Mini Nutritional Assessment-Short Form Score Research Articles

Nutritional status and prognostic factors for mortality in patients admitted to emergency department observation units: a national multi-center study in China.

Nutritional risk is common among patients admitted to the emergency department and is associated with adverse clinical outcomes. Despite its large population, few comprehensive studies have been conducted in China concerning the nutritional status of patients admitted to emergency department observation units (EDOUs). Patients admitted to EDOUs of 90 tertiary hospitals in China between June 2020 and December 2020 were enrolled. Demographic information, laboratory parameters, nutritional support therapies, and 28-day mortality were recorded. Risk factors for mortality were examined using multi-variate-adjusted logistic regression analysis. Receiver operating characteristic (ROC) curves for each predictor of mortality were plotted, and the area under the ROC (AUROC) curves was compared. A total of 2,005 eligible patients were finally enrolled. At the 28-day follow-up, 1,911 patients survived, and 94 died. The group with a Nutritional Risk Screening 2002 (NRS 2002) score of 3-4 points was the largest (52.01%). The number of patients receiving oral nutritional supplements, enteral nutrition (EN), parenteral nutrition (PN), and the combination of EN and PN was 425, 314, 853, and 413, respectively. Among the total, 77.55% of patients had nutritional risk (NRS 2002 ≥3). The proportion of patients with high nutritional risk (NRS2002≥5) in the age group >80 years was significantly higher than that in the age group 66-80 years (29.00% vs. 23.93%, P=0.032), but not significantly higher than that in the age group 18-65 years (29.00% vs. 26.54%, P=0.449). Logistic regression analysis revealed that heart failure (odds ratio [OR] 1.856, 95% confidence interval [CI] 1.087-3.167, P=0.023), consciousness (OR 2.967, 95% CI 1.894-4.648, P<0.001), Acute Physiology and Chronic Health Evaluation II (APACHE II) score (OR 1.037, 95% CI 1.017-1.058, P<0.001), NRS 2002 score (OR 1.286, 95% CI 1.115-1.483, P=0.001), and Mini Nutritional Assessment-Short Form score (OR 0.946, 95% CI 0.898-0.997, P=0.039) were all independent risk factors for 28-day mortality. APACHE II and NRS 2002 scores were superior to other predictors according to the comparison of AUROC. Nutritional risk is prevalent among older patients in EDOUs in China. APACHE II and NRS 2002 scores are important risk factors for mortality in patients admitted to the EDOU. Timely and appropriate nutritional screening and support measures are critical to reduce patients' length of hospital stay and mortality.

The Trajectory of Nutritional Status and Physical Activity before and after Transcatheter Aortic Valve Implantation.

It is suggested that older patients waiting for an elective surgical procedure have a poor nutritional status and low physical activity level. It is unknown if this hypothesis is true and if these conditions improve after a medical procedure. We aimed to determine the trajectory of both conditions before and after transcatheter aortic valve implantation (TAVI). Included patients (n = 112, age 81 ± 5 years, 58% male) received three home visits (preprocedural, one and six months postprocedural). Nutritional status was determined with the mini nutritional assessment—short form (MNA-SF) and physical activity using an ankle-worn monitor (Stepwatch). The median MNA-SF score was 13 (11−14), and 27% of the patients were at risk of malnutrition before the procedure. Physical activity was 6273 ± 3007 steps/day, and 69% of the patients did not meet the physical activity guidelines (>7100 steps/day). We observed that nutritional status and physical activity did not significantly change after the procedure (β 0.02 [95% CI −0.03, 0.07] points/months on the MNA-SF and β 16 [95% CI −47, 79] steps/month, respectively). To conclude, many preprocedural TAVI patients should improve their nutritional status or activity level. Both conditions do not improve naturally after a cardiac procedure.

The impact of preoperative nutrition status on abdominal surgery outcomes: A prospective cohort study.

