Mini Nutritional Assessment (MNA) is Rather a Reliable and Valid Instrument to Assess Nutritional Status in Iranian Healthy Adults and Elderly with a Chronic Disease

This study aimed to evaluate the usefulness of the Mini Nutritional Assessment (MNA) to assess nutritional status of Iranian population and to compare its psychometric properties between patients suffering from a chronic disease, healthy elderly and younger adults. As a group of elderly with a chronic disease, 143 Parkinson’s disease (PD) patients and as the control group, 467 healthy persons were enrolled. The Persian-translated version of MNA was filled-up through interviews together with anthropometric measurements. Cronbach’s α coefficient of entire MNA was 0.66 and 0.70 in healthy individuals and PD patients, respectively. The total MNA score could significantly discriminate the ones with BMI ≥ 24kg/m² in both groups. In general, MNA was a valid and reliable tool for nutritional assessment. We acknowledge study limitations including lack of serum measurements and a selection bias towards mild-to-moderate PD. MNA is a more reliable tool in older healthy individuals and rather younger elderly with PD.     

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。     

Full Mini Nutritional Assessment and Prognosis in Elderly Patients with Pulmonary Tuberculosis

Objective: Malnutrition is observed frequently in elderly patients with pulmonary tuberculosis (TB). Full Mini Nutritional Assessment (full MNA) is a useful method of measuring nutrition status for elderly person. The objective of this study is to examine the relationship between full MNA and the mortality of elderly patients with pulmonary TB.

Methods: We evaluated 53 elderly patients with pulmonary TB. The nutrition risk assessment was carried out using full MNA.

Results: A receiver operating characteristic (ROC) curve was generated for further analysis of the prognostic value of full MNA score. The area under the curve was 0.856 (95% confidence interval [CI], 0.751–0.961). We used the maximum Youden index to obtain optimal cutoff values for full MNA score for prognostic assessment in elderly patients with pulmonary TB. For predicting the risk of mortality, the optimal cutoff value for full MNA score was 13.75. Based on this cutoff value, the Cox proportional hazard model was applied to assess the ability of full MNA score < 14 to predict the prognosis of elderly patients with pulmonary TB. Multivariate analysis identified age (hazard ratio [HR] = 1.114, 95% CI, 1.018–1.219, p = 0.019) and full MNA score < 14 (HR = 9.038, 95% CI, 1.064–76.768, p = 0.044) to be significant independent prognostic factors for survival.

Conclusion: Severe malnutrition, as defined by full MNA score < 14, was a predictor of high mortality.     

Use of the mini nutritional assessment tool in elderly people from long-term institutions of Southeast of Brazil

Background: the Mini Nutritional Assessment (MNA) is a multidimensional method of nutritional evaluation that allows the diagnosis of malnutrition and risk of malnutrition in elderly people, it is important to mention that this method has not been well studied in Brazil.Objective: to verify the use of the MNA in elderly people that has been living in long term institutions for elderly people.Design: transversal study.Participants: 89 people (≥ 60 years), being 64.0% men. The average of age for both genders was 73.7±9.1 years old, being 72.8±8.9 years old for men, and 75.3±9.3 years old for women.Setting: long-term institutions for elderly people located in the Southeast of Brazil.Methods: it was calculated the sensibility, specificity, and positive and negative predictive values. It was data to set up a ROC curve to verify the accuracy of the MNA. The variable used as a “standard” for the nutritional diagnosis of the elderly people was the corrected arm muscle area because it is able to provide information or an estimative of the muscle reserve of a person being considered a good indicator of malnutrition in elderly people.Results: the sensibility was 84.0%, the specificity was 36.0%, the positive predictive value was 77.0%, and the negative predictive value was 47.0%; the area of the ROC curve was 0.71 (71.0%).Conclusion: the MNA method has showed accuracy, and sensibility when dealing with the diagnosis of malnutrition and risk of malnutrition in institutionalized elderly groups of the Southeastern region of Brazil, however, it presented a low specificity.     

