EVALUATION OF INPATIENTS NUTRITIONAL STATUS AND PROGNOSTIC INVOLVEMENT

Background: There is an association between malnutrition and mortality. However, it is unclear if this association is truly independent of confounding factors. Objectives: The objective of this study is to evaluate nutritional status, defined according to the three categories defined in the Nutritional Screening Tool “Mini Nutritional Assessment”, and to investigate its prognostic involvement. Design, Setting and Participants: Single cohort retrospective observational study in hospitalized patients between December 2013 and January 2014, who were placed under observation until September 2015 (21 months) (n=144). Nutritional status was determined by MNA short form at the beginning of the study, as well as clinical and epidemiological data. Results: Based on categories defined by MNA SF, 59 (40.97%) were well nourished, 55 (38.19%) were at risk of malnutrition, and 30 (20.83%) patients showed malnutrition. 45 patients died during follow up (31.25%). Of them, 40% (18) were malnourished, 38% (17), at risk of malnutrition, and 22% (9), well nourished. After adjusting for confounding factors, hazard ratio (95% CI) for all-cause mortality was significantly greater in the malnourished group (3.44 (1,27-9,31: p 0,015)), comparing to the reference group (well-nourished patients). Conclusions: Nutritional status defined according to the 3 categories defined in MNA short form predicts the probability of mid-term death in hospitalized patients, after adjusting for confounding factors as age and comorbidities. These data show the importance of knowing nutritional status during hospitalization for avoiding potential complications and helping the patient to overcome them.

Download Full-text

Association of GDF15 With Inflammation and Physical Function During Aging and Recovery After Acute Hospitalization: A Longitudinal Study of Older Patients and Age-Matched Controls

The Journals of Gerontology Series A ◽

10.1093/gerona/glab011 ◽

2021 ◽

Cited By ~ 1

Author(s):

Juliette Tavenier ◽

Line Jee Hartmann Rasmussen ◽

Aino Leegaard Andersen ◽

Morten Baltzer Houlind ◽

Anne Langkilde ◽

...

Keyword(s):

Nutritional Status ◽

Physical Function ◽

Plasma Levels ◽

Older Patients ◽

Nutritional Assessment ◽

Short Form ◽

Mini Nutritional Assessment ◽

Acute Illness ◽

Urokinase Plasminogen Activator Receptor

Abstract Growth differentiation factor 15 (GDF15) is a stress-induced cytokine. Its plasma levels increase during aging and acute illness. In older Patients and age-matched Controls, we evaluated whether GDF15 levels (i) were associated with recovery after acute illness, and (ii) reflected different trajectories of aging and longitudinal changes in health measures. Fifty-two older Patients (≥65 years) were included upon admission to the emergency department (ED). At 30 days after discharge (time of matching), Patients were matched 1:1 on age and sex with Controls who had not been hospitalized within 2 years of inclusion. Both groups were followed up after 1 year. We assessed plasma levels of GDF15 and inflammatory biomarkers, frailty, nutritional status (mini nutritional assessment short-form), physical and cognitive function, and metabolic biomarkers. In Patients, elevated GDF15 levels at ED admission were associated with poorer resolution of inflammation (soluble urokinase plasminogen activator receptor [suPAR]), slowing of gait speed, and declining nutritional status between admission and 30-day follow-up. At time of matching, Patients were frailer and overall less healthy than age-matched Controls. GDF15 levels were significantly associated with participant group, on average Patients had almost 60% higher GDF15 than age-matched Controls, and this difference was partly mediated by reduced physical function. Increases in GDF15 levels between time of matching and 1-year follow-up were associated with increases in levels of interleukin-6 in Patients, and tumor necrosis factor-α and suPAR in age-matched Controls. In older adults, elevated GDF15 levels were associated with signs of accelerated aging and with poorer recovery after acute illness.

Download Full-text

Inflammation, Appetite and Food Intake in Older Hospitalized Patients

Nutrients ◽

10.3390/nu11091986 ◽

2019 ◽

Vol 11 (9) ◽

pp. 1986 ◽

Cited By ~ 5

Author(s):

Sieske ◽

Janssen ◽

Babel ◽

Westhoff ◽

Wirth ◽

...

