNA-SF）对外科术前住院患者进行营养筛查，以确定上述工具的适用性。方法分别采用NRS2002、MUST和MNA．SF对259例术前患者进行营养筛查，以白蛋白和前清蛋白为标准评定上述工具的特异度、敏感度和预测值。结果以白蛋白为标准，NRS2002、MUST和MNA—SF的灵敏度分别为57．9％、84．2％、94．7％，特异度分别为84．2％、59．2％、30．4％，阳性预测值为22．4％、14．0％、9．7％，阴性预测值为96．2％、97．9％、98．6％，符合率为81．9％、71．0％、46．7％。以前清蛋白为标准，NRS2002、MUST和MNA．SF的灵敏度分别为34．4％、73．4％、90．6％，特异度分别为86．2％、65．6％、34．9％，阳性预测值为44．9％、41．2％、31．4％，阴性预测值为80．0％、88．3％、91．9％，符合率为73．4％、67．6％、48．6％。结论3种营养筛查工具中，MNA—SF筛出率最高，NRS2002准确性最高，建议患者入院时采用NRS2002和MUST进行营养筛查。     

应用微型营养评定（MNA）及生物电阻抗分析法（BIA）评定外科住院病人营养状况及人体组成

目的调查北京协和医院外科住院病人蛋白质-热量营养不良（PEM）发病率,评定并比较中青年及老年患者的人体组成。方法应用微型营养评定（MNA）及生物电阻抗分析（BIA）技术,对随机抽取的北京协和医院378例外科择期手术病人,在人院后一周内测定其营养状况、人体组成及生化检查。结果（1）MNA评定外科住院病人术前PEM发病率为33．4％,老年患者显著高于中青年患者（41．6％vs27．9％,P＜0．05）;存在发生PEM危险者占14．8％。（2）经MNA评定,营养正常与营养不良患者的人体测量及生化检查结果有显著性差异（P＜0．05）。（3）与中青年相比,老年患者瘦体组织（LBM）显著降低（男性：46．1％±6.3kgvs51．3±6．1kg,P＜0．05;女性：34．2±4．5kgvs38．2±4．1kg,P＜0．05）;老年女性LBM％显著降低（62．2±8．7％vs68．4±7．9％,P＜0．05）,总体脂肪比例（TBF％）显著升高（38．0±5．8％vs31．2％±7．5％,P＜0．05）。结论（1）外科住院病人中,PEM患者及存在发生PEM危险的患者占总数的48．2％,应考虑对外科住院病人术前术后进行肠内与肠外营养支持;（2）MNA及BM为准确、快速、安全和实用的床旁营养状况评定方法,应在临床推广;（3）老年外科病人PEM发病率高,且易发生LBM丢失,故对其更     

微型营养评定用于饮食干预指导临床效果分析

目的:探讨微型营养评定用于饮食干预指导临床效果。方法:选取我院近年来收治脑卒中患者72例,入院时行微型营养评定法(MNA)进行营养风险筛查,并对具有营养风险及营养不良患者进行饮食干预,并在入院后第2、6周后再行评价。结果:患者入院时、入院后2周及6周营养状况比较差异有统计学意义(p<0.05);营养风险及营养不良患者入院时、入院后2周及6周MNA评分比较差异有统计学意义(p<0.05)。结论:微型营养评定可有效改善患者营养状况,对实现科学饮食干预具有重要意义。     