The European Society for Clinical Nutrition and Metabolism recommends nutrition screening using the Mini Nutritional Assessment Short-Form (MNA-SF) in older adult patients preoperatively. However, the association of nutrition condition with postoperative complications is poorly documented. We aimed to identify preoperative nutrition status using the MNA-SF and to determine whether preoperative nutrition status affects postoperative outcomes. Inpatients aged ≥55 years who underwent elective abdominal surgery under general anesthesia between April 1, 2016, and December 28, 2018, were included. We assessed nutrition status using the MNA-SF before surgery. Multiple logistic regression including the MNA-SF score was applied to determine associated factors with our primary outcome, postoperative complications defined as Clavien-Dindo classification ≥3a. Secondary outcomes including length of hospital stay and unplanned readmission were compared between normal, at risk, and malnourished patients. The data of 1248 patients with a mean age of 69 years were analyzed. The prevalence of at risk and malnutrition was 33.0% (412 of 1248) and 6.9% (87 of 1248), respectively. Overall, 12.4% (155 of 1248) had major postoperative complications, and the MNA-SF score was a significant predictor (odds ratio: 0.92, 95% CI: 0.86-0.99) after adjusting for confounders. Patients at risk of malnutrition and those with malnutrition had a longer hospital length of postoperative stay than normal patients (P = 0.001); however, there was no statistical significance in unplanned readmission rate between the three groups (P = 0.14). Preoperative nutrition disorder was common, and it affected postoperative adverse outcomes. The MNA-SF score was associated with major postoperative complications.

Prevalence of pre-operative undiagnosed cognitive impairment and its association with handgrip strength, oral hygiene, and nutritional status in older elective surgical patients in Japan.

Preoperative cognitive impairment is a significant factor influencing post-operative delirium. We have been performing routine pre-operative comprehensive assessments, including evaluation of cognitive function, handgrip strength, oral hygiene, and nutritional status, in patients aged ≥ 65years since April 2021. This study aimed to examine the completion rate of pre-operative comprehensive assessment and assess the prevalence of pre-operative undiagnosed cognitive impairment. In this prospective observational study including patients aged ≥ 65years scheduled for elective surgery with general or regional anesthesia, cognitive impairment was defined as a Mini-Cog score ≤ 2, and its associations with handgrip strength, oral hygiene, and nutritional status were evaluated. Oral hygiene and nutritional status were assessed using an oral frailty self-checklist and the Mini Nutritional Assessment-Short Form, respectively. The incidence of pre-operative undiagnosed cognitive impairment was estimated, and its associated factors were explored with multiple logistic regression. Among 331 eligible patients, the completion rate was 97.7% (305/312). The mean age was 74.8years, and 13.1% (40/305) (95% confidence interval [CI], 9.7-17.3%) of the patients had pre-operative undiagnosed cognitive impairment. Multiple logistic regression revealed that handgrip strength (odds ratio [OR] = 0.94, 95%CI = 0.89-0.99) and oral frailty self-checklist score (OR = 1.19, 95%CI = 1.02-1.40) were associated with pre-operative undiagnosed cognitive impairment, while the Mini Nutritional Assessment-Short Form score was not significantly associated (OR = 0.97, 95%CI = 0.82-1.14). Preoperative comprehensive assessment was feasible. The prevalence of pre-operative undiagnosed cognitive impairment was 13%, and poor handgrip strength and worse oral hygiene were significantly associated factors.

Oral Dysfunction in Patients with Oral Cancer Could Occur Before Treatment and Require Early Nutritional Improvement: A Cross-Sectional Study.

Patients with oral cancer have poor nutritional status before treatment. However, there have been no reports of the detailed evaluation of preoperative oral function in patients with oral squamous cell carcinoma (OSCC). Therefore, this study aimed to evaluate the preoperative oral function of patients with OSCC and examine the relationship with nutritional status. Oral function measurements (microorganisms, oral dryness, occlusal force, tongue pressure, masticatory function, EatingAssessment Tool, and Postoperative Oral Dysfunction Scale) and Mini Nutritional Assessment-Short Form (MNA-SF) data were collected from 51 patients with OSCC (men: 37, women: 14, mean age: 72.1years) who visited the Shimane University Hospital, Department of Oral and Maxillofacial Surgery, from September 2019 to September 2021. The tongue was the most prevalent primary gingiva site [22 patients (43.1%)], and 36 patients (70.6%) had advanced cancer. Comparisons between nutritional status and each related factor revealed significant differences in the number of individuals in the household, cancer stage, presence of pulmonary disease, number of teeth, microorganisms (grade), and masticatory function (mg/dL) (p < 0.05). Multiple regression analysis using the total MNA-SF score as the dependent variable with adjustment for confounding factors showed significant association between oral dryness and tongue pressure (p < 0.05). No significant association was found for the Eating Assessment Tool or Postoperative Oral Dysfunction scale. Patients with OSCC may have decreased oral function because of the tumor at the time of diagnosis, which causes a decline in nutritional status. Preoperative interventions are necessary to improve nutrition based on the state of oral function.