Keyword(s):

Food Intake ◽

Nutritional Status ◽

Nutritional Assessment ◽

Short Form ◽

Mini Nutritional Assessment ◽

Hospitalized Patients ◽

Assessment System ◽

Diagram Method ◽

Poor Appetite ◽

Severe Inflammation

The effect of inflammation on appetite and food intake has been rarely studied in humans. In this study, we examined the association of C-reactive protein (CRP), as an inflammatory marker, with appetite and food intake among older hospitalized patients. A total of 200 older individuals, who were consecutively admitted to a geriatric acute care ward, participated in this prospective observational study. Appetite was evaluated using the Edmonton Symptom Assessment System (ESAS) and the Simplified Nutritional Appetite Questionnaire (SNAQ), respectively. Food intake was measured according to plate diagram method and participants were categorized as having food intake <75% and ≥75% of meals served. Nutritional status was evaluated using the Mini Nutritional Assessment Short Form (MNA-SF). In addition, serum CRP was analyzed and the levels >3.0 (mg/dL) were considered as moderate to severe inflammation. Of total population with mean age 81.4 ± 6.6 years (62.5% females), 51 (25.5%) had no inflammation and 88 (44.0%) and 61 (30.5%) had mild and moderate to severe inflammation, respectively. According to MNA-SF, 9.0% and 60.0% had normal nutritional status or a risk of malnutrition, respectively, whereas 31.0% were malnourished. Based on the SNAQ-appetite-question, 32.5% of the patients demonstrated poor and very poor appetite whereas 23.5% reported severe loss of appetite according to ESAS. Ninety-five (48.0%) of the participants had food intake <75% of the meals offered. Significant associations between SNAQ-appetite (p = 0.003) and ESAS-appetite (p = 0.013) scores and CRP levels were observed. In addition, significant differences were observed in CRP levels between intake ≥75% and <75% of meals served (p < 0.001). Furthermore, there were significant associations between appetite and nutritional status whereas malnourished older patients demonstrated a decreased appetite compared to those with normal nutritional status (p = 0.011). In a regression analysis, inflammation was the major independent risk factor for patients’ appetite (p = 0.003) and food intake (p = 0.011) whereas other variables such as infection (p = 0.960), chronic inflammatory diseases (p = 0.371), age (p = 0.679) and gender (p = 0.447) do not show any impact on appetite. Our findings confirm that poor appetite and low food intake are associated with inflammation in older hospitalized patients, suggesting that inflammation may contribute an important aspect to the development of malnutrition in these patients.

Download Full-text

Complementarity of the Mini-Nutritional Assessment and Activities of Daily Living for predicting follow-up mortality risk in elderly Taiwanese

British Journal Of Nutrition ◽

10.1017/s0007114512001730 ◽

2012 ◽

Vol 109 (4) ◽

pp. 658-666 ◽

Cited By ~ 6

Author(s):

Alan C. Tsai ◽

Li-Chin Lee ◽

Jiun-Yi Wang

Keyword(s):

Nutritional Status ◽

Activities Of Daily Living ◽

Mortality Risk ◽

Daily Living ◽

Nutritional Assessment ◽

Short Form ◽

Mini Nutritional Assessment ◽

Cox Regression Analysis ◽

All Cause Mortality

Physical functional ability and nutritional status are two major indicators for predicting the risk of mortality in older adults. The present study examined the complementarity of the Activities of Daily Living (ADL) and the Mini-Nutritional Assessment (MNA) for predicting follow-up 4-year all-cause mortality risk in elderly Taiwanese. We analysed data of the ‘Survey of Health and Living Status of the Elderly in Taiwan’, a population-based longitudinal cohort study which involved 2872 men and women of ≥ 65 years old at baseline (1999). We rated their functional dependency with the ADL scale and nutritional status with the MNA (both the long form, LF and the short form, SF) at baseline, and analysed the complementarity of the two scales in predicting follow-up 4-year all-cause mortality with Cox regression analysis and the net reclassification improvement (NRI) to quantify the improvement. The results showed that both ADL and MNA offered improvement in predicting follow-up mortality risk beyond that predicted by either one alone according to the Akaike information criterion and the NRI. The MNA-SF was nearly as effective as the MNA-LF in improving the predictive ability of the ADL. The present study suggests that the MNA (especially the SF because of its simplicity and time-saving feature) together with the ADL scale might be of value for predicting the mortality risk of frail elderly living in various settings.

