Total Mini Nutritional Assessment Score Research Articles

Evaluations of nutritional status according to mini nutritional assessment in elder home-care patients

Objective To assess the risk of malnutrition in elder home-care patients through mini nutritional assessment (MNA) and study the correlations between total MNA score and 18 individual questions in this patient group.Methods In May 2011,62 elder home-care patients from our center answered the MNA questionnaire.And the results were used to analyze the correlations between total MNA score and individual questions and the correlations among MNA classifications and body mass index(BMI),mid-arm muscle circumference (MAMC) and calf circunference (CC).Results According to MNA,18％ were malnourished ( 11/62 ),47％ at risk of malnutrition ( 29/62 ) and 35％ well-nourished ( 22/62 ) ; BMI,independence,mobility,neuropsychological problems,ingesting method,MAMC,CC and selfperceived nutritional status,self-perceived health status showed strong correlations with total MNA score (0.601,0.600,0.666,0.611,0.627,0.618,0.726,0.612,0.672,P ＜0.05).And weight loss within a month,number of daily meals and intake of drinks showed weak correlations with total MNA score (0.35,0.319,0.288,P ＜ 0.05 ).Positive correlations existed among MNA classifications and BMI,MAMC,CC (15.45,19.85,31.89,P＜0.05).Conclusions The elder home-care patients have a high risk for malnutrition.Half of 18 individual questions are strongly correlated with total MNA score in this patient group. Key words: Nutrition assessment; Home care services ; Questionnaires; Cross-sectional studies

Different components of nutritional status in older inpatients with cognitive impairment.

To evaluate different components of nutritional status in older patients with cognitive deficit, particularly in those with mild cognitive impairment (MCI). Cross-sectional study. 560 elderly subjects aged ≥ 65 years consecutively admitted to an acute Geriatric Unit of Apulia region of southern Italy. A standardized comprehensive geriatric assessment was used to evaluate medical, cognitive, affective and social aspects. Nutritional status was assessed using the mini nutritional assessment (MNA). The cognitive function was categorized into three levels - MCI, dementia or normal cognition (NoCI) - according to the neuropsychological test score. Subjects with cognitive decline had significantly lower frequency of well-nourished (MCI=10%, dementia=8%, NoCI=22%, p<0.05) and higher frequency of malnourished (MCI=47%, dementia=62%, NoCI=19%, p<0.001) than patients with normal cognition. Similarly, MNA total score, MNA-3 and MNA-4 subscores were significantly lower in patients with MCI and dementia than patients with normal cognition (p<0.001). These results suggest that cognitive decline may be associated with malnutrition in this sample of hospitalized older patients. Dietary habits (MNA-3) and subjective assessment of self-perceived quality of health and nutrition (MNA-4) are particularly poor also in patients with MCI and could be very important variables to be considered in the multidimensional evaluation of subjects with cognitive impairment.

Nutritional status using multidimensional assessment in Iranian elderly

Background: Nutrition is an important determinant of health in elderly and nutritional assessment is necessary for development of treatment protocols. The study aimed to evaluate nutritional status using multidimensional assessment in elderly. Methods: One hundred fourteen subjects (76 men and 64 women) from elderly residence house in Kermanshah, Western Iran were studied. Data was collected using Mini-Nutritional Assessment (MNA), FFQ, anthropometry, bioelectric impedance, biochemistry tools. Hematologic and biochemistry markers were assessed in 5 ml fasting blood sample. Results: 46.4% showed normal nutritional status while 38.7% have been classified as mild to moderate malnutrition and 14.9% suffered from severe malnutrition based on MNA scores. Malnutrition using different cut-offs were; body mass index 16.4%, haemoglobin 19%, albumin (with normal CRP level) 9.8%, ferritin 9.4% (<20 µg/l). Lean body mass and percent of body fat was lower than normal in 23% and 21% respectively. There was significant correlation between lean body mass, total body water and MNA score (p<0.05). A strong positive correlation was found between; BMI, percent of body fat, Mid arm circumference and MNA total score (p<0.001). Conclusion: The study confirmed that MNA score was significantly associated with anthropometric, bioelectric and biochemical findings. It is concluded that an appropriate nutrition intervention program need to introduce to improve nutritional status in older people living in elderly homes.

