Mini Nutritional Assessment Short Form Research Articles

Correlates of malnutrition in patients with heart failure: the role of social support.

Heart failure (HF) is a major public health challenge. Malnutrition has a significant effect on HF prognosis. Understanding the impact of social and clinical factors on the risk of malnutrition is necessary because it may aid in improving the health status of HF patients. Three hundred twenty patients with HF who were hospitalized in a heart centre in Shiraz, Iran, from March to November 2022 were studied. Two validated questionnaires were used to evaluate malnutrition and social support: (1) Mini-Nutritional Assessment Short Form and (2) Medical Outcomes Study Social Support Survey. The participants were then divided into three groups: those with normal nutritional status (scores 12-14), those at risk of malnutrition (scores 7-11), and those who were malnourished (scores 0-6). The potential correlates of malnutrition (including socio-demographic, clinical, comorbidities, and laboratory factors) were included in the study. Then, ordinal logistic regression was used to investigate the correlates of malnutrition. The mean age of the participants was 64.2±11.2years, and more than half were male and married. Normal nutritional status was seen in 110 (34.4%) participants, 151 (47.2%) were at risk of malnutrition, and 58 (18.1%) were malnourished. The mean social support score of the participants was 61.65±12.91. According to the adjusted odds ratios (95% confidence intervals) obtained from multivariate analysis, increased risk of malnutrition was associated with having a lower social support score [0.95 (0.93-0.97), P-value≤0.001], lower body mass index [0.91 (0.86-0.97), P-value=0.004], higher New York Heart Association classification [1.26 (1.02-1.56), P-value=0.03], longer duration of disease [1.006 (1.001-1.01), P-value=0.006], and lower serum albumin level [0.25 (0.08-0.75), P-value=0.01]. Besides the clinical conditions affecting the risk of malnutrition in patients with HF, social support may play an important role. Including this factor in HF guidelines and developing educational programmes may help improve HF patients' health.

Association between malnutrition and motor/non-motor symptoms in elderly with Parkinson disease

Background: Parkinson disease (PD) is a prevalent neurodegenerative disorder characterized by both movement and non-motor symptoms, potentially contributing to malnutrition. This study aims to investigate the association between malnutrition, assessed through the mini nutritional assessment-short form (MNA-SF), and motor/non-motor symptoms in elderly PD patients.Methods: A total of 48 PD patients were recruited, and their nutritional status was evaluated using MNA-SF. Motor/non-motor symptoms were assessed using the unified Parkinson’s disease rating scale (UPDRS). Statistical analysis was performed using linear regression, considering various covariates such as disease severity, cognitive function, and disease duration.Results: The mean age of the study group was 76.8 years, with 75% displaying abnormal nutritional status. An inverse correlation was evident between MNA-SF and UPDRS I, II, III, and overall scores. Patients with abnormal nutritional status developed severe limitations in daily activities and motor dysfunction. Both motor and non-motor symptoms were associated with malnutrition.Conclusions: This study suggests the significant relationship between nutritional status and motor/non-motor symptoms in elderly PD patients. The prevalence of malnutrition was particularly notable among older PD patients, highlighting the importance of consistent nutritional assessment due to its impact on PD severity. These findings suggest a complex interplay between PD symptoms and malnutrition, warranting further investigation with larger participant cohorts.

Concordance in oral frailty five-item checklist and oral hypofunction: Examining their respective characteristics

ObjectivesThis study examined the diagnostic concordance and characteristics of the oral frailty five-item checklist (OF-5) and oral hypofunction (OHF). Materials and methodsIn this extensive cross-sectional study, older adults were enrolled at a research hospital frailty clinic between July 2021 and July 2023. The diagnosis of OF-5 and OHF was conducted using the proposed assessment methods. The concordance rate of these criteria was determined by evaluating each patient and calculating the number of patients meeting each diagnosis's criteria. Patients who tested negative for the OF-5 and OHF criteria and those who met only one criterion were included in the OF-5 and OHF characteristic analysis. ResultsA total of 248 patients were included in the analysis (mean age 77.6 ± 6.8 years; 36.7 % men). Among the patients, 114 (46.0 %) and 116 (46.8 %) met the OF-5 and OHF criteria, respectively. Furthermore, 78 (31.5 %) participants met both the OF-5 and OHF criteria, whereas 96 (38.7 %) did not meet either criterion. Moreover, 36 (14.5 %) and 38 (15.3 %) patients tested exclusively positive for OF-5 and OHF, respectively. The OF-5-positive and OHF-negative group showed an older age, lower Mini Nutritional Assessment Short Form score, and higher fall risk than the OF-5-negative and OHF-negative group. However, no significant differences were observed between the OF-5-negative and OHF-positive and OF-5-negative and OHF-negative groups. ConclusionThe concordance rate of OF-5 and OHF diagnoses was 70.2 %. OF-5 showed a potential association with nutritional status and fall risk. Further longitudinal analyses are warranted to explore our study results.

