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Research Article
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Comparison of revised mini nutritional assessment-short form with the three most popular malnutrition screening tools in hospitalized elderly patients

Year 2019, Volume: 58 Issue: 3, 274 - 281, 20.09.2019

Sumru Savas

https://doi.org/10.19161/etd.454035

Abstract

Aim: There is no gold standard to identify
nutritional risk (NR) at the hospitals for geriatric population. Mini
Nutritional Assessment-Short Form (MNA-SF) is widely used at hospitals where
body mass index (BMI) measurements are not applicable for most of patients.
Thus, revised MNA-SF (rMNA-SF) including calf circumference (CC) instead of BMI
may be an alternative. There are a few studies investigating efficacy of
rMNA-SF in this group. The aim of this study was to evaluate nutritional status
(NS) in hospitalized elderly patients with MNA-SF and revised form, NR
Screening–2002 (NRS-2002), and Malnutrition Universal Screening Tool (MUST),
and to compare the results.

Materials and Methods: Elderly patients hospitalized in Internal
Medicine Department were enrolled in the study retrospectively assessing NS.
with four nutritional screening tools (NST). from hospital records.

Results: A hundred patients (≥65 years) were
enrolled in the study. Any NR varied greatly, ranging from 18.4% to 86%. When
malnutrition and risk of malnutrition were evaluated together, NSTs showing the
highest frequency of NR to the lowest were rMNA-SF, MNA-SF, NRS-2002, and MUST,
respectively. While there was strong agreement between MNA-SF and rMNA-SF (κ =
0.861, P < 0.001), agreements between MUST and both NRS-2002 (κ = 0.509, P
<0.001) and rMNA-SF (κ = 0.322, P = 0.003) were moderate-poor.







Conclusions: Nutritional risk was
variable depending on the NST, and rMNA-SF may be a practical alternative for
bedridden elderly patients and/or when BMI measurements are lacking at
hospital. It should be kept in mind that NR might be overestimated.

Keywords

Malnutrition hospitals elderly nutrition assessment.