A Nutritionally Complete Oral Nutritional Supplement Powder Improved Nutritional Outcomes in Free-Living Adults at Risk of Malnutrition: A Randomized Controlled Trial.

Background: This randomized controlled trial investigated the effectiveness of an oral nutritional supplement (ONS) on nutrition-related outcomes over 12 weeks in Chinese adults with or at risk of malnutrition. Methods: 88 Chinese adults ≥18 years living independently in Hong Kong with Mini Nutritional Assessment-Short Form (MNA-SF) score ≤11 were randomly assigned to (1) 2 servings/day of nutritionally complete ONS powder made with water (Fresubin® Powder (Fresubin Kabi Deutschland GmbH, Bad Homburg, Germany), 600 kcal, 22.4 g protein) for 12 weeks (intervention group) or (2) no treatment (control group). The primary outcome was increase in body weight (BW) over 12 weeks. Secondary outcomes included improvement in body mass index (BMI), mid-arm circumference (MAC), calf circumference, MNA-SF score, quality of life, self-rated health, frailty, and diet quality. Results: The intervention group showed a significantly higher mean increase in BW compared with the control group (1.381 kg, intervention vs control, p < 0.001). The intervention group also showed significantly higher mean increases in BMI, MAC, calf circumference, intake of energy, protein, vitamin D, and calcium compared with the control group. No group differences in the changes of other outcomes were observed. Conclusions: For Chinese free-living adults at risk of malnutrition, daily consumption of a nutritionally complete ONS powder improved nutritional outcomes compared with the control group.

Obesity may increase survival, regardless of nutritional status: a Swedish cohort study in nursing homes

BackgroundTo investigate the associations between the body mass index (BMI), Mini Nutritional Assessment–Short Form (MNA-SF) scores, and 2-year mortality.MethodsA nationwide cohort study using data from a national quality register of older (age ≥ 65 years) nursing home residents (N = 47,686). Individuals were categorized according to BMI as underweight (< 18.5 kg/m2), normal-weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), and obese (class I, 30.0–34.9 kg/m2; class II, 35.0–39.9 kg/m2; class III, ≥ 40.0 kg/m2). Participants’ nutritional status were categorized as good (MNA-SF score 12–14), at risk of malnutrition (MNA-SF score 8–11), or malnutrition (MNA-SF score 0–7). Associations with mortality were analysed using Cox proportional-hazards models.ResultsAt baseline, 16.0% had obesity, and 14.6% were malnourished. During 2 years of follow-up, 23,335 (48.9%) individuals died. Compared with normal-weight individuals, mortality was greater among underweight individuals [hazard ratio (HR) 1.62, 95% confidence interval (CI) 1.55–1.69] and lesser among individuals with class I (HR 0.63, 95% CI 0.60–0.66), class II (HR 0.62, 95% CI 0.56–0.68), and class III (HR 0.80, 95% CI 0.69–0.94) obesity. Compared with individuals with good nutritional status, mortality was increased for those with malnutrition (HR 2.98,95% CI 2.87–3.10). Lower mortality among obese individuals was also seen in subgroups defined according to MNA-SF scores.ConclusionsAmong older nursing home residents, obesity, including severe obesity, was associated with lower 2-year mortality. Higher BMIs were associated with better survival, regardless of nutritional status according to MNA-SF.

Longitudinal association between nutritional status and behavioral and psychological symptoms of dementia in older women with mild cognitive impairment and early-stage Alzheimer's disease

While cross-sectional studies report associations between behavioral and psychological symptoms of dementia (BPSD) and nutritional status as a modifiable factor, their causal relationship remains unclear. Therefore, this study investigated the impact of nutritional status on BPSD. This study included women with mild cognitive impairment (MCI) and early-stage Alzheimer's disease (AD) from Memory Clinic, National Center for Geriatrics and Gerontology. The participants were assessed for nutritional status and BPSD using the Mini Nutritional Assessment Short-Form (MNA-SF) and the Dementia Behavior Disturbance Scale (DBD), respectively. Based on their MNA-SF scores, the subjects were classified as well-nourished, at risk of malnutrition, or malnourished. Nutritional status and change in BPSD was examined for association by univariate and multivariate linear regression analyses. This study analyzed 181 women (79 with MCI and 102 with early-stage AD). The multivariate analysis showed that the malnourished subjects or those at risk of malnutrition (54.1%) were significantly associated with increased DBD scores (β=0.255, P=0.003) during follow-up. In addition, multivariate regression analysis incorporating change in DBD sub-score as a dependent variable showed that the malnourished subjects or those at risk of malnutrition were associated with increased DBD sub-scores for "verbal aggressiveness/emotional disinhibition" (β=0.247, P=0.005). Poor nutritional status increased BPSD, especially verbal aggressiveness/emotional disinhibition, in those with MCI and early-stage AD during 2.5-year follow-up. Patients with MCI and early-stage AD may need to be assessed for nutritional status from early on, at the onset of mild cognitive decline, and require intervention to prevent worsening of BPSD. Further intervention studies in large prospective cohorts are needed to establish nutritional measures to prevent progression of BPSD in older adults with cognitive impairment.