Download Full-text

Nutritional status and screening tools to detect nutritional risk in hospitalized patients with hepatic echinococcosis

Parasite ◽

10.1051/parasite/2020071 ◽

2020 ◽

Vol 27 ◽

pp. 74

Author(s):

Zhan Wang ◽

Jin Xu ◽

Ge Song ◽

MingQuan Pang ◽

Bin Guo ◽

...

Keyword(s):

Nutritional Status ◽

Nutritional Assessment ◽

Short Form ◽

Risk Index ◽

Mini Nutritional Assessment ◽

Hospitalized Patients ◽

Screening Tools ◽

Nutritional Risk ◽

Nutritional Screening ◽

Nrs 2002

Background: Echinococcosis is a chronic consumptive liver disease. Little research has been carried out on the nutritional status of infected patients, though liver diseases are often associated with malnutrition. Our study investigated four different nutrition screening tools, to assess nutritional risks of hospitalized patients with echinococcosis. Methods: Nutritional Risk Screening 2002 (NRS 2002), Short Form of Mini Nutritional Assessment (MNA-SF), Malnutrition Universal Screening Tool (MUST), and the Nutrition Risk Index (NRI) were used to assess 164 patients with alveolar echinococcosis (AE) and 232 with cystic echinococcosis (CE). Results were then compared with European Society for Clinical Nutrition and Metabolism (ESPEN) criteria for malnutrition diagnosis. Results: According to ESPEN standards for malnutrition diagnosis, 29.2% of CE patients and 31.1% of AE patients were malnourished. The malnutrition risk rates for CE and AE patients were as follows: NRS 2002 – 40.3% and 30.7%; MUST – 51.5% and 50.9%; MNA-SF – 46.8% and 44.1%; and NRI – 51.1% and 67.4%. In patients with CE, MNA-SF and NRS 2002 results correlated well with ESPEN results (k = 0.515, 0.496). Area-under-the-curve (AUC) values of MNA-SF and NRS 2002 were 0.803 and 0.776, respectively. For patients with AE, NRS 2002 and MNA-SF results correlated well with ESPEN (k = 0.555, 0.493). AUC values of NRS 2002 and MNA-SF were 0.776 and 0.792, respectively. Conclusion: This study is the first to analyze hospitalized echinococcosis patients based on these nutritional screening tools. Our results suggest that NRS 2002 and MNA-SF are suitable tools for nutritional screening of inpatients with echinococcosis.

Download Full-text

Malnutrition is Associated with Behavioral and Psychiatric Symptoms of Dementia in Older Women with Mild Cognitive Impairment and Early-Stage Alzheimer’s Disease

Nutrients ◽

10.3390/nu11081951 ◽

2019 ◽

Vol 11 (8) ◽

pp. 1951 ◽

Cited By ~ 8

Author(s):

Ai Kimura ◽

Taiki Sugimoto ◽

Kazuya Kitamori ◽

Naoki Saji ◽

Shumpei Niida ◽

...

Keyword(s):

At Risk ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Nutritional Status ◽

Nutritional Assessment ◽

Psychiatric Symptoms ◽

Early Stage ◽

Short Form ◽

Mini Nutritional Assessment ◽

Analysis Of Covariance

We examined the nutritional status and its association with behavioral psychiatric symptoms of dementia (BPSD) among 741 memory clinic patients (normal cognition (NC), 152; mild cognitive impairment (MCI), 271; early-stage Alzheimer disease (AD), 318). Nutritional status and BPSD were assessed using the Mini Nutritional Assessment Short-Form (MNA-SF) and the Dementia Behavior Disturbance Scale (DBD), respectively. Compared to subjects with NC, more subjects with MCI and early-stage AD were at risk of malnutrition (MNA-SF, 8–11: NC, 34.2%; MCI, 47.5%; early-stage AD, 53.8%) and were malnourished (MNA-SF, 0–7: NC, 4.6%; MCI, 5.9%; early-stage AD, 8.2%). Among patients with MCI or early-stage AD, those at risk of/with malnutrition showed higher DBD scores than those well-nourished (12.7 ± 9.0 vs. 9.5 ± 7.3; p < 0.001). Moreover, analysis of covariance adjusting for confounders showed that nutritional status was significantly associated with specific BPSD, including “verbal aggressiveness/emotional disinhibition” (F = 5.87, p = 0.016) and “apathy/memory impairment” (F = 15.38, p < 0.001), which were revealed by factor analysis of DBD. Our results suggest that malnutrition is common among older adults with mild cognitive decline, and possibility that nutritional problems are associated with individual BPSD.