Perception of Nutrition in Adults with Sickle Cell Disease: Concept Elicitation of Nutritional Status and the Mini Nutrition Assessment

Introduction Sickle Cell Disease (SCD) is a genetic disorder that causes recurrent vaso-occlusive pain events, functional impairment, and nutritional deficiencies due to increased metabolic demands. Prior studies have highlighted nutritional issues in people with SCD, such as micronutrient and macronutrient deficiencies, low body mass index (BMI), and a recent rise in obese adults with SCD. In older adults in the general population, evaluation and management of nutritional status is essential since malnutrition can weaken the immune system and increase the risk of hospitalization and death. Despite the importance of nutrition, little is known about the best way to evaluate nutritional status in older adults with SCD. To identify a relevant yet efficient method to evaluate nutritional status, we conducted content elicitation interviews to describe how younger and older adults conceptualized nutrition. Based on the content of the interviews, we piloted a brief nutritional survey called the Mini Nutritional Assessment (MNA); a common nutritional measure in geriatric assessments. Methods As standard practice for concept elicitation, we conducted semi-structured interviews with adults SCD in 4 separate focus groups: two groups of young adults age 18-39 and two groups of older adults age ≥ 40 years. Participants were asked about their perception of the construct of nutrition as part of a longer concept elicitation interview assessing the content validity of the Sickle Cell Disease Functional Assessment (SCD-FA), which is the geriatric assessment for adults with SCD. After focus group transcripts were analyzed using rapid qualitative analysis, we administered the MNA to a separate cohort of adults with SCD, since its content on macronutrients and hydration was consistent with how adults with SCD conceptualized nutrition. The scores on the 6-item MNA-Short Form (MNA-SF) range from 0 to 14 with higher scores indicating better nutritional status. Scores 12-14 indicate a normal nutritional status, 8-11 indicate at risk for malnutrition, and 0-7 indicate a malnourished state. Results The 4 focus group interviews included 6 younger adults (age 18-39) and 8 older adults (age ≥ 40 years) with SCD. Participants were 57% females and 79% had severe SCD genotype (HbSS or HbSβnull-thalassemia). In the focus groups, participants described a healthy diet as one that included the major food groups, which were generally defined as protein, fruits and vegetables, and starches/carbs. The majority discussed the importance of adequate hydration to reduce the risk of pain crises. Additionally, participants reported trying to substitute water for soda, juice, and caffeine containing beverages. Many participants stated that a healthy diet involved limited processed foods and sugars. Despite knowledge of the characteristics of a “healthy” diet, some participants expressed difficulty maintaining this diet. Based on these qualitative results, we selected the MNA to evaluate nutrition since it included items on hydration and assessed intake of various food groups as described by focus group participants. We administered the MNA-SF to a cohort of 88 adults with SCD and 81 had complete data to score the MNA-SF. The mean score for the MNA-SF for all participants was 11.7 ± 1.8 (younger adults 11.6 ± 1.9 and older adults 11.9 ± 1.8; p= 0.44). The MNA-SF identified 40% (n=34) as being at risk of malnutrition [36% of older adults and 46% younger adults]. Two participants were identified as being malnourished (1 younger and 1 older adult). On remaining MNA items (Table 1), 25% of participants reported decreased food intake with 17% having only 1 meal/day. Most participants (85%) consumed ≥ 1 serving of protein/day and 75% had ≥ 2 servings of fruits or vegetables/day. Most participants (68%) drank > 5 cups of water/day. Results were similar for younger and older adults with SCD. Conclusion Data from the focus group interviews revealed that BMI and unintentional weight loss measures alone did not comprehensively capture how people with SCD perceived the concept of nutrition. Incorporating the MNA-SF enhanced measurement of the nutritional domain in the SCD-FA by capturing data on food intake and hydration. In future studies we will assess the construct validity of the full MNA in a larger sample to identify older adults with SCD who would benefit most from nutritional interventions.