微型营养评定法在恶性肿瘤病人中的应用

为探讨微型营养评定法 (MNA)在恶性肿瘤病人的营养状况评价中的价值 ,测定 2 6 2例恶性肿瘤病人的MNA总分、身高、体重、年龄、体力状况、血液血红蛋白量 (Hb)、红细胞数 (RBC)、血清白蛋白浓度 (Alb)、血清前白蛋白浓度 (PA)。计算实际体重 健康时平时体重比 (UBW % )。根据MNA总分评价病人营养状况 :营养不良组 (MNA总分 <17) ;营养不良危险组 (MNA总分介于 17～ 2 3 5 ) ;营养良好组 (MNA总分≥ 2 4)。结果显示 :MNA总分与UBW %、Alb、PA、BMI值呈显著相关 (r=0 5 0 1～ 0 72 4,P =0 0 0 0 )。MNA与UBW %、BMI、PA、Alb方法评价病人的营养状况有良好的一致性 ,符合率分别为 82 %、76 %、71%、6 8%。根据MNA方法评价全组病人 ,营养不良者占 31 7% (83 2 6 2例 ) ,营养不良危险者占 2 5 9% (6 8 2 6 2例 ) ,营养良好者占 42 4%(111 2 6 2例 ) ;营养不良与营养不良危险的发生率无显著性差异 ;老年与非老年患者营养不良发生率无明显差异。胃癌、肝癌的营养不良发生率明显高于肺癌 (P =0 0 0 1)。体力状况越差 (ECOG分级越高 )、营养不良发生率越高。贫血患者营养不良发生率明显高于非贫血者。感染患者营养不良发生率明显高于非感染者。结果提示 ,MNA对于恶性肿瘤患者具有良好的营养评价作用。胃癌?     

简易营养评价法在评价老年糖尿病患者营养状况中的应用

目的探讨简易营养评价法（MNA）在评价老年糖尿病患者营养状况时的敏感性和特异性。方法对116例住院老年糖尿病患者进行MNA问卷调查、人体测量、生化检测和24小时膳食回顾调查。分析MNA用于评价老年糖尿病患者营养状况的敏感性和特异性。结果MNA问卷调查显示住院老年糖尿病患者28．4％营养不良，32．8％具有营养不良危险，38．8％营养良好。当以MNA〈17为界点时，MNA的敏感性分别为75．0％、64．7％和65．8％，特异性分别为76．9％、77．8％和79．5％；当以MNA≤23．5为界点时，MNA的敏感性分别增加为100％、100％和97．4％，特异性下降至43．2％、45．5％和50．0％。MNA与体质指数（r=0．474，P〈0．01）、三头肌皮褶厚度（r=0．369，P〈0．01）、上臂肌围（r=0．479，P〈0．01）、血清白蛋白（r=0．613，P〈0．01）、血红蛋白（r=0．335，P〈0．01）和总淋巴细胞计数（r=0．433，P〈0．01）均呈显著正相关。结论老年糖尿病患者营养不良的发生率高。MNA是一种用于老年糖尿病患者营养状况评价的可靠、灵敏方法。     

糖尿病患者的微型营养评价

目的用微型营养评价法（MNA）评价糖尿病（DM）患者的营养状况,了解营养不良的患病率,提出改善营养状况的措施。方法对重庆市新桥医院106例糖尿病患者进行MNA问卷调查,根据MNA评分标准评价糖尿病患者营养状况。结果 MNA问卷调查结果显示糖尿病患者8.5%营养不良,64.2%具有营养不良危险,27.3%营养良好。老年糖尿病患者（年龄≥60岁）有48例,其中有16.7%营养不良,62.5%具有营养不良危险,20.8%营养良好。结论糖尿病营养不良患病率与年龄正相关,心理指导对提高DM患者营养状况有益。     

住院病人的营养不良风险筛查

目的:采用主观全面评定法(SGA),营养风险评估2002(NRS 2002),营养不良通用筛查工具(MUST)和微型营养评定简表(MNA-SF),对住院病人进行评估,以确定营养风险筛查工具的临床适用性. 方法:对856例住院病人在入院后48 h内采用4种营养筛查工具进行营养筛查,以MNA简表为标准,绘制其他3种营养筛查工具的ROC曲线及曲线下面积(AUC),评估其特异性、灵敏度和Youden指数. 结果:使用MUST、SGA、NRS 20002以及MNA-SF进行评估,营养不良或存在营养不良风险的检出率分别为13.3％,13.6％,49.5％和56.0％.以MNA-SF为标准,绘制SGA、NRS 2002和MUST的ROC曲线,AUC分别为0.616、0.809和0.715,灵敏度分别为23.8％、74.5％和46.8％;特异性分别为99.5％、87.3％和96.3％;Youden指数分别为0.233、0.618和0.431.结论:4种营养筛查工具中,NRS 2002的灵敏度和正确性最高,建议病人入院时采用NRS 2002进行营养筛查.     