References

  • Healthcare Cost and Utilization Project Facts and Figures 2008. Statistics on Hospital-Based Care in the United States. Agency for Healthcare Research and Quality (AHRQ) [cited 23 May 2018]. Available from: http://www.hcup-us.ahrq.gov/reports/factsandfigures/2008/section1_TOC.jsp.
  • Marengoni A, Winblad B, Karp A, Fratiglioni L. Prevalence of chronic diseases and multimorbidity among the elderly population in Sweden. Am J Public Health 2008; 98 (7): 1198-200.
  • Wallace JI, Schwartz RS, LaCroix AZ, Uhlmann RF, Pearlman RA. Involuntary weight loss in older outpatients: incidence and clinical significance. J Am Geriatr Soc 1995; 43 (4): 329-37.
  • de Luis D, Lopez Guzman A. Nutritional status of adult patients admitted to internal medicine departments in public hospitals in Castilla y Leon, Spain. Eur J Intern Med 2006; 17 (8): 556-60.
  • Feldblum I, German L, Castel H, Harman-Boehm I, Shahar DR. Individualized nutritional intervention during and after hospitalization: the nutrition intervention study clinical trial. J Am Geriatr Soc 2011; 59 (1): 10-7.
  • White JV, Guenter P, Jensen G, Malone A, Schofield M. A.S.P.E.N. Board of Directors. Consensus statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). JPEN J Parenter Enteral Nutr 2012; 36 (3): 275-83.
  • Cederholm T, Bosaeus I, Barazzoni R, et al. Diagnostic criteria for malnutrition – an ESPEN consensus statement. Clin Nutr 2015; 34 (3): 335-40.
  • Cederholm T, Barazzoni R, Austin P, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr 2017; 36 (1): 49-64.
  • Vellas B, Guigoz Y, Garry P J et al. The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition 1999; 15 (2): 116–22.
  • Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening. Clin Nutr 2003; 22 (4): 415-21.
  • Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: developing the short-form Mini-Nutritional Assessment (MNA-SF). J Gerontol A Biol Sci Med Sci 2001; 56 (6): M366-72.
  • Kaiser MJ, Bauer JM, Ramsch C, et al. Validation of the Mini Nutritional Assessment Short-Form(MNA®-SF): A practical tool for identification of nutritional status. J Nutr Health Aging 2009;13 (9): 782-8.
  • Kondrup J, Rasmussen H H, Hamberg O et al. Nutritional Risk Screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 2003; 22 (3): 321–36.
  • Poulia KA, Klek S, Doundoulakis I, et al. The two most popular malnutrition screening tools in the light of the new ESPEN consensus definition of the diagnostic criteria for malnutrition. Clin Nutr 2017;36(4):1130-5.
  • Kondrup J, Johansen N, Plum L, et al. Incidence of nutritional risk and causes of inadequate nutritional care in hospitals. Clin Nutr 2002; 21 (6): 461-8.
  • Jensen G, Bistrian B, Roubenoff R, Heimburger D. Malnutrition syndromes: a conundrum vs continuum. J Parenter Enteral Nutr 2009; 33 (6): 710-6.
  • Poulia KA, Yannakoulia M, Karageorgou D, et al. Evaluation of the efficacy of six nutritional screening tools to predict malnutrition in the elderly. Clin Nutr 2012; 31 (3): 378-85.
  • Sánchez-Rodríguez D, Marco E, Annweiler C, Ronquillo-Moreno N, Tortosa A, Vázquez-Ibar O, et al. Malnutrition in postacute geriatric care: Basic ESPEN diagnosis and etiology based diagnoses analyzed by length of stay, in-hospital mortality, and functional rehabilitation indexes. Arch Gerontol Geriatr 2017; 73: 169-76.
  • Power L, Mullally D, Gibney ER, Clarke M, Visser M, Volkert D, et al. A review of the validity of malnutrition screening tools used in older adults in community and healthcare settings - A MaNuEL study. Clin Nutr ESPEN 2018; 24: 1-13.
  • Tsai AC, Chang TL, Wang YC, Liao CY. Population-specific short-form mini nutritional assessment with body mass index or calf circumference can predict risk of malnutrition in community-living or institutionalized elderly people in taiwan. J Am Diet Assoc 2010; 110 (9): 1328-34.
  • Bahat G, Tufan A, Tufan F, Kilic C, Akpinar TS, Kose M, et al. Cut-off points to identify sarcopenia according to European Working Group on Sarcopenia in Older People (EWGSOP) definition. Clin Nutr 2016;35(6):1557-63.
  • Bharadwaj S, Ginoya S, Tandon P, et al. Malnutrition: laboratory markers vs nutritional assessment. Gastroenterol Rep 2016; 4 (4): 272-80.
  • Simsek H, Sahin S, Ucku R, Sieber CC, Meseri R, Tosun P, et al. The diagnostic accuracy of the Revised Mini Nutritional Assessment Short Form for older people living in the community and in nursing homes. J Nutr Health Aging 2014; 18 (8): 725-9.
  • Sarikaya D, Halil M, Kuyumcu ME, Kilic MK, Yesil Y, Kara O, et al. Mini nutritional assessment test long and short form are valid screening tools in Turkish older adults. Arch Gerontol Geriatr 2015; 61 (1): 56-60.
  • Skipper A, Ferguson M, Thompson K, Castellanos VH, Porcari J. Nutrition screening tools: an analysis of the evidence. JPEN J Parenter Enteral Nutr 2012; 36 (3): 292-8.
  • van Bokhorst-de van der Schueren MA, Guaitoli PR, Jansma EP, de Vet HC. Nutrition screening tools: does one size fit all? A systematic review of screening tools for the hospital setting. Clin Nutr 2014; 33 (1): 39-58.
  • Garcia-Meseguer MJ, Serrano-Urrea R. Validation of the revised mini nutritional assessment short-forms in nursing homes in Spain. J Nutr Health Aging 2013; 17 (1): 26-9.
  • Velasco C, García E, Rodríguez V, et al. Comparison of four nutritional screening tools to detect nutritional risk in hospitalized patients: a multicentre study. Eur J Clin Nutr 2011; 65 (2): 269-74.
  • Eglseer D, Halfens RJ, Lohrmann C. Is the presence of a validated malnutrition screening tool associated with better nutritional care in hospitalized patients? Nutrition 2017; 37: 104-11.