Effectiveness of nurse-delivered stepwise swallowing training on dysphagia in patients with Alzheimer's disease: A multi-center randomized controlled trial

BackgroundAlthough swallowing exercises are a fundamental treatment for dysphagia, few studies have evaluated the effectiveness of swallowing training in patients with Alzheimer's disease. MethodsWe recruited 93 patients with Alzheimer's disease from three hospitals in Guangdong, China. This was a parallel armed randomized controlled trial that randomly assigned patients to intervention (n = 48) and control (n = 45) groups. The intervention group adopted systematic stepwise swallowing training for four weeks based on routine dysphagia care. The control group implemented routine dysphagia care, including diet and posture management and health education about swallowing dysfunction. The swallowing function was the primary outcome, which was assessed using the Water Swallowing Test and Standard Swallowing Assessment. An abnormal eating behavior questionnaire was used to assess the incidence of aberrant eating behavior in patients with Alzheimer's disease. The Mini-Nutritional Assessment Short Form and Barthel index were adopted to evaluate the nutritional status and ability to carry out daily activities between groups. SPSS software was used to perform the chi-square test, t-test, and generalized estimation equation for data analysis. ResultsWe analyzed the effects of the stepwise swallowing training program using the generalized estimating equation method. The intervention group exhibited greater improvements in their swallowing function (Water Swallowing Test: β = −3.133, 95 % CI: −4.113, −2.154, P < 0.001; Standard Swallowing Assessment: β = −5.813, 95 % CI: −7.782, −3.844, P < 0.001), abnormal eating behaviors (abnormal eating behavior questionnaire: β = −13.324, 95 % CI: −21.643, −5.005, P = 0.002), daily function (Barthel index: β = 11.280, 95 % CI: 4.021, 18.540, P = 0.002), and nutritional status (Mini-Nutritional Assessment Short Form: β = 2.402, 95 % CI: 1.313, 3.490, P < 0.001) over time than the routine-care group in the fourth week. ConclusionsStepwise swallowing training is a safe and effective intervention for managing dysphagia and other related symptoms in patients with Alzheimer's disease.

Nutritional and Sarcopenia Assessment in Bilateral Lung Transplantation Recipient: Can “The Strongest One” Expect Improved Short-Term Outcomes?

Background: Scant data are available on nutritional status in bilateral lung transplant (BLT) candidates. Methods: All consecutive recipients admitted to the intensive care unit (ICU) of the University Hospital of Padua (February 2016–2020) after bilateral-lung transplant (BLT) were retrospectively screened. Data collected: (i) nutritional indices (body mass index (BMI), albumin level, prognostic nutritional index (PNI), mini nutritional assessment short-form (MNA-SF)); and (ii) muscular indices (creatinine height index (CHI)), skeletal muscle index (SMI), densitometry of paravertebral muscles on chest CT). Results: 108 BLT recipients were enrolled: 55% had a normal BMI, 83% had serum albumin levels &gt; 35 g/L; high PNI and MNA-SF scores were recorded in most of patients. A total of 74% had a “normal or slightly reduced protein state“ according to the CHI score; 17% were identified as “sarcopenic” according to muscle densitometry (Hu &lt; 30). Lower serum albumin was associated with longer invasive mechanical ventilation days (IMV) and ICU length of stay (p-value for non-linearity &lt; 0.01). PNI and BMI were also associated with an increased ICU length of stay (p-value for non-linearity &lt; 0.01). Conclusions: Most of the BLT recipients had normal nutritional and sarcopenia status. Pre-transplant albumin values correlated with the duration of IMV; serum albumin, PNI and BMI were associated with ICU stay. No nutritional or muscle parameters predicted re-intubation, 30-days rejection and overall length of hospital stay.

Influence of Nutritional Status and Physical Fitness on Cognitive Domains among Older Adults: A Cross-Sectional Study.

The health issues presented by the aging population can result in reduced muscle mass, poorer physical function, and cognitive impairment. The goal of this study was to determine how nutritional status and physical fitness relate to cognitive impairment in older adults. A cross-sectional descriptive and analytical study involving 100 participants was carried out to analyze the impact of nutritional status and physical fitness on cognitive impairment. Nutritional status was assessed with the Eating Assessment Tool (EAT-10) and The Mini Nutritional Assessment-Short Form (MNA-SF); physical fitness via the implementation of manual grip evaluation, the 4-m walking test (4-MWT), and the Timed Up and Go (TUG) test; and cognitive impairment evaluation was conducted using the Mini-Mental State Examination (MMSE), the Boston Naming Test (BNT) and the Controlled Oral Word Association Test (COWAT). Data analysis revealed that higher malnutrition status was associated with fewer correct responses in the COWAT (R2 = 0.421), while a correlation between higher MMSE and BNT scores, faster completion times for the 4-m walking and TUG tests, and an increase in handgrip strength load was also observed. The analysis of the data revealed that those individuals with superior nutritional status and greater levels of physical fitness outperformed others on the cognitive evaluation.