P896: DEVELOPMENT AND VALIDATION OF A FRAILTY PREDICTION MODEL MORE SUITABLE FOR MULTIPLE MYELOMA IN CHINESE PATIENTS: THE TM FRAILTY SCORE.

Background: Frailty is associated with adverse clinical outcomes in patients with multiple myeloma (MM). Accurate evaluation of frailty is critical when choosing appropriate chemotherapy regimens for elderly patients. Currently, the IMWG geriatric assessment (GA) is widely used to assess tolerance to chemotherapy for elderly patients. However, the applicability of the IMWG GA in the Chinese MM population is limited. Aims: To developed a new frailty model that is more suitable for Chinese patients with MM. Methods: The applicability of the IMWG GA was evaluated in 167 consecutive patients diagnosed with MM from June 2019 to September 2021 at the First Affiliated Hospital of Sun Yat-sen University. Eight comprehensive geriatric assessment (CGA) domains were analyzed in 135 of these patients to screen items most closely associated with the outcomes, including grade ≥ 3 adverse events (AEs), treatment discontinuation, TTP, and OS. A new frailty prediction model was developed, and its fitness and predictive performance were compared to those of the IMWG GA. Results: The patients in the IMWG GA Frail group had a higher rate of grade ≥3 AEs, a higher rate of treatment discontinuation, and a greater risk of death than those in the Fit group (P<0.05). No significant differences were observed in patients in the Int-fit group who experienced chemotherapy AEs, treatment discontinuation, and TTP compared with the Fit group. By screening items in all 8 CGA domains, multivariate analysis confirmed that the Timed Up and Go test（TUG） and the Mini Nutritional Assessment Short-Form（MNA-SF） were independent prognostic factors for grade ≥3 AEs and OS. We found that the TUG and MNA-SF scores could stratify the risk of grade ≥ 3 AEs in the IMWG GA Int-fit group (P < 0.05). After MNA-SF was added to construct the IMWG GA Plus model, Harrell’s concordance index (C-index) of the IMWG GA Plus model for the prediction of grade ≥3 AEs increased from 0.662 to 0.701. The C-index for treatment discontinuation rose from 0.636 to 0.669. We further combined the TUG test and the MNA-SF to construct the TM frailty scoring system. The KM curve analysis showed that the TM frailty score could well distinguish the risk of AEs between the Fit and Frail groups (P<0.05). The C-index of the TM frailty score was 0.741, 0.690, and 0.702 for grade ≥ 3 AEs, treatment discontinuation, and OS, respectively, suggesting good predictive ability, which was higher than that of the IWMG GA (C-index=0.662, 0.636 and 0.631, respectively) and the IMWG GA Plus model (C-index=0.701, 0.656 and 0.618, respectively). Image:Summary/Conclusion: A novel scoring system—the TM frailty score—was developed by combining the TUG (T) and MNA-SF (M). The TM frailty score is more appropriate than the IMWG GA for evaluating frailty in the Chinese population.

Relationship between chewing ability and malnutrition, sarcopenia, and frailty in older adults.