微型营养评定法评价胃肠道肿瘤病人营养状况的应用

目的:应用微型营养评定(MNA)法调查和分析胃肠道肿瘤病人的营养状态,并比较与其他营养评价方法的相关性. 方法:应用MNA法问卷调查、人体测量和实验室检查,对496例胃肠道肿瘤拟手术病人,入院24 h内进行营养评价,研究营养不良的发生率,并比较MNA法与人体测量和实验室检查的相关性. 结果:①MNA法:胃肠道肿瘤病人中营养不良者84例(16.94%),营养不良危险者211例(42.54%),营养良好者201例(40.52%).②人体测量:体质指数(BMI)、肱三头肌皮皱厚度(TSF)、上臂围(AC)和上臂肌围(AMC)等指标,病人的营养不良发生率分别为13.5%、21.9%、15.1%和15.5%.③实验室检查:ALB、PA和总淋巴细胞计数,病人的营养不良发生率分别为14.9%、25.4%和30.8%.④MNA法与BMI、ALB、AC、TSF、AMC、TLC的相关系数在0.18～0.53(P<0.05),有良好的相关性. 结论: ①应用MNA法评价胃肠道肿瘤病人中营养不良和营养不良高危状态的发生率高.②MNA是一种简单、易行、无创性、适合于外科胃肠道肿瘤病人的营养评价方法.     

营养评定工具NRS2002、MNA和实验室检查在老年住院病人营养调查中的应用

目的:通过对老年住院病人进行营养筛查,为进一步营养支持治疗提供参考信息. 方法:选取在我院住院≥70岁的老年病人119例,采用营养风险筛查(NRS 2002)和微型营养评定(MNA)分别评定病人的营养风险和营养状况,同时记录入院时病人的年龄、体质量指数(BMI)、消化功能、有无感染等基本信息,以及前清蛋白、清蛋白、血红蛋白、淋巴细胞计数、总胆固醇、三酰甘油、肌酐、尿素氮、血清铁等实验室检验指标. 结果:①NRS 2002评估结果为“营养风险”的老年病人有21例,占17.6％;MNA评估结果为“营养不良风险或营养不良”的老年病人共有42例,占35.3％.②在上述调查中有营养风险的老年病人入院时BMI、前清蛋白、清蛋白、血红蛋白均明显低于无营养风险组.③在上述检测指标中,清蛋白与NRS 2002或MNA的相关性均优于其他指标,且其灵敏性和特异性均较高. 结论:NRS 2002和MNA均可用于评定老年病人的营养状况,BMI、前清蛋白、清蛋白、血红蛋白也可用于辅助评定老年病人的营养状况.在无条件行营养工具筛查时,清蛋白是最佳的营养评定指标.     

Evaluation of Mini-Nutritional Assessment for Japanese frail elderly

OBJECTIVE: We evaluated the Mini-Nutritional Assessment (MNA) test and the short-form MNA as screening tools for malnutrition in the Japanese elderly population. METHODS: A cross-sectional study of 226 elderly Japanese patients (78.6 +/- 0.5 y of age, mean +/- standard deviation; 67 men and 159 women) in various settings was carried out. Nutritional assessment included MNA, anthropometric measurements, and biochemical markers. RESULTS: According to the original cutoff point of the full MNA, 19.9% of those assessed were malnourished, 58.0% were at risk of malnutrition, and 22.1% were well nourished. Significant correlations were found between full MNA scores and age (r = -0.14), body mass index (r = 0.59), serum albumin (r = 0.60), total cholesterol (r = 0.36), midarm circumference (r = 0.50), and triceps skinfold (r = 0.37). The sensitivity and specificity of the full MNA score (< 17) for hypoalbuminemia were 0.810 and 0.860, respectively. With a cutoff point lower than 18, sensitivity and specificity hypoalbuminemia were 0.857 and 0.815, respectively. Using a short-form MNA score 12 and higher as normal, its sensitivity and specificity for predicting undernutrition were 0.859 and 0.840, respectively. CONCLUSIONS: The full and short forms of the MNA were useful tools to identify elderly Japanese patients with malnutrition or risk of malnutrition. However, the full MNA cutoff point for malnutrition should be modulated for this population.     