A comprehensive assessment of oral health, swallowing difficulty, and nutritional status in older nursing home residents

Declines in oral consumption and swallowing function are common reasons which may elevate the risk of malnutrition in the older adults. This study aimed to provide valuable information and contribute to the existing body of knowledge in this field as well as highlight the importance of a comprehensive assessment of oral health, swallowing function, and nutritional status in long-term care residents. This was a cross-sectional study. Thirty-nine participants were recruited from a nursing home. The comprehensive assessment was evaluated in participants, including oral health (Oral Health Assessment Tool (OHAT)), swallowing function (Functional Oral Intake Scale (FOIS) and Eating Assessment Tool (EAT)-10), and nutritional status (Mini Nutritional Assessment-Short Form (MNA-SF). The average age of participants was 80.4 ± 11.7 years, and 46% of these older adults were found to be at the risk of malnutrition. There was a negative correlation between the OHAT and MNA-SF scores. In addition, subjects with poor oral health (OHAT score = 5~8), oral consumption of a modified diet (FOIS score = 4~6), and reduced swallowing function (EAT-10 score ≥ 3) were more likely to be at risk of malnutrition. A comprehensive evaluation of oral health and swallowing function was closely connected with the nutritional status of older nursing home dwellers.

Exploring the Association between Delirium and Malnutrition in COVID-19 Survivors: A Geriatric Perspective.

Older individuals face an elevated risk of developing geriatric syndromes when confronted with acute stressors like COVID-19. We assessed the connection between in-hospital delirium, malnutrition, and frailty in a cohort of COVID-19 survivors. Patients aged ≥65, hospitalized in a tertiary hospital in Milan for SARS-CoV-2 pneumonia, were enrolled and screened for in-hospital delirium with the 4 'A's Test (4AT) performed twice daily (morning and evening) during hospital stay. Malnutrition was assessed with the malnutrition universal screening tool (MUST) at hospital admission and with the mini-nutritional assessment short-form (MNA-SF) one month after hospital discharge. Frailty was computed with the frailty index one month after hospital discharge. Fifty patients (median age 78.5, 56% male) were enrolled. At hospital admission, 10% were malnourished. The 13 patients (26%) who developed delirium were frailer (7 vs. 4), experienced a higher in-hospital mortality (5 vs. 3), and were more malnourished one month after discharge (3 of the 4 patients with delirium vs. 6 of the 28 patients without delirium who presented at follow up). The 4AT scores correlated with the MNA-SF scores (r = -0.55, p = 0.006) and frailty (r = 0.35, p = 0.001). Frailty also correlated with MUST (r = 0.3, p = 0.04), MNA-SF (r = -0.42, p = 0.02), and hospitalization length (r = 0.44, p = 0.001). Delirium, malnutrition, and frailty are correlated in COVID-19 survivors. Screening for these geriatric syndromes should be incorporated in routine clinical practice.

Nutritional status of elderly patients previously ill with COVID-19: Assessment with nutritional risk screening 2002 (NRS-2002) and mini nutritional assessment (MNA-sf)

BackgroundLong-term effects of COVID-19 showed a wide range of symptoms. Also, it was found that older patients were five times more likely than younger patients to develop long-COVID symptoms (1). This study aimed to investigate the use of Nutrition Risk Screening 2002 (NRS-2002) and the Mini Nutrition Assessment–Short Form (MNA-sf) among COVID-19 in elderly patients in Saudi Arabia. MethodsA total of (n = 159) COVID-19 elderly patients were recruited in the study; the relationship between patients' characteristics, including age, gender, Body Mass Index (BMI), infection history, vaccination and chronic disease were evaluated using NRS-2002 and MNA-sf. Multivariate logistic regression to estimate the Odd Ratio (OR) by comparing the OR of different variables between normal nutritional Status and at-risk and Cohen's kappa (κ) coefficient was assessed to analyse the agreement between both tools. ResultsMNA-sf showed a positive association between age and malnutrition risk ≥ 66 years old P = 0.035. Both tools showed a negative association between BMI (P < 0.001 and P = 0.046), respectively and vaccination (P = 0.002 and P = 0.01), respectively, with risk for malnutrition. There was no significant association between Diabetes (DM) and malnutrition risk, but elderly Cardiovascular Disease (CVD) were at malnutrition risk using the NRS- 2002 tool P = 0.003. Inversely, people infected six months or more before malnutrition assessment have a lower risk of malnutrition P = 0.05. ConclusionsBoth tools were valuable and practical tools for screening elderly people with COVID-19 who are at nutritional risk and those in need of additional nutritional intervention. Further research needed to be applied in the relationship between nutritional status during and post-infectious disease for elderly people using cross-sectional and intervention studies in order to prevent malnutrition complications in Saudi Arabia.