Several studies reported that impaired nutrition is associated with reduced muscle mass, muscle strength, and physical performance. Chewing ability is essential to maintain balanced oral nutrient intake. The study was designed to define the possible relationship between chewing ability and nutrition-related problems (malnutrition, sarcopenia, and frailty) in a holistic perspective. This cross-sectional study recruited adults aged ≥65 years. All patients were evaluated with comprehensive geriatric assessment. Sarcopenia was diagnosed according to European Working Group on Sarcopenia in Older People criterion. Malnutrition was determined according to body mass index, calf circumference, and Mini Nutritional Assessment short form (MNA-SF). Frailty status was diagnosed with the Clinical Frailty Scale. Masseter and gastrocnemius muscle thicknesses (MTs) were measured via ultrasonography imaging. Oral examinations were carried out by a dentist, and chewing performance was examined with a color-changeable chewing gum. Overall, 135 older adults (76 females) were analyzed. Mean ± SD age was 75.7 ± 7.2 years; 37.0% of the patients were frail, 3.7% were malnourished, 12.6% were sarcopenic, and 20.0% had poor chewing function. In the poor chewing function group, age and frailty scores were increased and the MNA-SF scores, handgrip strength, skeletal muscle index, and masseter MT were reduced (all P < 0.05). After adjusting for confounders, regression analysis showed that low grip strength and low gastrocnemius MT were independently associated with poor chewing ability. Chewing ability was related to sarcopenia. Age and low grip strength in females and low cognitive scores and having low gastrocnemius MT in males were independent variables affecting chewing ability.

A Comparative Study of Three Nutritional Risk/Screening Indices for Predicting Cardiac Events and Physical Functioning Among Patients with Acute Heart Failure.

Undernutrition is very common among patients with heart failure (HF). This study evaluated the prognostic values of three nutritional risk/screening indices among patients with acute HF. We retrospectively calculated scores for 465 patients with acute HF using the Controlling Nutritional Status (CONUT) tool, the Geriatric Nutritional Risk Index (GNRI), and the Mini-Nutritional Assessment Short Form (MNA-SF). The outcomes of interest were the 1-year rate of cardiac events (cardiac-related death or HF-related readmission) and the Barthel index as an index of physical function during hospitalization. The CONUT, GNRI, and MNA-SF scores were significantly correlated, although the proportions of a normal nutritional state varied (CONUT: 18.3%, GNRI: 32.9%, and MNA-SF: 43.9%). Kaplan-Meier estimates revealed that cardiac events were more common among patients with undernutrition based on the CONUT score, and multivariable regression analysis revealed that only the CONUT score independently predicted poor outcomes. Furthermore, changes in the Barthel index during hospitalization were significantly correlated with the CONUT score but not with the GNRI and MNA-SF scores. In receiver operating characteristic analyses, the CONUT score had the most powerful predictive values on both the postdischarge incidence of cardiac events and the decline of physical function during hospitalization compared with the GNRI and the MNA-SF. These results indicate that the CONUT score might provide useful information for predicting poor outcomes in patients with acute HF.

Management of Malnutrition Based on Multidisciplinary Team Decision-Making in Chinese Older Adults (3M Study): A Prospective, Multicenter, Randomized, Controlled Study Protocol.

BackgroundIn hospital settings, malnutrition affects 30–50% of aged inpatients and is related to a higher risk of hospital complications and death. This study aims to demonstrate the effectiveness of a tailored optimum nutritional therapy in malnourished, elderly inpatients based on multidisciplinary team recommendations in hopes of decreasing the incidence of deleterious clinical outcomes.Methods and DesignThis trial will be a multicenter, open-label, randomized control trial conducted in the geriatric wards of at least five hospitals in five different regions. We aim to include 500 inpatients over the age of 60 with or at risk of malnutrition based on a Mini Nutritional Assessment Short-Form (MNA-SF) score of ≤ 11 points and the Global Leadership Initiative on Malnutrition with an expected length of stay of ≥ 7 days. Eligible inpatients will be randomized into a 1:1 ratio, with one receiving a multidisciplinary team intervention and the other receiving standard medical treatment or care alone. A structured comprehensive assessment of anthropometry, nutritional status, cognition, mood, functional performance, and quality of life will be conducted twice. These assessments will take place on the day of group allocation and 1 year after discharge, and a structured screening assessment for elderly malnutrition will be conducted at 3 and 6 months after discharge using the MNA-SF. The primary outcome will be nutritional status based on changes in MNA-SF scores at 3, 6 months, and 1 year. The secondary outcome will be changes in cognition, mood, functional status, length of hospital stay, and all-cause mortality 1 year after discharge.DiscussionGuided by the concept of interdisciplinary cooperation, this study will establish a multidisciplinary nutrition support team that will develop an innovative intervention strategy that integrates nutritional screenings, evaluations, education, consultation, support, and monitoring. Moreover, nutritional intervention and dietary fortification will be provided to hospitalized elderly patients with or at risk of malnutrition. The nutrition support team will formulate a clinical map for malnutrition in elderly patients with standardized diagnosis and treatment for malnutrition in this population.Clinical Trial Registration[www.ClinicalTrials.gov], identifier [ChiCTR2200055331].