Mini Nutritional Assessment in elderly subjects receiving home nursing care

Background: Old age and disease are risk factors for malnutrition. We assessed the nutritional status in elderly receiving home nursing care. Methods: Eighty people (86% women) over the ages of 70 years (mean±SD 84±6) were investigated. One-third had lung and/or cardiovascular disease, 10% had diabetes mellitus and the remainder had miscellaneous disorders. The Mini Nutritional Assessment (MNA) scale (0–30 points), consisting of 18 point-weighted questions, including anthropometry, e.g. body mass index (BMI, kg m^?2), was used. Results: Fifty patients (62%) were assessed as having suspected malnutrition (MNA 17–23.5 points), while two were assessed as being malnourished (MNA < 17 points). The mean BMI was 22.7±5. One third of the subjects had BMI values <20 and 64% had BMI ≤ 23. Patients with cardiac failure and/or lung disease had the lowest MNA values (20.9±3.3 points) and 85% of these patients were assessed as being at risk for malnourishment. More than half drank ≤1 L of fluid per day. Over half of those who were malnourished or were suspected to be malnourished did not have meal support, whereas almost half of the well-nourished patients had meal support. Conclusion: Two-thirds of the patients receiving home nursing care were assessed as having suspected or confirmed malnutrition, or were underweight. Nutritional routines may need more focus within home nursing care services.     

应用前白蛋白检测营养风险筛查2002、主观全面评定和微小营养评定的灵敏度和特异度：探索性、前瞻性、多中心临床研究

目的 探索应用前白蛋白水平为参考标准检测营养风险筛查2002( NRS 2002)、主观全面评定(SGA)及微小营养评定(MNA)的灵敏度和特异度.方法 自2010年11月至2011年3月,在3个医院的肿瘤科住院患者中采用连续定点抽样方法,将符合入选条件的126例食管癌患者纳入本研究.于入院次日分别采用NRS 2002、SGA及MNA工具由经过培训的营养师、肿瘤内科医师进行营养筛查或评定.以前白蛋白低于180 g/L为营养不良(不足)的参考标准,分析上述3种工具的灵敏度、特异度.结果 126例符合入选条件的患者均完成NRS 2002、SGA及MNA的筛查或评定.NRS 2002、SGA及MNA检出的有营养风险和营养不良(不足)率分别为67.0％、46.2％、64.8％.以与临床结局有关的前白蛋白为参考标准,NRS 2002、SGA及MNA的灵敏度分别为78.2％、58.2％、89.1％,特异度分别为50.0％、72.2％、27.8％.结论 3种工具中,NRS 2002检出的是营养风险,而SGA和MNA检出的是营养不良(不足),3种工具之间有不同特点.由于单一的前白蛋白不是一个适当的参考标准,不能用于3种工具的比较.但NRS 2002有关临床结局,适用于住院患者.需要进一步进行以临床结局为检测标准的多中心研究.     

Rheumatoid cachexia,central obesity and malnutrition in patients with low-active rheumatoid arthritis: feasibility of anthropometry,Mini Nutritional Assessment and body composition techniques

Background and aims  The concurrent decrease in fat free mass (FFM) and increase in fat mass (FM), including central obesity, in patients with rheumatoid arthritis (RA) may be related to increased cardiovascular morbidity as well as to functional decline. The objectives of this study were to evaluate body composition and nutritional status in patients with RA and the feasibility of bioelectrical impedance (BIA) to detect rheumatoid cachexia. Methods  Eighty RA outpatients (76% women), mean age 61 (range 22–80) years and with mean disease duration of 6 (range 1–52) years, were assessed by body mass index (BMI), waist circumference (WC), whole-body dual-energy X-ray absorptiometry (DXA), BIA and the Mini Nutritional Assessment (MNA). Results  Fat free mass index (FFMI; kg/m²) was low in 26% of the women and in 21% of the men. About every fifth patient displayed concomitant low FFMI and elevated fat mass index (FMI; kg/m²), i.e. rheumatoid cachexia. BMI and MNA were not able to detect this condition. Sixty-seven percent had increased WC. Reduced FFM was independently related to age (p = 0.022), disease duration (p = 0.027), ESR (p = 0.011) and function trendwise (p = 0.058). There was a good relative agreement between DXA and BIA (FM r ² = 0.94, FFM r ² = 0.92; both p < 0.001), but the limits of agreement were wide for each variable, i.e. for FM −3.3 to 7.8 kg; and for FFM −7.9 to 3.7 kg. Conclusion  Rheumatoid cachexia and central obesity were common in patients with RA. Neither BMI nor MNA could detect this properly. There was a good relative agreement between DXA and BIA, but the limits of agreement were wide, which may restrict the utility of BIA in clinical practice. This work has in part been presented at the Congress of American College of Rheumatology in San Francisco, October 2008.     