Use of Geriatric Assessment and Genetic Profiling to Personalize Selection of Intensive Versus Low Intensity Chemotherapy in Older Adults with Acute Myeloid Leukemia (AML): Final Results of a Phase II Trial

Introduction: Geriatric assessment can predict the risk of toxicities of chemotherapy in older adults. Genetic risk categories are associated with survival following intensive chemotherapy in AML. Integrating geriatric assessment for patient profiling and genetic profiling of leukemic cells represents an innovative precision medicine approach to personalize therapy selection in older adults with AML. We report final results of a pragmatic phase II trial using such strategy, aiming to reduce early mortality (NCT03226418). Methods: Patients ≥60 years with a new diagnosis of AML underwent geriatric assessment prior to initiation of treatment. Geriatric assessment of physical function, cognitive function and comorbidity burden were used to determine fitness for intensive chemotherapy (Table 1). Additional assessment included Karnofsky Performance Scale (KPS), Patient Health Questionnaire-9 (PHQ-9), and Mini Nutritional Assessment-Short Form (MNA). Genetic profiling for therapy selection relied on karyotyping and followed the 2017 European LeukemiaNet criteria. While available mutation test results were incorporated to risk stratify, the study did not require waiting for the results prior to therapy initiation, given an anticipated turnaround time of 1-2 weeks for mutation test results. Therapy selection followed the algorithm in Figure 1. Patients with good or intermediate-risk AML received intensive chemotherapy such as 7+3 +/- gemtuzumab or midostaurin if determined to be fit. Patients with high-risk AML received low-intensity chemotherapy such as a hypomethylating agent with or without venetoclax or novel drugs (based on timing of FDA approval of these drugs), or CPX 351 if they were fit and met the FDA-approved indications. Patients with organ dysfunction (e.g. creatinine ≥2 mg/dl) and those requiring chemotherapy for other malignancy were eligible for low-intensity chemotherapy. Chemotherapy could be administered in community oncology settings. Patients were followed for quality of life assessments, as well as functional and oncologic outcomes. Results: Between July 2017-October 2022, 75 patients were consented; 2 patients were considered screen failure. Baseline characteristics of 73 eligible patients included a median age of 69 years (range 60-87 years), 49% female, 92% white, and a median KPS of 80 (range 60-100). As presented in Table 1, most had ≥3 comorbidities (55%), impaired physical function measured by Short Physical Performance Battery (70% had a score of 9 or less) and impaired cognition measured by Montreal Cognitive Assessment (64% had a score of 25 or less). Genetic risk categories included adverse (62%), intermediate (22%), and good-risk AML (16%). Patients had one or more of the following mutations: TET2 (26%), NPM1 (22%), RUNX1 (19%), ASXL1 (19%), TP53 (19%), DNMT3A (16%), IDH2 (15%), IDH1 (11%), FLT3 ITD (10%), FLT3 TKD (10%), biallelic CEBPA (4%), EZH2 (2%). Seven patients (10%) received intensive chemotherapy; CPX 351 (n=4) or 7+3 based regimen (n=3). Other patients received low-intensity chemotherapy: azacitidine or decitabine and venetoclax (n=43, 59%), decitabine or azacitidine alone (n=18, 24%) prior to approval of venetoclax, and other (n=5, 7%). The median time from diagnosis to therapy initiation was 6 days and from enrollment to therapy initiation was 1 day (range 0-13). Mortality at 30 days from diagnosis was 6.8% (95% confidence interval, CI 3.0-15.1%) and at 90 days was 21.9% (95% CI 14.0-32.7%). Mortality compared favorably to an unmatched historical cohort of patients ≥60 years treated at our center between 2011-2016, where 30-day mortality was 30% (95% CI 22-40%) and 90-day was 41% (95% CI 32-52%) (Future Oncol. 2019;15:1989-95). Conclusions: Our model to personalize AML therapy selection represents an innovative approach to precision medicine that incorporates both geriatric assessment for patient profiling and genetic profiling of leukemia cells. Geriatric assessment demonstrated high frequency of impairment in objective physical and cognitive function. Patients were able to start therapy within a median of 1 day following enrollment. Pragmatic aspects of the trial included broad eligibility criteria and co-management of patients with community oncologists. The results from our final analysis appear promising with lower rates of early mortality compared to unmatched historical controls.

FRAIL Scale: an independent predictor of in-hospital mortality among older adults.