Download Full-text

Predictive ability of the Mini Nutritional Assessment Short Form (MNA-SF) in a free-living elderly population: a cross-sectional study

PeerJ ◽

10.7717/peerj.3345 ◽

2017 ◽

Vol 5 ◽

pp. e3345 ◽

Cited By ~ 17

Author(s):

Raimunda Montejano Lozoya ◽

Nieves Martínez-Alzamora ◽

Gonzalo Clemente Marín ◽

Silamani J.A. Guirao-Goris ◽

Rosa María Ferrer-Diego

Keyword(s):

At Risk ◽

Nutritional Status ◽

Nutritional Assessment ◽

Short Form ◽

Mini Nutritional Assessment ◽

Predictive Ability ◽

Cross Sectional Study ◽

Sectional Study ◽

Free Living ◽

Cross Sectional

Background Various scales have been used to perform a quick and first level nutritional assessment, and the MNA is one of the most used and recommended by experts in the elderly in all areas. This scale has a short form, the MNA-SF, revised and validated in 2009, which has two versions: the BMI-MNA-SF contains the first six items of the full scale including Body Mass Index while the CC-MNA-SF includes Calf Circumference instead of BMI. Objective To evaluate the predictive ability for nutritional status of the two versions of the MNA-SF against the MNA in free-living elderly in the province of Valencia. Methods Cross-sectional study of 660 free-living elderly in the province of Valencia selected in 12 community centres using stratified sampling by blocks. Inclusion criteria: being aged 65 or over, living at home, having functional autonomy, residing in the province of study for more than one year, regularly attending community centres and voluntarily wanting to take part. Results Of the 660 subjects studied, 319 were men (48.3%) and 341 (51.7%) women with a mean age of 74.3 years (SD = 6.6). In terms of nutritional assessment, using the BMI-MNA-SF and the CC-MNA-SF we found that 26.5% and 26.2% were at risk of malnutrition and 0.9% and 1.5% were malnourished respectively. With the full MNA, 23.3% were at risk of malnutrition. Spearman’s rank correlation coefficients indicate a high association between the full MNA score and the MNA-SFs scores (BMI-MNA-SF: ρ = 0.78p < 0.001; CC-MNA-SF: ρ = 0.78p < 0.001). In addition we obtained a very high correlation between the two MNA-SFs (ρ = 0.96p < 0.001). We evaluated the agreement between the full MNA and the MNA-SFs classification in three nutritional categories (normal nutritional status, risk of malnutrition, malnutrition) with Cohen’s kappa coefficients (BMI-MNA-SF: κ = 0.54p < 0.001; CC-MNA-SF: κ = 0.52p < 0.001). These values indicate moderate agreement with the full MNA. There is very good agreement between the BMI-MNA-SF and CC-MNA-SF (κ = 0.88p < 0.001). In order to determine the ability of both MNA-SFs to identify subjects not requiring any nutritional intervention, we considered the dichotomised categorisation of the full MNA and the MNA-SFs as “normal nutritional status” vs. “malnutrition and risk of malnutrition” Areas under the ROC curves using MNA as the gold standard indicate moderately high prognostic accuracy (BMI-MNA-SF: AUC = 0.88p < 0.001; CC-MNA-SF: AUC = 0.87 p < 0.001). Both versions of the MNA-SF showed similar sensitivity, specificity and diagnostic effectiveness (BMI-MNA-SF: 73.4%, 86.6%, 83.5%; CC-MNA-SF 73.4%, 86.2%, 83.2%). Conclusions In its two versions the MNA-SF presents useful predictive ability against the MNA. The advantage of the CC-MNA-SF is that using it requires fewer resources and less time in primary care, although always the characteristics of the population must take into account to make the right decision based on the MNA-SF scales.