Population-specific anthropometric cut-points improve the functionality of the Mini Nutritional Assessment (MNA) in elderly Taiwanese

The objective of this study was to determine the population-specific cut-points of body mass index (BMI), mid-arm circumference (MAC) and calf circumference (CC) for identifying subnormal nutritional status in elderly Taiwanese, and to evaluate the possibility of improving the functionality of the Mini Nutritional Assessment (MNA) by adopting these cut-points. This study analyzed data from 1583 men and 1307 women, 65 years or older, of a national survey. The survey involved in-home, face-to-face, interviews and anthropometric measurements. Results showed that based on the cumulative percentile curves, the fifth percentile values were: BMI, 17 kg/m2 for both men and women; MAC, 22.5 cm for men and 21 cm for women; and CC, 28 cm for men and 25 cm for women. Substitution of these population-specific cut-points for respective values in the MNA screen resulted in lowered proportions of elderly classified malnourished or at risk of malnutrition. The prevalence of malnutrition was reduced from 1.7% to 1.4% in men and from 2.4% to 1.5% in women. The proportions classified at risk of malnutrition were reduced from 10.1% to 8.9% for men and 16.8% to 12.8% for women. In conclusion, results suggest that the MNA is a valuable tool for geriatric nutritional risk assessment. However, in populations where significant differences exist in anthropometric measurements from the Caucasian populations, population-specific cut-points should be used.     

Assessment of Nutritional Risk in Community-Dwelling Older Adults (65 to 75 Years) in Kolkata,India

This study was conducted to profile nutritional risk factors in a population of community-dwelling older adults in Kolkata, India. We applied the short version of the Mini Nutritional Assessment–Short Form (MNA-SF) questionnaire among 500 participants (65 to 75 years)—263 males and 237 females. The prevalence of undernutrition was 8.8% in females and 4.9% in males; a risk of undernutrition was found in 24.5% females and 17.5% males. All those with undernutrition or at-risk were studied further using the full version of the MNA. Data regarding education, occupation, socioeconomic status, and food intake pattern were also collected. Females had a significantly lower (P < 0.01) education level than males; 73.4% males were financially independent, whereas 72.7% females were financially dependent on others. Moderate appetite loss was commonly found (64.9%), and in 24.3% of the participants appetite loss was severe. Digestive and chewing problems were present in 32.4% and 21.6% of study participants, respectively. The rate of psychological stress and/or acute disease 3 months prior to study was 47%, and 62.2% of the study population were taking 3 or more medicines per day. Weight loss of greater than 3 kg and of 1 to 3 kg during past 3 months of the study period was observed in 27% and 32.5% of the population, respectively. Undernourished individuals were also found to consume fewer protein-rich foods. We hypothesize that low education levels and lack of financial independence were the strongest underlying causes of high undernutrition in this population, particularly, among females.     

Mini Nutritional Assessment in geriatric rehabilitation: Inter-rater reliability and relationship to body composition and nutritional biochemistry