To screen for geriatric syndromes in older in-hospital patients and investigate their relationship with mortality. Demographic data, comorbidities, and medical history of the patients were recorded. Anthropometric measurements were obtained at 72 hours after hospital admission. The Mini Nutritional Assessment-Short Form, strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) sarcopenia screening questionnaire, Katz Activities of Daily Living scale, Lawton-Brody instrumental activities of daily living scale, the fatigue, resistance, ambulation, illness, and loss of weight (FRAIL) scale and the Eating Assessment Test-10 (EAT-10) screening test were used to assess geriatric syndromes. All patients were evaluated for delirium, pain, falls, polypharmacy, sleep disorders, incontinence, and pressure injury by the same researcher. A total of 85 patients were included in the study. The mean age was 75±7 years (range: 66-97). During hospital follow-up, 15.3% (n=13) of the patients died and 84.7% (n=72) were discharged. The median length of stay was 19 days (range: 3-126 days). In the multivariate analysis, frailty (hazard ratio: 2.67, 95% CI: 1.41-5.06, p=0.003) was found to be associated with in-hospital mortality. Frailty is an independent risk factor for in-hospital mortality in older adults.

Anorexia of aging: An international assessment of healthcare providers' knowledge and practice gaps.

Anorexia of aging is a common geriatric syndrome that includes loss of appetite and/or reduced food intake, with associated undernutrition, unintended weight loss, sarcopenia, functional decline, loss of independence and other adverse health outcomes. Anorexia of aging can have multiple and severe consequences and is often overlooked by healthcare professionals (HCPs). Even more concerningly, clinicians commonly accept anorexia of aging as an inevitable part of 'normal' aging. The aim of this assessment was to identify current gaps in professional knowledge and practice in identifying and managing older persons with anorexia. Results may guide educational programmes to fill the gaps identified and therefore improve patient outcomes. This international assessment was conducted using a mixed-methods approach, including focus group interviews with subject matter experts and an electronic survey of practicing HCPs. The assessment was led by the Society on Sarcopenia, Cachexia and Wasting Disorders (SCWD) and was supported by in-country collaborating organizations. A quantitative survey of 26 multiple-choice questions was completed by physicians, dietitians and other HCPs (n=1545). Most HCPs (56.8%) recognize a consistent definition of anorexia of aging as a loss of appetite and/or low food intake. Cognitive changes/dementia (91%) and dysphagia (87%) are seen as the biggest risk factors. Most respondents were confident to give nutritional (62%) and physical activity (59.4%) recommendations and engaged caregivers such as family members in supporting older adults with anorexia (80.6%). Most clinicians assessed appetite at each visit (66.7%), although weight is not measured at every visit (41.5%). Apart from the Mini-Nutritional Assessment Short Form (39%), other tools to screen for appetite loss are not frequently used or no tools are used at all (29.4%). A high number of respondents (38.7%) believe that anorexia is a normal part of aging. Results show that treatment is focused on swallowing disorders (78%), dentition issues (76%) and increasing oral intake (fortified foods [75%] and oral nutritional supplements [74%]). Nevertheless, the lack of high-quality evidence is perceived as a barrier to optimal treatment (49.2%). Findings from this international assessment highlight the challenges in the care of older adults with or at risk for anorexia of aging. Identifying professional practice gaps between individual HCPs and team-based gaps can provide a basis for healthcare education that is addressed at root causes, targeted to specific audiences and developed to improve individual and team practices that contribute to improving patient outcomes.

Association of nutritional status and comorbidity with long-term survival among community-dwelling older males

BackgroundEstimates of survival in the older can be of benefit in various facets, particularly in medical and individual decision-making. We aim to validate the value of a combination of nutrition status evaluation and comorbidity assessment in predicting long-term survival among community-dwelling older.MethodsThe Charlson Comorbidity Index (CCI) was applied for comprehensive evaluation of comorbidities. Participants were classified into CCI score ≤ 2 and ≥ 3 subgroups. Nutritional status was assessed by using Mini Nutritional Assessment-Short Form (MNA-SF) and Geriatric Nutritional Risk Index (GNRI) evaluations. Mortality rates and survival curves over a 5-year period were compared among subgroups classified by CCI and/or MNA-SF/GNRI evaluations.ResultsA total of 1033 elderly male participants were enrolled in this study, with an average age of 79.44 ± 8.61 years. 108 deceased participants (10.5%) were identified during a follow-up of 5 years. Cox proportional hazards regression analysis showed that age, CCI, MNA-SF and GNRI were independent predictors of 5-year all-cause death in this cohort. Compared to those with normal nutrition status and CCI ≤ 2, the subgroup at risk of malnutrition and CCI ≥ 3 had a significantly higher 5-year all-cause mortality rate (HR = 4.671; 95% CI:2.613–8.351 for MNA-SF and HR = 7.268; 95% CI:3.401–15.530 for GNRI; P < 0.001 for both). Receiver operating characteristic curve analysis demonstrated that a combination of either MNA-SF or GNRI with CCI had significantly better performance than CCI, MNA-SF or GNRI alone in predicting all-cause death.ConclusionThe combination of nutritional assessment (MNA-SF or GNRI) with CCI can significantly improve the predictive accuracy of long-term mortality outcomes among community-dwelling older males.

