Mini-Nutritional Assessment, Malnutrition Universal Screening Tool, and Nutrition Risk Screening Tool for the Nutritional Evaluation of Older Nursing Home Residents

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• 作者：Lorenzo M. Donini ; MD^a ; ^&dagger ; ; Eleonora Poggiogalle ; MD^a ; Alessio Molfino ; MD ; PhD^b ; Aldo Rosano ; PhD^c ; Andrea Lenzi ; MD^a ; Filippo Rossi Fanelli ; MD^b ; Maurizio Muscaritoli ; MD^b ; ^&dagger ; ; ^{maurizio.muscaritoli@uniroma1.it" class="auth_mail" title="E-mail the corresponding author}
• 关键词：MNA ; MUST ; NRS-2002 ; malnutrition ; older adults
• 刊名：Journal of the American Medical Directors Association
• 出版年：2016
• 出版时间：1 October 2016
• 年：2016
• 卷：17
• 期：10
• 页码：959.e11-959.e18
• 全文大小：516 K

文摘

Malnutrition plays a major role in clinical and functional impairment in older adults. The use of validated, user-friendly and rapid screening tools for malnutrition in the elderly may improve the diagnosis and, possibly, the prognosis. The aim of this study was to assess the agreement between Mini-Nutritional Assessment (MNA), considered as a reference tool, MNA short form (MNA-SF), Malnutrition Universal Screening Tool (MUST), and Nutrition Risk Screening (NRS-2002) in elderly institutionalized participants.

Methods

Participants were enrolled among nursing home residents and underwent a multidimensional evaluation. Predictive value and survival analysis were performed to compare the nutritional classifications obtained from the different tools.

Results

A total of 246 participants (164 women, age: 82.3 ± 9 years, and 82 men, age: 76.5 ± 11 years) were enrolled. Based on MNA, 22.6% of females and 17% of males were classified as malnourished; 56.7% of women and 61% of men were at risk of malnutrition. Agreement between MNA and MUST or NRS-2002 was classified as “fair” (k = 0.270 and 0.291, respectively; P < .001), whereas the agreement between MNA and MNA-SF was classified as “moderate” (k = 0.588; P < .001). Because of the high percentage of false negative participants, MUST and NRS-2002 presented a low overall predictive value compared with MNA and MNA-SF. Clinical parameters were significantly different in false negative participants with MUST or NRS-2002 from true negative and true positive individuals using the reference tool. For all screening tools, there was a significant association between malnutrition and mortality. MNA showed the best predictive value for survival among well-nourished participants.

Conclusions

Functional, psychological, and cognitive parameters, not considered in MUST and NRS-2002 tools, are probably more important risk factors for malnutrition than acute illness in geriatric long-term care inpatient settings and may account for the low predictive value of these tests. MNA-SF seems to combine the predictive capacity of the full version of the MNA with a sufficiently short time of administration.