Screening efficacy of PhA and MNA-SF in different stages of sarcopenia in the older adults in community.

OBJECTIVE: To compare the screening ability of the phase Angle (PhA) and the Short-Form Mini Nutritional Assessment (MNA-SF) alone and combined detection in the different stages of sarcopenia among the older adults in the community. METHODS: The older adults aged 65 and above were enlisted during community outpatient service and their nutritional status was evaluated by MNA-SF scale. PhA was measured by bioelectrical impedance analysis (BIA). AWGS2019 and EWGSOP2010 were used to define the different stages of sarcopenia. We measured skeletal mass index (SMI) and grip strength with BIA and electronic grip apparatus and measured body function with 6-m pace, SPPB test, and standing test. RESULTS: The AUC of PhA in the screening of possible sarcopenia was 0.640, the sensitivity was 58.49%, the specificity was 66.67%, and the cut-off value was 4.5. The AUC of the combined PhA and MNA-SF for possible sarcopenia was 0.642, the sensitivity was 57.55%, and the specificity was 70.00%. The AUC of MNA-SF for the screening of pre-sarcopenia was 0.805, the sensitivity was 66.67%, the specificity was 85.83%, and the cut-off value was 12. The AUC of the combined PhA and MNA-SF was 0.826, the sensitivity was 75.00%, and the specificity was 85.00%. The AUC of PhA in the screening of sarcopenia (common type) was 0.808, the sensitivity was 82.35%, the specificity was 73.33%, the cut-off value was 4.4. The AUC of the combined PhA and MNA-SF for sarcopenia (common type) was 0.835, the sensitivity was 76.47% and the specificity was 81.67%. The AUC of PhA and for the screening of severe sarcopenia was 0.935, the sensitivity was 93.33%, the specificity was 92.50%, and the cut-off value was 4.1. The AUC of the combined PhA and MNA-SF was 0.943, the sensitivity was 86.67%, and the specificity was 93.33%. CONCLUSION: The screening ability of PhA alone or in combination was higher than that of MNA-SF in the screening of possible sarcopenia. The screening ability of the combined detection was higher than that of PhA alone in the screening of pre-sarcopenia. The combination of PhA and MNA-SF or PhA alone all performed better value in the screening of sarcopenia (common type). Compared to MNA-SF, the PhA performed better in the screening of severe sarcopenia, which provided references for identifying patients with different stages of sarcopenia in the community.

The association between nutritional status and sleep quality of Chinese community-dwelling older adults.

BACKGROUND: Sleep disorders are a common syndrome and could affect the life quality of the older adults. AIMS: This study aimed to investigate the association between nutritional status and sleep quality in the Chinese community-dwelling older adults. METHODS: A total of 2,878 participants ≥ 65 years old from the Yiwu Elderly Cohort were included in the study. Nutritional status was assessed using the Mini Nutritional Assessment Short Form (MNA-SF). Participants were categorized as subjects with malnutrition, at risk of malnutrition or well-nourished based on their MNA-SF score. Pittsburgh Sleep Quality Index (PSQI) was used to identify sleep disorders. PSQI score ≥ 6 was categorized as poor sleep quality. RESULTS: Among the 2,878 participants (mean age 72.71 ± 5.79 years, 50.3% men), 31.5% (n = 906) were classified as having sleep disorders, and 25.5% were identified as malnutrition or at risk of malnutrition. We found a significantly relationship between nutritional status and sleep quality in older adults, and the results showed well-nourished decreased the risk of sleep disorders (OR = 0.32, 95% CI = 0.13, 0.75). And well-nourished status was significantly associated with less daytime dysfunction, adequate sleep duration, and good subjective sleep quality (all P < 0.05). CONCLUSION: There was a close association of nutritional status and sleep quality in older adults. We should pay more attention to the nutritional status of older people with sleep problems, as well as the sleep quality of older adults with malnutrition.

Oral function and nutritional status in non-acute hospitalised elders.