Evaluation of the Role of Dentures & Dietary Advice on Nutritional Status of Complete Edentulous Patients Using MNA®-SF: An Observational Study.

Aim This study aims to evaluate the role of dentures and dietary advice on the nutritional status of complete edentulous patients using the mini nutritional assessment-short form (MNA®-SF). Objective The objective of this study is to assess patients' nutrition using MNA®-SF before denture insertion and nutritional advice, to evaluate patients' nutrition usingMNA®-SF after denture insertion and nutritional advice at one month and three months, and to assess and compare pre- and post-insertion differences in nutrition usingMNA®-SF. Material and Method An observational study was conducted among 50 completely edentulous patients using theMNA®-SFquestionnaire. They were asked the questions at baseline and then after they were given complete dentures, after which they were recalled after one month and three months to assess the nutritional status usingMNA®-SF. All the questions were in the native language, so it was easy to understand the question and respond to it. Result It was found that the patient's nutritional status had significant changes, which shows that the dietary advice and complete denture affected the patient's nutritional status. Conclusions This study helped assess the efficacy and application ofMNA®-SFin completely edentulous patients. In this study, we provided nutritional guidance to patients in addition to complete denture prostheses to encourage them to have healthy eating habits.

Association of Nutritional Status and Diet Diversity with Skeletal Muscle Strength and Quality of Life among Older Arab Adults: A Cross-Sectional Study.

There is little research evaluating skeletal muscle strength, nutritional status, and quality of life in older Arab adults. This study examined the association of nutritional status with skeletal muscle strength and quality of life among older adults living in Saudi Arabia. A cross-sectional study was conducted among older adults (n = 166 older adults; 57.8% females) who visited primary outpatient clinics at King Khalid University Hospital in Riyadh City. Sociodemographic data, Mini Nutritional Assessment short-form (MNA-SF), diet variety score (DVS), and health-related quality of life (HR-QoL) were assessed. Furthermore, handgrip strength (HGS) and knee extension strength (KES) were measured to evaluate skeletal muscle strength. Malnourishment and risk of malnutrition were found in 16.9% of our sample. Nutritional status was significantly associated with muscle strength and HR-QoL (p < 0.05). The well-nourished group had higher HGS, KES, and total HR-QoL scores compared to the at risk of malnutrition or malnourished group. Moreover, there was a moderate positive correlation between MNA-SF and total HR-QoL scores (r = 0.40). The percentage of individuals in the well-nourished group categorized with a high or moderate DVS was significantly higher than those at risk of malnutrition or are malnourished; however, DVS was not associated with muscle strength and HR-QoL. The MNA-SF score had a significant positive correlation with HGS (r = 0.30) and KES (r = 0.23). An increase in the MNA-SF score was significantly associated with higher odds of being moderate/high (HGS and HR-QoL) in the crude and adjusted models. In conclusion, maintaining adequate nutritional status is beneficial for preserving skeletal muscle strength and promoting better HR-QoL among older individuals. Therefore, applications of appropriate nutritional and muscle strength assessments in geriatric care institutions are recommended.

Diagnostic test accuracy of preoperative nutritional screening tools in adults for malnutrition: a systematic review and network meta-analysis.

Good nutritional screening tests can triage malnourished patients for further assessment and management by dietitians before surgery to reduce the risk of postoperative complications. The authors assessed the diagnostic test accuracy of common nutritional screening tools for preoperative malnutrition in adults undergoing surgery and determined which test had the highest accuracy. MEDLINE, EMBASE, CINAHL, and Web of Science were searched for relevant titles with no language restriction from inception till 1 January 2023. Studies reporting on the diagnostic test accuracy of preoperative malnutrition in adults using one or more of the following index nutritional screening tools were included: Malnutrition Screening Tool (MST), Malnutrition Universal Screening Tool (MUST), Mini Nutritional Assessment (MNA), short-form Mini Nutritional Assessment (MNA-SF), Nutritional Risk Index (NRI), Nutrition Risk Screening Tool 2002 (NRS-2002), and Preoperative Nutrition Screening (PONS). The reference standard was the Subjective Global Assessment (SGA) before surgery. Random-effects bivariate binomial model meta-analyses, meta-regressions, and a network meta-analysis were used to estimate the pooled and relative sensitivities and specificities. Of the 16 included studies (5695 participants with an 11957 index and 11957 SGA tests), all were conducted after hospital admission before surgery. Eleven studies ( n =3896) were at high risk of bias using the Quality Assessment of Diagnostic Accuracy Studies tool due to a lack of blinded assessments. MUST had the highest overall test accuracy performance (sensitivity 86%, 95% CI: 75-93%; specificity 89%, 95% CI: 83-93%). Network meta-analysis showed NRI had similar relative sensitivity (0.93, 95% CI: 0.77-1.13) but lower relative specificity (0.75, 95% CI: 0.61-0.92) than MUST. Of all easy-to-use tests applicable at the bedside, MUST had the highest test accuracy performance for screening preoperative malnutrition. However, its predictive accuracy is likely insufficient to justify the application of nutritional optimization interventions without additional assessments.

