Abstract
Up to 28% of elderly residents in Europe are at risk of malnutrition. As uniform diagnostic criteria for malnutrition have not been formulated, in autumn 2018, the Global Leadership Initiative on Malnutrition (GLIM) presented a consensus on its diagnosis. According to the consensus, the diagnosis of malnutrition requires a positive screening test result for the risk of malnutrition, and the presence of at least one etiologic and one phenotypic criterion. This study aimed to assess the diagnostic performance and accuracy of the Mini Nutritional Assessment—Short Form (MNA-SF) against GLIM criteria. The analysis involved 273 community-dwelling volunteers aged ≥ 60 years. All participants were screened for malnutrition with the MNA-SF questionnaire. Next, the GLIM phenotypic and etiologic criteria were assessed in all subjects. Based on the presence of at least one phenotypic and one etiologic criterion, malnutrition was diagnosed in more than one-third of participants (n = 103, 37.7%). According to the MNA-SF, only 7.3% of subjects had malnutrition, and 28.2% were at risk of malnutrition. The agreement between the MNA-SF score and the GLIM criteria were observed in only 22.3% of the population. The sensitivity and specificity of MNA-SF against the GLIM criteria were fair (59.2% and 78.8%, respectively). The area under the curve (AUC) was 0.77, indicating the fair ability of MNA-SF to diagnose malnutrition. Based on the present study results, the best solution may be an optional replacement of the screening tool in the first step of the GLIM algorithm with clinical suspicion of malnutrition.
Highlights
The global number of older adults with malnutrition is constantly increasing
This study aimed to evaluate the diagnostic performance and accuracy of the Mini Nutritional Assessment—Short Form (MNA-SF) against phenotypic and etiologic Global Leadership Initiative on Malnutrition (GLIM) criteria and to emphasize the importance of clinical suspicion in the diagnostics of malnutrition
As Da Silva Passos and De-Souza first noticed in their Letter to the Editor in 2019 [31], the GLIM criteria overlap items of validated screening questionnaires, which biases its sensitivity and specificity. They suggested that the high sensitivity and low specificity of the GLIM diagnostic criteria make them more appropriate as a screening tool than a malnutrition diagnostic, owing to the high risk of a false positive result
Summary
The global number of older adults with malnutrition is constantly increasing. Malnutrition may accompany inflammatory diseases associated with increased basal metabolic rate and changes in body composition [7,8]. Older people are at particular risk of malnutrition due to age-related physiologic changes, multimorbidity, psychological and socio-economic problems [9,10,11]. Malnutrition in elderly subjects is associated with increased risk of falls, disability, overall morbidity and mortality, health-related costs, and decreased quality of life [2,12,13,14]. [14] demonstrated that up to 28% of older adults in Europe are at risk of malnutrition, which was assessed with various diagnostic tools The systematic review and meta-analysis performed by Leij-Halfwerket al. [14] demonstrated that up to 28% of older adults in Europe are at risk of malnutrition, which was assessed with various diagnostic tools
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