Aim: To determine the inter‐rater reliability of the Mini Nutritional Assessment (MNA) and relationship with body composition and nutritional biochemistry among older Australians undergoing rehabilitation. Methods: Thirty‐eight adults aged ≥65 years were prospectively and consecutively recruited from an Australian rehabilitation ward. Two dietitians independently administered the 18‐item MNA to determine inter‐rater reliability. MNA classifications (well nourished, at risk of malnutrition, malnourished) were compared with body composition (using dual‐energy X‐ray absorptiometry) and serum albumin. These analyses were also performed for the short‐form version of the MNA (six items). Results: In this cross‐sectional study, inter‐rater reliability of the 18‐item MNA score, estimated by the intraclass correlation coefficient, was 0.833, while inter‐rater reliability estimated by the weighted kappa index was 0.53. The two raters reached agreement on MNA classification for 26 of 38 cases (68%). Women classified as malnourished/at risk of malnutrition using the 18‐item MNA had lower total body fat (11 kg vs 29 kg, P < 0.01) and per cent body fat (25% vs 40%, P < 0.01), compared with women classified as well nourished. Similar findings were not apparent for men, although men classified as malnourished/at risk of malnutrition had lower serum albumin (32 g/L vs 36 g/L, P = 0.04) compared with men classified as well nourished. Similar findings were evident for the short‐form version of the MNA. Conclusion: The MNA was found to be useful for identifying older women with lower body fat in the Australian rehabilitation setting. The 18‐item MNA score has substantial inter‐rater reliability, and fair inter‐rater reliability when used according to the classifications. Inclusion of subjective and self‐reported items in surveys can be problematic for optimal reliability as can the use of such items in a subject population that is experiencing rapid progress in recovery.     

Risk of malnutrition among Brazilian institutionalized elderly: A study with the Mini Nutritional Assessment (MNA) questionnaire

Background  

Brazilian population has passed for a process of demographic transition throughout latest years, characterized for the increase of the elderly population. Malnutrition is a serious problem to frail elderly.     

Preoperative nutritional evaluation of elderly patients: the Mini Nutritional Assessment as a practical tool

BACKGROUND AND GOAL: Age and malnutrition are each surgical risk factors. Because the Mini Nutritional Assessment (MNA) has been specifically designed for assessing the nutritional status of elderly patients, it can be used for preoperative nutritional evaluation. Therefore, the MNA was included in the preoperative clinical evaluation of patients over 60 years of age to describe their nutritional status. METHODS: Every patient over 60 years of age, scheduled for elective surgery, was seen in anaesthesiology consultation and was submitted to the MNA. The MNA is a clinical score consisting of four additive items: 'Anthropometric assessment' based on BMI, mid-arm and calf circumferences, weight loss; global evaluation; dietetic assessment, and subjective assessment - these last three items being obtained through a specific questionnaire. It requires no biological marker. Awarding to the obtained score, the MNA stratifies patients in the following categories: well-nourished (24 相似文献   

各年龄段老年人生活方式对生活质量的影响

目的 探讨老年人上臂围（MAC）和小腿围（CC）诊断营养不良的最佳截断值,为老年人营养状况评估提供参考依据。 方法 于2015年9 — 12月采用分层随机整群抽样方法在山东省济南市和上海市抽取868名 ≥ 60岁老年人进行身高、体重、MAC、CC、血压、空腹血糖（FBG）、总胆固醇（TC）和甘油三酯（TG）等指标的测量和检测,分析男性和女性老年人营养学指标的差异及MAC和CC截断值的有效性,并采用受试者工作特征曲线（ROC）和约登指数法获得MAC和CC判定营养不良的最佳截断值。 结果 济南市和上海市调查的868名老年人中,营养不良者60例,营养不良率为6.91 %;男性老年人的MAC和CC值分别为（29.79 ± 4.50）和（35.98 ± 4.51）cm,均大于女性老年人的（28.90 ± 4.20）和（34.41 ± 3.60）cm,差异均有统计学意义（均P < 0.01）;男性老年人MAC和CC的最佳截断值分别为28.10和32.60 cm,女性老年人MAC和CC的最佳截断值分别为25.10和31.10 cm,经有效性分析,所得到的男、女性老年人的MAC和CC最佳截断值均能较好地将营养不良者与营养正常者区分开,且区分效果与根据体质指数（BMI）定义的营养状况无显著差异。 结论 在评价老年人营养状况时可采用适合目标人群的MAC和CC最佳截断值作为重要的参考指标。     

High Rates of Malnutrition in Older Adults Receiving Different Levels of Health Care in Lleida,Catalonia: An Assessment of Contributory Factors

The aim of this study was to define the factors associated with the presence or risk of malnutrition in older adults (>65 years of age) attending health care centers in Lleida, Catalonia, using a cross-sectional study approach. Nutritional parameters assessed included the Mini Nutritional Assessment Scale, sociodemographic and psychosocial factors, functional and cognitive status, swallowing and oral problems, texture and route of administration of the diet, changes in dietary intake, and presence of digestive disorders. A total of 398 individuals (184 men) with an average age of 77 years were included in the assessment. Poor nutritional status was recorded in 58% of the individuals. Factors independently associated with unsatisfactory nutritional status included weight loss, functional dependence, cognitive impairment, loneliness, living without a partner, history of heart disease, lung disease, and the presence of acute vomiting.     