Correlation between nutrition, oral health, and different sarcopenia groups among elderly outpatients of community hospitals: a cross-sectional study of 1505 participants in China

BackgroundStudies have rarely explored the association between oral health status and different sarcopenia groups (possible sarcopenia, diagnosed sarcopenia, and severe sarcopenia). Moreover, these studies have not reported any definitive conclusions of their relationship. We aimed to characterize the oral health status, prevalence of sarcopenia, and risk factors in different sarcopenia groups of elderly outpatients of community hospitals. Furthermore, we determined the correlation among nutrition, oral health, and different sarcopenia groups.MethodsOverall, 1505 elderly participants (aged ≥ 65 years) completed the survey. The Mini Nutritional Assessment short-form (MNA-SF) was used to assess the nutrition status of the elderly. Oral health was assessed using the instrument of the oral health assessment index of the elderly (General Oral Health Assessment Index [GOHAI]), and the number of remaining natural teeth (NRT) was counted. Data on muscle mass, muscle strength, and gait speed were collected, and sarcopenia was classified into three groups (possible sarcopenia, diagnosed sarcopenia, and severe sarcopenia) according to the Asian Working Group for Sarcopenia 2019. Multinomial logistic regression multivariate analysis was used to test their relationships.ResultsEighty-eight (5.8%) participants were identified as having possible sarcopenia; 142 (9.5%), diagnosed sarcopenia; 136 (9.0%), severe sarcopenia; and 1139 (75.7%), no sarcopenia. Of the seven variables, advancing age was typically associated with an increasing prevalence of sarcopenia (odds ratio [OR] = 1.06–1.47, 95% confidence interval [CI] = 1.06–1.47). The results showed that household income (OR = 0.57, 95% CI = 0.33–0.98), education level (OR = 3.32, 95% CI = 1.09–10.07), and chronic diseases (OR = 0.34, 95% CI = 0.19–0.62) were significantly associated with the severe sarcopenia group. Physical activity scores were significantly associated with the diagnosed sarcopenia and severe sarcopenia groups. Participants with < 20 NRT were more likely to have diagnosed sarcopenia (OR = 5.55, 95% CI = 3.80–8.12) or severe sarcopenia (OR = 6.66, 95% CI = 4.13–10.76) than participants with > 20 NRT. The GOHAI score was associated with the diagnosed sarcopenia (OR = 5.55, 95% CI = 3.80–8.12) and severe sarcopenia (OR = 6.66, 95% CI = 4.13–10.78) groups. The MNA-SF score was associated with the different sarcopenia groups.ConclusionsAssessing early and improving lifestyle with respect to nutrition and oral health may be an effective way to reduce or delay the occurrence of sarcopenia.

Interrater reliability of routine screening for risk of malnutrition with the Mini Nutritional Assessment Short-Form in hospital

Background/objectivesThe Mini Nutritional Assessment Short-Form (MNA-SF) is the recommended screening tool for older persons. Data on interrater reliability in clinical routine are rare. Thus, we wanted to quantify the interrater reliability of the MNA-SF in hospital.Subjects/methodsThis observational cross-sectional study was undertaken retrospectively. The study population comprised 105 participants. Risk of malnutrition was measured twice with the routine MNA-SF performed by nurses (within 24 h after admission) and a dedicated dietician (one to three days after the first MNA-SF). The MNA-SF score was analyzed for interrater reliability between nurse and dietician.ResultsParticipants’ mean age was 82.4 (±7.1) years and 71 (68%) were women. The mean total MNA-SF score was 7.4 (±2.4) assessed by dietician and 7.8 (±2.3) assessed by nurse. The intra-class correlation coefficient between the total MNA-SF scores was 0.74 (0.61; 0.82), indicating moderate reliability. For the MNA-SF nutritional status, Cohens Kappa was 0.37 (p < 0.05) showing a fair agreement.ConclusionMultiple misclassifications were observed between malnutrition and risk of malnutrition. Because mean scores were near the border between malnutrition and risk of malnutrition, we recommend to consider the total MNA-SF score in addition to the three risk groups to assess nutritional risk in geriatric hospital patients.

An Increased Anticholinergic Drug Burden Index Score Negatively Affect Nutritional Status in Older Patients Without Dementia.