Associations of intrinsic capacity, fall risk and frailty in old inpatients.

This study explored the associations of intrinsic capacity (IC), fall risk, and frailty in geriatric inpatients. A total of 703 hospitalized patients aged 75 years or older were recruited for this retrospective observational study from Zhejiang Hospital using a comprehensive geriatric assessment. The IC composite score was constructed from the scores of the Chinese version of the Mini-Mental State Examination, Short Physical Performance Battery, Short Form Mini Nutritional Assessment, 15-item Geriatric Depression Scale, and self-reported hearing and vision impairment. Adverse outcomes were recorded as the fall risk and frailty using the Morse Fall Scale and the Clinical Frailty Scale. Spearman's correlation coefficient analyses and multivariate logistic regression models were used to explore the associations between IC, high fall risk, and frailty. Declined IC composite scores were associated with increased risks of falls [odds ratio (OR) = 0.64, 95% confidence interval (CI): 0.57-0.72] and frailty (OR = 0.45, 95%CI: 0.37-0.54) among older hospitalized patients after adjusting for the related potential confounders. In addition, decreased cognitive, vitality, locomotion, and psychological scores were associated with increased adverse health conditions, with ORs ranging from 0.26 to 0.70. Vision impairment was observed to increase the risk of frailty (OR = 0.42, 95%CI: 0.23-0.76) after adjusting for the related potential confounders. This study indicated that declined IC was associated with fall risk and frailty in older inpatients. Further prospective studies are needed to explore the longitudinal associations between baseline IC and subsequent risk of falls and frailty.

Frailty and visual, auditory, olfactory, and taste senses in older patients visiting a frailty outpatient clinic.

Although studies have analyzed the relationship between frailty and human senses, few have comprehensively evaluated and examined their correlations. This study aimed to clarify the relationship between frailty and the senses of sight, hearing, smell, and taste. The subjects were outpatients at the Locomo Frail Outpatient Clinic. Sensory organ items were evaluated subjectively, and frailty was classified as nonfrail or frail using the Kihon Checklist. Univariate analysis was performed using the presence or absence of frailty as the dependent variable. Logistic regression analysis (forced entry method) was performed for the variables that showed significant differences. A total of 269 and 226 participants were assigned to the nonfrail and frail groups, respectively. The frequency of sensory organ impairment was 10.1% for taste, 12.7% for smell, 44.6% for vision, and 58.3% for hearing. Univariate analysis using the presence or absence of frailty as the dependent variable was determined to be significant for years of education, number of medications, Geriatric Depression Scale, Mini-Mental State Examination, Mini Nutritional Assessment-Short Form, grip strength, gait speed, sense of taste, sense of smell, sense of vision, and sense of hearing. Logistic regression analysis using the presence or absence of frailty as the dependent variable, adjusted for age, showed significant correlations with the Geriatric Depression Scale, gait speed, Mini Nutritional Assessment-Short Form, and olfactory impairment. Olfactory impairment had the strongest correlation with frailty. Although the sense of smell decreases with disease and aging, olfactory impairment may be correlated with frailty as a symptom of neurodegenerative diseases. Geriatr Gerontol Int 2023; 23: 871-876.

Prevalence of sarcopenia and its association with diet and physical activity in older adults with type 2 diabetes: A cross-sectional study.

This cross-sectional study explored the prevalence of sarcopenia in older adults with type 2 diabetes and investigated the effects of diet and physical activity on sarcopenia. In total, 577 older adults with diabetes were recruited from a teaching hospital in Taiwan. Diet and physical activity were assessed using self-rated questionnaires, including the Healthy Diet Inventory, the Mini Nutritional Assessment-Short Form, and the International Physical Activity Questionnaire-Short Form. Sarcopenia was defined in accordance with the Asian Working Group for Sarcopenia 2019 guidelines. In total, 51.12% of participants had either possible sarcopenia, sarcopenia, or severe sarcopenia. Participants who were female, old age, prolonged sedentary times, poor nutritional status, and lower level of moderate-to-vigorous physical activity were identified as risk factors for possible to severe sarcopenia. Older adults with diabetes and possible to severe sarcopenia had poor nutrition status and engaged in inadequate physical activity. The findings indicate that sarcopenia may be related to nutrition status and physical activity, especially in older adults with diabetes.