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.     

营养风险筛查和主观全面评定用于肺癌非手术患者营养筛查的比较

目的调查肺癌非手术患者营养风险、营养不良（不足）、超重／肥胖发生率，比较营养风险筛查2002（NRS2002）和主观全面评定（SGA）用于肺癌非手术患者营养筛查的适用性和结果。方法连续定点抽样，对符合入选标准、获知情同意的153例肺癌非手术患者在人院次日晨分别采用NRS2002和SGA进行营养筛查，NRS2002筛查营养不足以体重指数（BMI）的中国标准判定。结果153例患者均完成NRS2002和SGA。用BMI中国标准判定营养不足、超重和肥胖发生率分别为10．5％、37．9％和9．1％。NRS2002筛查显示营养风险发生率为34．6％，SGA筛查显示营养不足发生率为33．3％；两种方法在营养不足筛查结果间差异无显著性（P=0．845）。结论NRS2002和SGA均适用于肺癌非手术患者营养不足筛查，NRS2002还可同时筛查患者的营养风险。     

A nationally representative survey of hospital malnutrition: the Italian PIMAI (Project: Iatrogenic MAlnutrition in Italy) study

Aim and methods  Nutrition, unhealthy lifestyles and cancer appear to be strictly related, but few authors have analysed the interest in dietary information of cancer patients and their families. This survey was conducted in the Veneto area (Italy) to investigate the concern of cancer patients and their family members about diet as a health tool before and after diagnosis of cancer. Results  Seven hundred and four questionnaires were collected: 380 from cancer patients and 324 from family members of cancer subjects. Breast cancer (BC) was the most frequent disease for patients (61.8%) as well as families (26.5%). Generally, the importance of having precise diet information after diagnosis is recognised by 40.3% of patients, with significant differences between the various types of cancer: gastric and colon/rectum cancer (GCC) patients were more concerned than BC women about precise information concerning a diet to follow immediately after diagnosis (p = 0.000, ODs = 3.10, CI 1.68–5.71) or during treatments (p = 0.001, ODs = 2.67, CI 1.46–4.89). The nutritional information is supplied to patients in 34% of cases and to relatives in 30.3%, often from non-medical sources. In total healthcare workers (family doctor, oncologist, surgeon, dietician) represented the exclusive source of dietary information for 24.9% of patients and 22.9% of family members. Diet after diagnosis changes in 69.1% of GCC patients and in 39.2% of BC women. Relatives, particularly women, report difficulties preparing patients’ meals in 30.7% of cases, changes in the eating habits of the entire family in 29.9% and discontent connected with patients diet in 13.9%. The concern about proper nutrition after diagnosis increases more in GCC subjects (p < 0.025) when compared to BC subjects and in patients with more recent diagnosis (p < 0.041) when compared with patients with diagnosis >5 years ago, while in family members the interest in diet after diagnosis increases more in women than in men (p < 0.030) without other differences regarding the degree of relationship, type of cancer or diagnosis time. Relatives (92.7%) have more interest in nutritional education than patients (74.9%). Cancer patients <65 years were more interested in educational initiatives concerning nutrition (p = 0.000, ODs = 4.46, CI 2.6–7.4) than older patients (>65 years) and female subjects were more concerned than male patients (p = 0.008, ODs = 2.11, CI 1.2–3.6). Conclusions  The interest in the dietary knowledge and in educational initiatives concerning nutrition is high in cancer patients and their relatives, although it decreases with the age. The poor attention paid to nutrition of cancer patients by various healthcare workers deserves consideration, since the psychophysical wellbeing and perhaps also survival of cancer patients can be improved by correct dietary management, as well as, naturally, by the principal treatments themselves.