Comparing the predictive ability of population-specific Mini-Nutritional Assessment with Subjective Global Assessment for Taiwanese patients with hemodialysis: A cross-sectional study

Abstract

BackgroundThe Mini-Nutritional Assessment (MNA) and Subjective Global Assessment (SGA) are two frequently used tools in nutritional assessment. ObjectivesThis study aimed to evaluate the feasibility of applying the MNA with population-specific anthropometric modifications and to compare the predictive ability of MNA with that of the SGA in patients with hemodialysis. DesignPurposive sampling. MethodsThis study was conducted in the Hemodialysis Unit of E-Da Hospital in Kaohsiung, Taiwan. A total of 192 patients with hemodialysis were evaluated their nutritional status concomitantly with the SGA and the MNA in two versions-MNA Taiwan version-I adopted population-specific anthropometric cut points, and MNA Taiwan version-II had body mass index (BMI) omitted. ResultsThe SGA graded 1% malnourished and 51% at risk of malnutrition for patients with hemodialysis; MNA Taiwan version-I graded 3% and 41%, respectively, whereas MNA Taiwan version-II graded 5% and 36%, respectively. There were significant differences between patterns of nutritional status predicted with the SGA and the MNA versions (P<0.05). The scores predicted with both tools correlated positively with appetite, serum albumin and creatinine levels, BMI, and mid-arm and calf circumferences, and negatively with number of emergency visits. However, only MNA versions negatively correlated with length of hospital stay (all P<0.05). Linear regression analysis revealed that the MNA Taiwan version-I, -II and SGA scores were positively associated with BMI and serum albumin level, and negatively associated with number of emergency visits after adjusting for confounders (all P<0.05). However, only MNA Taiwan version-I and -II were negatively associated with C-reactive protein (CRP) level (P<0.05). The associations of MNA Taiwan version-II with albumin and CRP levels were stronger than those obtained using MNA Taiwan version-I and SGA. ConclusionsThe present study suggests that both the modified MNA versions can evaluate nutritional risk of patients with hemodialysis in Taiwan. The MNA Taiwan version-II which adopted population-specific anthropometric cut values without BMI is better able to assess nutritional status and reflect health status of patients with hemodialysis than MNA Taiwan version-I and SGA.