Revize mini nütrisyonel değerlendirme-kısa form ile sık kullanılan üç malnütrisyon tarama aracının hastanede yatan yaşlı hastalarda karşılaştırılması

Year 2019, Volume: 58 Issue: 3, 274 - 281, 20.09.2019

Sumru Savas

https://doi.org/10.19161/etd.454035

Abstract

Amaç: Geriatrik popülasyonda hastanede nütrisyonel riski (NR) tanımlamak için altın standart bir yöntem bulunmamaktadır. Mini Nütrisyonel Değerlendirme-Kısa Form (MNA-SF) hastanelerde sık olarak kullanılmaktadır, bu gruptaki hastaların çoğunda vücut kitle indeksi (VKİ) ölçümleri yapılamamaktadır. Bu yüzden, baldır çevresi (BÇ)’ni VKİ yerine kullanan revize MNA-SF (rMNA-SF); pratik bir alternatif olabilir. Revize MNA-SF’un hastanede yaşlı hastalarda etkinliğini araştıran az sayıda çalışma mevcuttur. Bu çalışmanın amacı, hastanede yatan yaşlı hastaların nütrisyonel durumlarını (ND) MNA-SF ile revize formu, Nütrisyonel Risk Taraması (NRS-2002) ve Malnütrisyon Universal Tarama Aracı (MUST) ile değerlendirmek ve sonuçları karşılaştırmaktır. 

Gereç ve yöntem: İç hastalıkları Servisi’nde yatan yaşlı hastalar retrospektif olarak çalışmaya alınarak, ND hastane verilerinden dört nütrisyonel tarama testi (NTT) ile değerlendirildi.

 

Bulgular: Yüz ≥ 65 yaş ve üzeri hasta çalışmaya alındı. Farklı tanımlarla NR %18.4 ile %86 arasında değişen oranlarda bulundu. Malnütrisyon ve malnütrisyon riski birleştiririlerek beraber değerlendirildiğinde, NR oranını en yüksekten en aza doğru gösteren NTT’leri sırasıyla; rMNA-SF, MNA-SF, NRS-2002 ve MUST idi. MNA-SF ve rMNA-SF arasında güçlü bir uyum mevcut iken (κ = 0.861, P < 0.001), MUST ile NRS-2002 (κ = 0.509, P <0.001) ve rMNA-SF (κ = 0.322, P = 0.003) arasında da orta-zayıf uyum saptandı.

Sonuç: Hastanede yatan yaşlı hastalarda NR kullanılan NTT’e bağlı olarak oldukça değişkendir ve rMNASF; yatağa bağımlılarda ve/veya VKİ ölçümü yapılamayanlarda pratik bir alternatif olabilir. Ancak NR’i yüksek olarak tahmin edebileceği akılda tutulmalıdır. 

Keywords

Malnütrisyon hastane yaşlı nütrisyonel değerlendirme.