Nutritional assessment in cancer: comparing the Mini-Nutritional Assessment (MNA) with the scored Patient-Generated Subjective Global Assessment (PGSGA)

The evaluation of nutritional status in cancer patients is often neglected in spite of the fact that poor nutritional status may adversely affect prognosis and treatment tolerance. In day-to-day oncology practice, a sensitive but simply applied nutritional assessment tool is needed to identify at-risk patients. Several tools exist; however, none has been universally accepted. The aim of this study was to compare two potential tools, the Mini-Nutritional Assessment (MNA) and the scored Patient Generated Subjective Global Assessment (PGSGA). The MNA is more simply applied and does not require a trained dietitian. The PGSGA has been previously validated in cancer patients. One hundred fifty-seven newly diagnosed cancer patients were assessed using both tools. Of these, 126 were reassessed at 4-6 wk, and 104 were reassessed at Weeks 8-12 after initial assessment. A significant negative correlation was found between the tools at all three time periods (at baseline r = -0.76; P < 0.001). Taking the PGSGA as the most accepted nutritional assessment tool, at baseline the MNA demonstrated a sensitivity of 97% and specificity of 54%. At 4-6 wk MNA sensitivity was 79% and specificity was 69%. At 8-12 wk MNA sensitivity was 93% and specificity was 82%. When comparing the tools in elderly patients alone (>65 yr), similar results were obtained. Both tools were able to correctly classify patients as malnourished, although the MNA lacks specificity. Therefore, the PGSGA should be the tool of choice for nutritional assessment in cancer patients.     

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.     

Characteristics of the Mini-Nutritional Assessment in elderly home-care patients

OBJECTIVE: To assess the risk of malnutrition among elderly people living at home and receiving regular home-care services using the Mini-Nutritional Assessment (MNA) and to study the characteristics of the instrument in this patient group. DESIGN: A cross-sectional study using the MNA score to assess the nutritional status of elderly home-care patients. SETTING: Municipal home-care services in rural Finland. SUBJECTS: A total of 178 (65%) out of 272 eligible patients aged 75-94 y agreed to participate. MAJOR OUTCOME METHODS: MNA questionnaire, anthropometrics, structured questionnaire, menu record. RESULTS: According to MNA, 3% were malnourished (MNA < 17 points), 48% at risk for malnutrition (17-23.5 points) and 49% well nourished (>23.5 points). The mean MNA score was 23.4. Weight loss, psychological stress, nutritional status, decline in food intake, self-perceived health status and mid-arm circumference (MAC) showed the strongest significant correlations (P=0.0001) to total MNA score. MNA questions with the strongest significant intercorrelations (P=0.0001) were body mass index with MAC and calf circumference; and the decline of food intake and self-perceived nutritional status. The number of eating problems correlated significantly to the MNA score (P=0.0011). Those with chewing and swallowing problems (n=64, 36%) had a significantly lower MNA score than others (P=0.0001). Dry mouth together with chewing and swallowing problems (n=40, 22%) reduced the MNA score even further (P=0.0001). CONCLUSIONS: The results suggest that MNA is a useful tool in the identification of elderly home-care patients at risk for malnutrition.     

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.     