Download Full-text

DOES THE MINI NUTRITIONAL ASSESSMENT-SHORT FORM PREDICT CLINICAL OUTCOMES IN YOUNGER REHABILITATION PATIENTS?

Journal of Aging Research and Lifestyle ◽

10.14283/jarcp.2014.29 ◽

2014 ◽

pp. 1-7

Author(s):

L. Wegener ◽

S. James ◽

A. Slattery ◽

M. Satanek ◽

M. Miller

Keyword(s):

At Risk ◽

Nutritional Status ◽

Clinical Outcomes ◽

Nutritional Assessment ◽

Short Form ◽

Mini Nutritional Assessment ◽

Assessment Tools ◽

Post Discharge ◽

Retrospective Case ◽

Nutrition Screening

Objectives: To identify the nutritional status of younger patients on admission to rehabilitation using the Mini Nutritional Assessment – Short Form (MNA-SF) and determine whether the MNA-SF has predictive validity for clinical outcomes in this setting. Design: Retrospective case note audit. Setting: Rehabilitation Unit, Repatriation General Hospital, Adelaïde, Australia. Participants: Fifty four patients under 65 years (mean age 52.9±10 years, 54% female). Measurements: Case notes for adults admitted consecutively to rehabilitation were reviewed. Risk of malnutrition was categorised using the MNA-SF. Outcomes measured were length of stay (LOS), complications and poor participation during admission, change in function, discharge to higher level of care, and acute readmissions and mortality 18 months post discharge. Results: Fourteen (26%) subjects were malnourished and 28 (52%) were at risk of malnutrition as classified by the MNA-SF. There were no significant differences in clinical outcomes between patients classified as malnourished or at risk of malnutrition and those of normal nutritional status. Conclusion: Over three quarters of subjects were classified as malnourished or at risk of malnutrition. These patients were more likely to have adverse clinical outcomes than their well-nourished counterparts but the difference was not significant. Further research is required to investigate the validity of the MNA-SF and other nutrition screening and assessment tools for adults under 65 years old undergoing rehabilitation.

Download Full-text

Short-form Mini-Nutritional Assessment with either BMI or calf circumference is effective in rating the nutritional status of elderly Taiwanese – results of a national cohort study

British Journal Of Nutrition ◽

10.1017/s0007114513000366 ◽

2013 ◽

Vol 110 (6) ◽

pp. 1126-1132 ◽

Cited By ~ 9

Author(s):

Alan C. Tsai ◽

Tsui-Lan Chang ◽

Jiun-Yi Wang

Keyword(s):

Nutritional Status ◽

Cox Regression ◽

Nutritional Assessment ◽

Short Form ◽

Mini Nutritional Assessment ◽

The Elderly ◽

Calf Circumference ◽

Cox Regression Analysis ◽

National Cohort

The present study was aimed to validate two normalised short-form (SF) Mini-Nutritional Assessments (MNA) that contained either BMI (Taiwan version 1, T1) or calf circumference (CC; Taiwan version 2, T2) for rating the nutritional status of elderly Taiwanese. Both versions adopted Taiwanese anthropometric cut-offs, but T2 further had the BMI item replaced by CC. We compared the ability of the two SF in rating the nutritional status of 2674 elderly Taiwanese in the 1999 ‘Taiwan Longitudinal Survey on Aging’ with their respective full versions. We evaluated the agreement between the SF and full scales with weighted κ and performed Cox regression analysis for the follow-up 4-year mortality according to nutritional status rated at baseline. The results showed that the agreements between the respective SF and the full MNA were good (weighted κ: 0·679 for T1 and 0·667 for T2). Both SF performed well in predicting follow-up 4-year mortality relative to the full MNA. In conclusion, MNA-T1-SF and -T2-SF have good consistency with the full MNA and have quite comparable abilities in rating the nutritional status of elderly Taiwanese. Both SF versions appear appropriate for functioning as stand-alone units for rating the nutritional status of the elderly in community-living settings or the general population.