Introduction/AimAnticholinergic drugs, which have severe central and peripheric side effects, are frequently prescribed to older adults. Increased anticholinergic drug burden is associated with poor physical and cognitive functions. On the other side, the impact of anticholinergics on nutritional status is not elaborated in the literature. Therefore, this study was aimed to investigate the effect of the anticholinergic burden on nutrition.Materials and MethodsPatients who underwent comprehensive geriatric assessment (CGA) 6 months apart were included in the study. Patients diagnosed with dementia were excluded because of the difference in the course of cognition, physical performance and nutrition. Nutritional status and global cognition were evaluated using Mini Nutritional Assessment-short form (MNA-SF), Mini-Mental State Examination (MMSE). Anticholinergic drug burden was assessed with the Drug Burden Index (DBI), enabling a precise dose-related cumulative exposure. Patients were divided into three groups according to DBI score: 0, no DBI exposure; 0–1, low risk; and ≥1, high risk. Regression analysis was performed to show the relationship between the difference in CGA parameters and the change in DBI score at the sixth month.ResultsA total of 423 patients were included in the study. Participants' mean age was 79.40 ± 7.50, and 68.6% were female. The DBI 0 score group has better MMSE and MNA-SF scores and a lower rate of falls, polypharmacy, malnutrition, and risk of malnutrition in the baseline. Having malnutrition or risk of malnutrition is 2.21 times higher for every one-unit increase in DBI score. Additionally, during the 6-month follow-up, increased DBI score was associated with decreased MNA-SF and MMSE score, albumin.ConclusionsThe harmful effects of anticholinergics may be prevented because anticholinergic activity is a potentially reversible factor. Therefore, reducing exposure to drugs with anticholinergic activity has particular importance in geriatric practice.

Association of Nutritional Status with New-Onset Delirium in Elderly, Acute Care, Orthopaedic Trauma Patients: A Single-Center Observational Study.

To determine whether nutritional status at hospital admission is independently associated with new-onset delirium (NOD) in elderly, orthopaedic trauma patients. Single-center, retrospective, cross-sectional study. Data from patients at a large teaching hospital in Boston, MA, were analyzed. All patients were ≥65 years and hospitalized for acute surgical management of their major fractures after trauma. None. Nutritional status was assessed at admission using the Mini Nutritional Assessment-Short Form (MNA-SF). Delirium was assessed using the Confusion Assessment Method within 24 hours of admission and daily throughout hospitalization. The incidence of delirium was 20% (94/471). Each unit decrement in MNA-SF was associated with a 14% higher risk of NOD (adjusted OR 1.14; 95% CI 1.05-1.28). Moreover, malnourished patients (MNA-SF score 0-7) were twice as likely to develop NOD (adjusted OR 2.07; 95% CI 1.01-4.35) compared with patients who were not malnourished (MNA-SF score 8-14). In hospitalized, elderly, orthopaedic trauma patients, poor nutritional status may be a modifiable risk factor for NOD. Future studies are needed to determine whether aggressive nutritional interventions can reduce the incidence of NOD and improve outcomes in this cohort of patients. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Delirium and geriatric syndromes in hospitalized older patients: Results from World Delirium Awareness Day

Objective: To determine the point prevalence of delirium and the associated risk factors in geriatric inpatients. Patients and Methods: Sixty-two hospitalized patients aged 60 years and over were recruited. The Mini Nutritional Assessment-Short Form (MNA-SF), the FRAIL scale, Katz Activities of Daily Living (ADL), and Lawton-Brody Instrumental ADL (IADL) questionnaires were administered. A delirium evaluation test (Confusion Assessment Method-CAM) was performed for diagnosing delirium. Mortality was evaluated one month after the index date. Results: The median age was 71.5 (range, 60-96) years. Delirium was detected in 29% of the patients. Frailty and dementia were associated with delirium (p<0.001 and p=0.001; respectively). Polypharmacy, indwelling urinary catheter, and low albumin were also related to delirium (p=0.025, p=0.007, and p=0.002; respectively). Age over 70 years, low Katz ADL and low MNA-SF scores were found to be independently associated with delirium in multivariate regression analysis models. The median hospitalization time was longer in the delirium group (p=0.029). Survival analysis at one month showed no significant difference between the delirium and non-delirium groups. Conclusion: Age over 70 years, impaired functionality in ADL and malnutrition were independently associated with delirium.