Bioelectrical Impedance Vector Analysis and Mini Nutritional Assessment in elderly nursing home residents.

The aim of this study was to establish the presence of malnutrition in elderly institutionalized people through Mini Nutritional Assessment (MNA) scores and to observe the changes of nutritional status through the Bioelectrical Impedance Vector Analysis (BIVA). Observational study. Nursing home located in the territory of Florence (Italy). 463 elderly individuals from twelve nursing homes, all aged 65 yrs or over. We carried out the MNA and measured the bioelectrical parameters of resistance (R) and reactance (Xc), with standard, tetrapolar analysis at 50 kHz frequency; these bioelectrical parameters were interpreted according to BIVA analysis. According to the MNA score, 23.1% of the women and 20.4% of the males are malnourished (MNA < 17), 60.0% and 52.8%, respectively, are at risk for malnutrition (17 ≤ MNA ≤ 23.5). Malnourished, at-risk and well-fed subjects differ significantly (p < 0.05) in their mean scores obtained in each of the MNA areas. Fifteen of eighteen MNA items show a significant correlation to the total MNA score (p < 0.001). The items not significantly related to the MNA global score were those concerning protein intake, independence and number of medicinal drugs taken. In both genders, the decrease of the MNA score increases the proportion of subjects placed outside the 95% confidence ellipse on the BIVA tolerance graph. A routine assessment of nutritional status through BIVA analysis combined with more "traditional" tools like the MNA could be useful for recognizing malnutrition and the risk of malnutrition in the elderly as these instruments provide complete information and are easy to use even with heavily impaired subjects.

Evaluation of the Mini Nutritional Assessment in the elderly, Tehran, Iran

To determine whether the Mini Nutritional Assessment (MNA) can screen and diagnose for malnutrition in the Iranian elderly. The MNA was administered to all volunteers. Each patient underwent anthropometric and serum albumin measurements. Reliability, validity, sensitivity, specificity, positive- and negative-predictive values were estimated. To identify optimal threshold values for predicting malnutrition, receiver-operating characteristic curve analysis was performed for MNA scores. Kahrizak Charity Foundation (Tehran, Iran). Two hundred and twenty-one consecutive elderly patients entered into the cross-sectional study. Amputees and patients with liver or renal disorders, oedema or any end-stage diseases were excluded. According to MNA score, 3.2 % were malnourished, 43.4 % were at risk of malnutrition and 53.4 % were well nourished. The proportions in these categories according to ideal body weight and serum albumin were 2.3 %, 17.1 % and 80.6 %, respectively. Cronbach's alpha coefficient (reliability) was 0.61. The correlations between total MNA score, anthropometric values and serum albumin (criterion-related validity) were all significant. There were significant differences in total MNA score between two BMI groups but not between two categories according to serum albumin and skin ulcers (construct validity). The sensitivity and specificity of the MNA according to its established cut-off points were 82 % and 63 %, respectively. Positive-predictive value was 35 % and negative-predictive value was 93 %. By using the best cut-off point (MNA score of 22 according to Youden index), the sensitivity, specificity, positive-predictive value and negative-predictive value were 88 %, 62 %, 57 % and 89 %, respectively. The MNA with its established cut-off points may not be a good fit for Asian populations, including Iranian elderly.

Clinical study of mini-nutritional assessment for older Chinese inpatients.

Malnutrition is a common problem in older patients. Early detection of malnutrition is an important task in clinical practice. The MNA has become an extensively used tool to evaluate nutritional status in European countries and the United States. We evaluated the Mini-Nutritional Assessment (MNA) test and the short-form MNA (MNA-SF) test as screening tools for malnutrition in older Chinese inpatients and focused on finding an optimal cutoff point for MNA total score and MNA-SF score. One hundred eighty-four older Chinese inpatients were enrolled in this study from July to August 2006. Nutritional assessment included MNA, anthropometric measurements, and biochemical markers. According to the original cutoff point of the full MNA, 19.6% of those assessed were malnourished, 53.2% were at risk of malnutrition and 27.2% were well nourished. Correlations were found between MNA, MNA-SF and body mass index, triceps skinfold thickness, serum albumin, lymphocyte count, hemoglobin, lymphocyte ratio. With the most proper cutoff point lower than 19 indicating malnutrition, when using serum albumin (< 35.0 g/L) as the indicator, the sensitivity and specificity of the MNA total score were 0.6286 and 0.7466; when using BMI (< 18.5 kg/m2) as the indicator, the sensitivity and specificity were 0.8636 and 0.7469. The incidence rate of malnutrition was 32.6%. The most proper cutoff point of MNA-SF was lower than 12. The MNA and MNA-SF were useful tools to identify older Chinese inpatients with malnutrition. However, the cutoff point of the MNA should be modulated for this population.