Download Full-text

The research methodology for malnutrition risk identification and dietary practices among community living elderly

IIUM Medical Journal Malaysia ◽

10.31436/imjm.v15i1.1232 ◽

2016 ◽

Vol 15 (1) ◽

Author(s):

Aliza Haslinda Hamirudin ◽

Nor Azlina A. Rahman ◽

Suriati Sidek ◽

Norain Zainudin

Keyword(s):

At Risk ◽

Nutritional Status ◽

Nutritional Assessment ◽

Short Form ◽

Mini Nutritional Assessment ◽

The Elderly ◽

Risk Identification ◽

Nutrition Intervention ◽

Dietary Practices ◽

Nutrition Screening

Introduction: Nutrition screening is an initial procedure to identify malnutrition, whilst subsequent nutrition intervention is warranted for at risk individuals. However, none of nutrition screening studies conducted among Malaysian elderly, accompanied by individualized nutrition intervention. The objective here is to describe the methodology to determine malnutrition risk and nutritional status of elderly in community at baseline and after 3 months of nutrition intervention; and to assess perception of elderly on their dietary practices. Methods: Elderly aged ≥ 60 years will be recruited as participants at several FELDA in Terengganu and Pahang with the calculated sample size of 416. Nutrition screening will be performed to identify malnutrition risk using a validated nutrition screening tool for the elderly in the community; the Mini Nutritional Assessment-Short Form. Dietary intake will be assessed using the diet history method and individualized nutrition intervention will be provided to improve nutritional status. Nutrition screening and assessment will be repeated after three months for malnourished and at risk elderly. An in-depth individual interview will be conducted to assess perception on dietary practices particularly prophetic food intake. Quantitative and qualitative data will be analyzed using IBM SPSS software and NVivo software, respectively. Results: Nutritional status of the elderly is anticipated to improve after 3 months of nutrition intervention and the elderly will perceive that their dietary practices are good. Conclusions: This research is at the forefront to provide individualized nutrition intervention following nutrition screening among Malaysian community elderly. It can potentially prevent further health complications associated with malnutrition through timely malnutrition identification and nutrition intervention.

Download Full-text

Population-specific Mini Nutritional Assessment effectively predicts the nutritional state and follow-up mortality of institutionalized elderly Taiwanese regardless of cognitive status

British Journal Of Nutrition ◽

10.1017/s0007114507873600 ◽

2008 ◽

Vol 100 (1) ◽

pp. 152-158 ◽

Cited By ~ 31

Author(s):

Alan C. Tsai ◽

Pei-Yu Ku

Keyword(s):

At Risk ◽

Nutritional Status ◽

Nutritional Assessment ◽

Mini Nutritional Assessment ◽

The Elderly ◽

Cognitive Status ◽

Severe Malnutrition ◽

Term Care ◽

Institutionalized Elderly

The study was conducted to determine the effectiveness of a modified Mini Nutritional Assessment (MNA) for assessing the nutritional status and predicting follow-up mortality of institutionalized elderly Taiwanese. The study was conducted in a large long-term care centre in central Taiwan. Trained interviewers assisted by the caregivers elicited sociodemographic data, healthcare and disease history, and answers to the MNA screen from each subject. One researcher performed all subjects' anthropometric measurements. Plasma albumin and cholesterol concentrations were determined. Results showed that the MNA without BMI, modified according to population-specific mid-arm circumference and calf circumference cut-points, effectively predicted the nutritional risk status of the elderly regardless of cognitive status. Substituting caregiver's assessments for self-viewed nutrition and health status (questions O and P of MNA) improved the predicting power of the tool in cognition-normal subjects. Results showed that 21·9 % of the elderly were malnourished, 59·2 % were at risk of malnutrition and 18·9 % were normal according to self-assessment whereas 14·2 % were malnourished, 59·2 % were at risk of malnutrition, and 26·6 % were normal according to caregiver's evaluation. The tool was also effective in predicting 12- and 6-month follow-up mortality in cognition-normal and cognition-impaired elderly, respectively. Results indicate that a population-specific MNA can effectively predict the nutritional status and 6-month follow-up mortality of elderly Taiwanese regardless of cognitive condition. Easier and wider application of the tool will enable early detection of emerging nutritional problems and timely intervention to prevent the development of severe malnutrition in the elderly.

Download Full-text