Association between nutritional status and depression among centenarians in Hainan Province

Objective: To explore the relationship between nutritional status and depression of centenarians in Hainan Province. Methods: A total of 1 002 elderly people in Hainan Province who were 100 years of age or older on June 1, 2014 were included in the study. The basic condition questionnaire, Mini Nutritional Assessment Short-Form (MNA-SF), Instrumental Activities of Daily Living-Lawton scale (Lawton-IADL) and Geriatric Depression Scale (GDS-15) were used to collect the subjects' demographic characteristics, disease history, nutritional status, functional status of daily activities, and depression, respectively. The restricted cubic spline fitting logistic regression model was used to analyze the relationship between the scores of MNA-SF and depression. The multivariable logistic regression model was used to analyze the relationship between nutritional status and depression in the total population and different subgroups of daily activity function. Results: The M (Q1, Q3) of subjects' age was 102 (101, 104) years old, among which 82.0% (822) were women. The prevalence of malnutrition, impaired daily activities, and depression was 20.8% (208 cases), 64.7% (648 cases) and 28.5%(286 cases), respectively. Restricted cubic spline fitting logistic regression model showed a linear association between the scores of the MNA-SF and depression (P=0.251). The higher the MNA-SF score was, the lower the risk of depression was in centenarians. Multivariable logistic regression model analysis showed that after adjusting for sex, education level, diabetes, hypertension, coronary heart disease, visual function, hearing function, and functional status of daily activities, malnutrition was positively associated with the development of depression in the total population and the subgroup with impaired daily activities [OR (95%CI) was 1.50 (1.07-2.11) and 1.56 (1.09-2.24), respectively], but not in the subgroup with good daily activities [OR (95%CI): 0.77 (0.21-2.80)]. Conclusion: Malnutrition is positively associated with depression, especially in the centenarians with impaired daily activities.

Association of anticholinergic burden with undernutrition in older adults: A cross-sectional study.

Limited data are available concerning the contribution of drugs with anticholinergic properties (DAPs) to undernutrition among older adults. This study aimed to determine the potential association of anticholinergic burden (ACB) to nutrition status in older people. We prospectively enrolled participants aged over 65 who underwent a comprehensive geriatric assessment between January 2017 and June 2020. Nutrition status was assessed by the Mini Nutritional Assessment-Short Form (MNA-SF). The ACB was assessed using the ACB scale. A total of 615 participants were included in the analysis (mean age ± SD, 78.5 ± 6.6 years; male, 55.3%). The prevalence of undernutrition (MNA-SF score <12) was 22.6% (n = 139). Participants with undernutrition were predominantly older (P < 0.001), had lower mean body mass index scores (undernutrition, 27.3 ± 5.4 vs healthy, 29.5 ± 8.0; P = 0.007), had a lower educational level (P = 0.016), had higher cardiovascular disease morbidity (P < 0.001), and had a higher ACB (P < 0.001) when compared with those with normal nutrition status. In adjusted analysis, the odds of having undernutrition were higher among participants with an ACB score >1 (odds ratio, 1.20; 95% CI, 1.01-1.43; P = 0.044). The weighted multivariate linear regression analysis showed a significant inverse association between the total ACB score and MNA-SF score controlling for multiple confounders. ACB appears to be inversely correlated with nutrition status among older adults. Undernutrition may be considered an additional reason to consider deprescribing DAPs in this population.

Features of older community-dwelling adults with osteosarcopenia requiring support or care.

[Purpose] This study aimed to investigate the problems associated with osteosarcopenia and its effect on physical performance, nutritional status, and support or care required by older community-dwelling adults. [Participants and Methods] This study investigated 141 older community-dwelling adults requiring support or care using an ambulatory rehabilitation service. The patients were divided into a control, osteopenia only, sarcopenia only, and osteosarcopenia group. We investigated the associations of each condition with the baseline information, grip strength, gait speed, Mini Nutritional Assessment-Short Form score, and support or care level required. [Results] The osteosarcopenia group consisted of 43.3% of the total study participants. Osteosarcopenia was more closely associated with body mass index, support or care level, grip strength, gait speed, skeletal muscle mass index, and Mini Nutritional Assessment-Short Form score than osteopenia or sarcopenia alone. [Conclusion] Osteosarcopenia is highly prevalent in older community-dwelling adults requiring support or care, which may suggest a greater effect on physical performance, nutritional status, and support or care required than that exerted by osteopenia or sarcopenia alone.