Evaluation of the efficacy of nutritional screening tools to predict malnutrition in the elderly at a geriatric care hospital

BACKGROUND/OBJECTIVESMalnutrition in the elderly is a serious problem, prevalent in both hospitals and care homes. Due to the absence of a gold standard for malnutrition, herein we evaluate the efficacy of five nutritional screening tools developed or used for the elderly.SUBJECTS/METHODSElected medical records of 141 elderly patients (86 men and 55 women, aged 73.5 ± 5.2 years) hospitalized at a geriatric care hospital were analyzed. Nutritional screening was performed using the following tools: Mini Nutrition Assessment (MNA), Mini Nutrition Assessment-Short Form (MNA-SF), Geriatric Nutritional Risk Index (GNRI), Malnutrition Universal Screening Tool (MUST) and Nutritional Risk Screening 2002 (NRS 2002). A combined index for malnutrition was also calculated as a reference tool. Each patient evaluated as malnourished to any degree or at risk of malnutrition according to at least four out of five of the aforementioned tools was categorized as malnourished in the combined index classification.RESULTSAccording to the combined index, 44.0% of the patients were at risk of malnutrition to some degree. While the nutritional risk and/or malnutrition varied greatly depending on the tool applied, ranging from 36.2% (MUST) to 72.3% (MNA-SF). MUST showed good validity (sensitivity 80.6%, specificity 98.7%) and almost perfect agreement (k = 0.81) with the combined index. In contrast, MNA-SF showed poor validity (sensitivity 100%, specificity 49.4%) and only moderate agreement (k = 0.46) with the combined index.CONCLUSIONSMNA-SF was found to overestimate the nutritional risk in the elderly. MUST appeared to be the most valid and useful screening tool to predict malnutrition in the elderly at a geriatric care hospital.     

Validity of the Mini-Nutritional Assessment Scale for Evaluating Frailty Status in Older Adults

Objectives

Comprehensive Geriatric Assessment (CGA) may not be performed in clinical practice as it takes too much time and requires special training. The Mini-Nutritional Assessment (MNA) is widely used to assess nutritional status in older adults. We aimed to determine whether or not the MNA can estimate frailty status defined by the Fried criteria.

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.     

Malnutrition screening tools: Comparison against two validated nutrition assessment methods in older medical inpatients

ObjectiveAlthough several validated nutritional screening tools have been developed to “triage” inpatients for malnutrition diagnosis and intervention, there continues to be debate in the literature as to which tool/tools clinicians should use in practice. This study compared the accuracy of seven validated screening tools in older medical inpatients against two validated nutritional assessment methods.MethodsThis was a prospective cohort study of medical inpatients at least 65 y old. Malnutrition screening was conducted using seven tools recommended in evidence-based guidelines. Nutritional status was assessed by an accredited practicing dietitian using the Subjective Global Assessment (SGA) and the Mini-Nutritional Assessment (MNA). Energy intake was observed on a single day during first week of hospitalization.ResultsIn this sample of 134 participants (80 ± 8 y old, 50% women), there was fair agreement between the SGA and MNA (κ = 0.53), with MNA identifying more “at-risk” patients and the SGA better identifying existing malnutrition. Most tools were accurate in identifying patients with malnutrition as determined by the SGA, in particular the Malnutrition Screening Tool and the Nutritional Risk Screening 2002. The MNA Short Form was most accurate at identifying nutritional risk according to the MNA. No tool accurately predicted patients with inadequate energy intake in the hospital.ConclusionBecause all tools generally performed well, clinicians should consider choosing a screening tool that best aligns with their chosen nutritional assessment and is easiest to implement in practice. This study confirmed the importance of rescreening and monitoring food intake to allow the early identification and prevention of nutritional decline in patients with a poor intake during hospitalization.     

脑卒中住院康复治疗患者营养状态评估方法的比较

目的分析比较营养风险筛查2002(NRS2002)、主观全面评估法(SGA)、微型营养评定法(MNA)在脑卒中住院康复治疗患者营养评估中的作用。方法以BMI、近三个月体重变化、白蛋白水平作为判断营养状态的标准诊断方法,分别采用SGA、MNA、NRS2002法对106例脑卒中患者进行营养状况评估,比较其与标准诊断方法的一致性及灵敏度、特异度。结果SGA与标准诊断方法有较好的一致性(Kappa值在0.410);在灵敏度、特异度比较中,发现SGA的特异度较高(94.4%),而MNA、NRS2002的灵敏度较高(92.3%)。结论SGA在判断营养正常时与标准诊断一致性良好,但判断营养不良时NRS2002及MNA灵敏度更高。