References

  • Healthcare Cost and Utilization Project Facts and Figures 2008. Statistics on Hospital-Based Care in the United States. Agency for Healthcare Research and Quality (AHRQ) [cited 23 May 2018]. Available from: http://www.hcup-us.ahrq.gov/reports/factsandfigures/2008/section1_TOC.jsp.
  • Marengoni A, Winblad B, Karp A, Fratiglioni L. Prevalence of chronic diseases and multimorbidity among the elderly population in Sweden. Am J Public Health 2008; 98 (7): 1198-200.
  • Wallace JI, Schwartz RS, LaCroix AZ, Uhlmann RF, Pearlman RA. Involuntary weight loss in older outpatients: incidence and clinical significance. J Am Geriatr Soc 1995; 43 (4): 329-37.
  • de Luis D, Lopez Guzman A. Nutritional status of adult patients admitted to internal medicine departments in public hospitals in Castilla y Leon, Spain. Eur J Intern Med 2006; 17 (8): 556-60.
  • Feldblum I, German L, Castel H, Harman-Boehm I, Shahar DR. Individualized nutritional intervention during and after hospitalization: the nutrition intervention study clinical trial. J Am Geriatr Soc 2011; 59 (1): 10-7.
  • White JV, Guenter P, Jensen G, Malone A, Schofield M. A.S.P.E.N. Board of Directors. Consensus statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). JPEN J Parenter Enteral Nutr 2012; 36 (3): 275-83.
  • Cederholm T, Bosaeus I, Barazzoni R, et al. Diagnostic criteria for malnutrition – an ESPEN consensus statement. Clin Nutr 2015; 34 (3): 335-40.
  • Cederholm T, Barazzoni R, Austin P, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr 2017; 36 (1): 49-64.
  • Vellas B, Guigoz Y, Garry P J et al. The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition 1999; 15 (2): 116–22.
  • Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening. Clin Nutr 2003; 22 (4): 415-21.
  • Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: developing the short-form Mini-Nutritional Assessment (MNA-SF). J Gerontol A Biol Sci Med Sci 2001; 56 (6): M366-72.
  • Kaiser MJ, Bauer JM, Ramsch C, et al. Validation of the Mini Nutritional Assessment Short-Form(MNA®-SF): A practical tool for identification of nutritional status. J Nutr Health Aging 2009;13 (9): 782-8.
  • Kondrup J, Rasmussen H H, Hamberg O et al. Nutritional Risk Screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 2003; 22 (3): 321–36.
  • Poulia KA, Klek S, Doundoulakis I, et al. The two most popular malnutrition screening tools in the light of the new ESPEN consensus definition of the diagnostic criteria for malnutrition. Clin Nutr 2017;36(4):1130-5.
  • Kondrup J, Johansen N, Plum L, et al. Incidence of nutritional risk and causes of inadequate nutritional care in hospitals. Clin Nutr 2002; 21 (6): 461-8.
  • Jensen G, Bistrian B, Roubenoff R, Heimburger D. Malnutrition syndromes: a conundrum vs continuum. J Parenter Enteral Nutr 2009; 33 (6): 710-6.
  • Poulia KA, Yannakoulia M, Karageorgou D, et al. Evaluation of the efficacy of six nutritional screening tools to predict malnutrition in the elderly. Clin Nutr 2012; 31 (3): 378-85.
  • Sánchez-Rodríguez D, Marco E, Annweiler C, Ronquillo-Moreno N, Tortosa A, Vázquez-Ibar O, et al. Malnutrition in postacute geriatric care: Basic ESPEN diagnosis and etiology based diagnoses analyzed by length of stay, in-hospital mortality, and functional rehabilitation indexes. Arch Gerontol Geriatr 2017; 73: 169-76.
  • Power L, Mullally D, Gibney ER, Clarke M, Visser M, Volkert D, et al. A review of the validity of malnutrition screening tools used in older adults in community and healthcare settings - A MaNuEL study. Clin Nutr ESPEN 2018; 24: 1-13.
  • Tsai AC, Chang TL, Wang YC, Liao CY. Population-specific short-form mini nutritional assessment with body mass index or calf circumference can predict risk of malnutrition in community-living or institutionalized elderly people in taiwan. J Am Diet Assoc 2010; 110 (9): 1328-34.
  • Bahat G, Tufan A, Tufan F, Kilic C, Akpinar TS, Kose M, et al. Cut-off points to identify sarcopenia according to European Working Group on Sarcopenia in Older People (EWGSOP) definition. Clin Nutr 2016;35(6):1557-63.
  • Bharadwaj S, Ginoya S, Tandon P, et al. Malnutrition: laboratory markers vs nutritional assessment. Gastroenterol Rep 2016; 4 (4): 272-80.
  • Simsek H, Sahin S, Ucku R, Sieber CC, Meseri R, Tosun P, et al. The diagnostic accuracy of the Revised Mini Nutritional Assessment Short Form for older people living in the community and in nursing homes. J Nutr Health Aging 2014; 18 (8): 725-9.
  • Sarikaya D, Halil M, Kuyumcu ME, Kilic MK, Yesil Y, Kara O, et al. Mini nutritional assessment test long and short form are valid screening tools in Turkish older adults. Arch Gerontol Geriatr 2015; 61 (1): 56-60.
  • Skipper A, Ferguson M, Thompson K, Castellanos VH, Porcari J. Nutrition screening tools: an analysis of the evidence. JPEN J Parenter Enteral Nutr 2012; 36 (3): 292-8.
  • van Bokhorst-de van der Schueren MA, Guaitoli PR, Jansma EP, de Vet HC. Nutrition screening tools: does one size fit all? A systematic review of screening tools for the hospital setting. Clin Nutr 2014; 33 (1): 39-58.
  • Garcia-Meseguer MJ, Serrano-Urrea R. Validation of the revised mini nutritional assessment short-forms in nursing homes in Spain. J Nutr Health Aging 2013; 17 (1): 26-9.
  • Velasco C, García E, Rodríguez V, et al. Comparison of four nutritional screening tools to detect nutritional risk in hospitalized patients: a multicentre study. Eur J Clin Nutr 2011; 65 (2): 269-74.
  • Eglseer D, Halfens RJ, Lohrmann C. Is the presence of a validated malnutrition screening tool associated with better nutritional care in hospitalized patients? Nutrition 2017; 37: 104-11.
There are 29 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Research Articles
Authors

Sumru Savas 0000-0003-4836-3786

Publication Date September 20, 2019
Submission Date May 25, 2018
Published in Issue Year 2019 Volume: 58 Issue: 3

Cite

Vancouver Savas S. Comparison of revised mini nutritional assessment-short form with the three most popular malnutrition screening tools in hospitalized elderly patients. EJM. 2019;58(3):274-81.
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