Abstract
Malnutrition is an independent marker of adverse outcomes in older adults. While the Simplified Nutritional Appetite Questionnaire (SNAQ) for anorexia has been validated as a nutritional screening tool, its optimal cutoff and validity in healthy older adults is unclear. This study aims to determine the optimal cutoff for SNAQ in healthy community-dwelling older adults, and to examine its factor structure and validity. We studied 230 community-dwelling older adults (mean age 67.2 years) who were nonfrail (defined by Fatigue, Resistance, Ambulation, Illnesses & Loss (FRAIL) criteria). When compared against the risk of malnutrition using the Mini Nutritional Assessment (MNA), the optimal cutoff for SNAQ was ≤15 (area under receiver operating characteristic (ROC) curve: 0.706, sensitivity: 69.2%, specificity: 61.3%). Using exploratory factor analysis, we found a two-factor structure (Factor 1: Appetite Perception; Factor 2: Satiety and Intake) which accounted for 61.5% variance. SNAQ showed good convergent, discriminant and concurrent validity. In logistic regression adjusted for age, gender, education and MNA, SNAQ ≤15 was significantly associated with social frailty, unlike SNAQ ≤4 (odds ratio (OR) 1.99, p = 0.025 vs. OR 1.05, p = 0.890). Our study validates a higher cutoff of ≤15 to increase sensitivity of SNAQ for anorexia detection as a marker of malnutrition risk in healthy community-dwelling older adults, and explicates a novel two-factor structure which warrants further research.
Highlights
Malnutrition is increasingly recognized as an important and independent marker of adverse outcomes in older adults, including higher chronic disease burden, frailty and mortality [1,2,3].The process of malnutrition and involuntary weight loss can be driven by anorexia, inadequate dietary intake, sarcopenia, cachexia, or a combination of these factors [4]
The higher Simplified Nutritional Appetite Questionnaire (SNAQ) cutoff lowers the threshold for detection of anorexia, improving its diagnostic performance as a screening tool by increasing sensitivity to rule out false negative cases of anorexia for further evaluation
A SNAQ cutoff of ≤15 could present an opportunity for early case detection of malnutrition risk in relatively healthy individuals, and early nutrition assessment, education and intervention to prevent adverse health outcomes and allow robust older adults to remain independent in the community [44,45,46]
Summary
Malnutrition is increasingly recognized as an important and independent marker of adverse outcomes in older adults, including higher chronic disease burden, frailty and mortality [1,2,3].The process of malnutrition and involuntary weight loss can be driven by anorexia, inadequate dietary intake, sarcopenia, cachexia, or a combination of these factors [4]. Over the last few decades, multiple screening tools have been developed to assess nutritional status, for example Mini-Nutritional Assessment (MNA), Malnutrition Universal Screening Tool (MUST), Nutritional Risk Screening 2002 (NRS-2002), and Geriatric Nutritional Risk Index (GNRI) While these tools are comprehensive and have been validated in various settings, there remains a need to strike a balance between efficacy and efficiency, especially for resource-intensive tools that require trained assessors or laboratory measurements [6,7,8]. These tools do not evaluate anorexia, which has been associated with increased risk for weight loss, malnutrition, and reduced quality of life in older adults [9]. A robust screening tool to evaluate appetite could serve as an early marker of malnutrition risk and downstream consequences of frailty and functional decline in robust older adults, and create opportunities for early intervention
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