Nutritional assessment interpretation on 22 007 Spanish community-dwelling elders through the Mini Nutritional Assessment test

To evaluate the prevalence of undernutrition among community-dwelling elderly people in Spain using the Mini Nutritional Assessment (MNA) and to analyse its distribution according to age, gender and residence region. Cross-sectional study assessing the nutritional status of elderly persons through both the short form and the full version of the MNA test. Pharmacy offices across the whole country (Spain) were enrolled to recruit participants. A total of 22 007 participants (8014 men and 13 993 women), aged >or=65 years, assessed during the last two months of 2005. According to MNA screening, 4.3 % subjects were classified as undernourished (MNA score <17) and 25.4 % were at risk of undernutrition (MNA score >or=17 to <or=23.5). The MNA short form correlated strongly with the full MNA version (r = 0.85). MNA total score was significantly higher in men than in women (25.4 (sd 3.7) v. 24.6 (sd 3.9); P < 0.001) and lower in the oldest than in the youngest subjects (P < 0.001) in both genders. According to regional distribution, the best nutritional status was found in elderly from the north of Spain excluding the north-west area. Female gender, older age and living in the south half or north-west of the country were associated with higher rates of undernutrition among community-dwelling elderly persons in Spain.

Food Consumption Analysis in Spanish Elderly Based upon the Mini Nutritional Assessment Test

Background/Aims: Aged people are an increasing population group worldwide, and nutritional impairments may contribute to additional health problems. The characterization of food consumption of elderly people is a good approach to implementing adequate nutritional policies in order to improve their nutritional status. The aim of this study was to describe and analyze specific aspects of food intake based upon the Mini Nutritional Assessment (MNA) test in a representative country sample. Methods: The survey consisted of a cross-sectional study assessing the nutritional status of 22,007 Spanish people aged 65 years or older using the MNA test. These data, including dietary information, were obtained by health professionals specifically trained to carry out the questionnaire. A multiple regression analysis was used to evaluate the contributing impact of the diet-related MNA questions on the total MNA score. Results: Differences in the food choices between men and women were found, but not in the mode of feeding. Obese and non-obese individuals, categorized by a body mass index (BMI) more or less than 30, showed similar intake patterns of protein-rich foods, but differences in fruits, vegetables and fluids. On the other hand, undernourished and non-undernourished subjects, according to the MNA criteria, revealed different food consumption. Loss of appetite and mode of feeding were the items with the highest influence the MNA total score. Conclusions: While age, gender and BMI considered together are responsible for 11.3% of the total MNA score, dietary-related items can predict the 62.4% of the total MNA classification in the overall elderly Spanish population.

Characteristics of the Mini-Nutritional Assessment in elderly home-care patients.

To assess the risk of malnutrition among elderly people living at home and receiving regular home-care services using the Mini-Nutritional Assessment (MNA) and to study the characteristics of the instrument in this patient group. A cross-sectional study using the MNA score to assess the nutritional status of elderly home-care patients. Municipal home-care services in rural Finland. A total of 178 (65%) out of 272 eligible patients aged 75-94 y agreed to participate. MAJOR OUTCOME METHODS: MNA questionnaire, anthropometrics, structured questionnaire, menu record. According to MNA, 3% were malnourished (MNA < 17 points), 48% at risk for malnutrition (17-23.5 points) and 49% well nourished (>23.5 points). The mean MNA score was 23.4. Weight loss, psychological stress, nutritional status, decline in food intake, self-perceived health status and mid-arm circumference (MAC) showed the strongest significant correlations (P=0.0001) to total MNA score. MNA questions with the strongest significant intercorrelations (P=0.0001) were body mass index with MAC and calf circumference; and the decline of food intake and self-perceived nutritional status. The number of eating problems correlated significantly to the MNA score (P=0.0011). Those with chewing and swallowing problems (n=64, 36%) had a significantly lower MNA score than others (P=0.0001). Dry mouth together with chewing and swallowing problems (n=40, 22%) reduced the MNA score even further (P=0.0001). The results suggest that MNA is a useful tool in the identification of elderly home-care patients at risk for malnutrition.

Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF).

The Mini-Nutritional Assessment (MNA) is a validated assessment instrument for nutritional problems, but its length limits its usefulness for screening. We sought to develop a screening version of this instrument, the MNA-SF, that retains good diagnostic accuracy. We reanalyzed data from France that were used to develop the original MNA and combined these with data collected in Spain and New MEXICO: Of the 881 subjects with complete MNA data, 151 were from France, 400 were from Spain, and 330 were from New MEXICO: Independent ratings of clinical nutritional status were available for 142 of the French subjects. Overall, 73.8% were community dwelling, and mean age was 76.4 years. Items were chosen for the MNA-SF on the basis of item correlation with the total MNA score and with clinical nutritional status, internal consistency, reliability, completeness, and ease of administration. After testing multiple versions, we identified an optimal six-item MNA-SF total score ranging from 0 to 14. The cut-point score for MNA-SF was calculated using clinical nutritional status as the gold standard (n = 142) and using the total MNA score (n = 881). The MNA-SF was strongly correlated with the total MNA score (r = .945). Using an MNA-SF score of > or = 11 as normal, sensitivity was 97.9%, specificity was 100%, and diagnostic accuracy was 98.7% for predicting undernutrition. The MNA-SF can identify persons with undernutrition and can be used in a two-step screening process in which persons, identified as "at risk" on the MNA-SF, would receive additional assessment to confirm the diagnosis and plan interventions.

The use of the Mini-Nutritional Assessment (MNA) tool in elderly orthopaedic patients.

To assess the use of the Mini-Nutritional Assessment (MNA) in elderly orthopaedic patients. An observation study assessing the nutritional status of female orthopaedic patients. The orthopaedic wards of the Royal Surrey County Hospital. Forty-nine female patients aged 60-103 y; dietary records were obtained for 41 subjects and 36 subjects gave a blood sample for biochemical analysis. MAJOR OUTCOME METHODS: MNA questionnaire, anthropometry, plasma albumin, transferrin, C-reactive protein (CRP) levels and dietary analyses. The group as a whole had low mean values for body weight, albumin and transferrin and high CRP levels. In addition, the group had mean energy intakes well below the estimated average requirement (EAR) and mean intakes of vitamin D, magnesium, potassium, selenium and non-starch polysaccharides (NSP) were below the lower reference nutrient intakes (LRNI). The MNA screening section categorized 69% of the patients as requiring a full assessment (scored 11 or below), but for the purposes of the study the MNA was completed on all patients. The MNA assessment categorized 16% of the group as 'malnourished' (scored<17 points), 47% as 'at risk' (scored 17.5-23.5) and 37% as 'well nourished' (scored>23.5). Significant differences were found between the malnourished and well nourished groups for body weight (P<0.001), body mass index (BMI) (P<0.001), demiquet (P<0.001) and mindex (P<0. 001). Mean values for energy and nutrient intakes showed a clear stepwise increase across the three groups for all nutrients except sodium, with significant differences for protein (P<0.05), carbohydrate (P<0.05), riboflavin (P<0.05) niacin (P<0.05), pyridoxine (P<0.05), folate (P<0.05), calcium (P<0.05), selenium (P<0.05), iron (P<0.05) and NSP (P<0.05) intakes. Stepwise multiple regression analysis indicated that anthropometric assessments were the most predictive factors in the total MNA score. The sensitivity and specificity of the MNA was assessed in comparison with albumin levels, energy intake and mindex. The sensitivity of the MNA classification of those scoring less than 17 points in comparison with albumin levels, energy intake and mindex varied from 27 to 57% and the specificity was 66-100%. This was compared with the sensitivity and specificity of using a score of less than 23.5 on the MNA to predict malnourished individuals. Using this cut-off the sensitivity ranged from 75 to 100%, but the specificity declined to between 37 and 50%. The results suggest that the MNA is a useful diagnostic tool in the identification of elderly patients at risk from malnutrition and those who are malnourished in this hospital setting. Nestlé Clinical Nutrition, Croydon, Surrey.