INTRODUCTION: Malnutrition and risk of malnutrition continues to be a common finding in elders, yet its association with oral function in hospitalised patients remains unclear. MATERIAL AND METHODS: Patients aged 70 years or over who had been hospitalised for non-acute rehabilitation were recruited. Nutritional risk was screened using the Mini-Nutritional Assessment Short Form (MNA-SF) and Nutritional Risk Screening (NRS) scores. Malnutrition was assessed according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. All participants underwent the oral hypofunction test battery, evaluating oral hygiene, oral dryness, occlusal force, tongue-lip motor function, tongue pressure, masticatory and swallowing function. Statistical analyses comprised Mann-Whitney or Kruskal-Wallis tests. Bivariate associations between categorical variables were tested using the Pearson chi-square test; for continuous variables, the Spearman correlation was calculated. A P-value < .05 was considered statistically significant. RESULTS: Sixty patients aged a mean 82.5 ± 7.0 years participated. Some 88.3% were diagnosed with oral hypofunction, and this was more common in older patients (P = .020). Analysing the 7 oral hypofunction tests as an interval variable (NiOF) revealed additional correlations with number of teeth (ρ = 0.477) as well as the nutritional risk, evaluated by the MNA-SF (ρ = -0.284) and NRS (ρ = 0.317) scores. NiOF scores were higher among denture wearers (P = .003). GLIM did not confirm the correlation with NiOF. Biomarkers such as serum albumin and CRP were not associated with the NiOF score. CONCLUSION: In this sample, the association between oral function and nutritional state is more obvious in nutritional risk scores than in the malnutrition diagnosis by GLIM.

The association between nutritional status and functional limitations among centenarians: a cross-sectional study.

BACKGROUND: Although there have been studies on the association between nutritional status and functional limitations, there were few studies on Asian centenarians in community. Therefore, this study aims to identify associations between nutritional status and functional limitations among centenarians in China. METHODS: This cross-sectional study was conducted with the data from the China Hainan Centenarian Cohort Study. These data ultimately included basic characteristics, hematologic indicators, and chronic disease status for 1,002 centenarians. The nutritional status was evaluated using the Mini Nutritional Assessment Short-Form scale. The functional limitations were assessed using the activities of daily living (ADL) scale, namely Barthel Index and Lawton Scale. The association between nutritional status and ADL was assessed using multivariate logistic regression models. RESULTS: In this study, the prevalence of malnutrition was 20.8 % among centenarians, basic ADL (BADL) limitation was 28.6 %, and instrumental ADL (IADL) limitation was 64.7 %. As the nutritional status deteriorated, the risk of ADL limitations increased in total population (BADL limitation: OR = 17.060, 95 % CI: 8.093-35.964; IADL limitation: OR = 11.221, 95 % CI: 5.853-21.511; p for trend < 0.001). Similar results were found in both men and women after stratifying sex but were more prominent in women. CONCLUSIONS: Malnutrition is associated with functional limitations among centenarians in China and more pronounced among women.

Malnutrition and other risk factors of geriatric depression: a community-based comparative cross-sectional study in older adults in rural Bangladesh.

BACKGROUND: Malnutrition and depression are highly prevalent in older adults and can lead to disparaging outcomes. Analytical studies on geriatric depression (GD) and its association with malnutrition are very scarce in Bangladesh, although the size of the older population is increasing fast in the country. The current study aimed to assess the association between malnutrition and depression and associated risk factors in rural older adults. METHODS: A community-based comparative cross-sectional study was conducted in 600 older adult residents (aged ≥60 years) of three rural communities of Bangladesh from January to October 2019. The study enrolled two groups of participants; 300 depressed as cases and another 300 non-depressed older adults as a comparison group matching their age and living area. We used a semi-structured questionnaire to collect data through a face-to-face interview. Geriatric Depression Scale-15 was used to determine depression, and a score of ≥5 was considered as depressed. We used the Bangla version of the Mini-Nutritional Assessment-Short Form to assess nutritional status, which comprised questions related to appetite, weight loss, mobility, recent illness/stress, dementia/depression, and BMI, and considered a score of 0-7 as the cutoff score for malnutrition. Measures included baseline and personal characteristics, malnutrition, GD, and its associated risk factors. A binary logistic regression model was fitted to identify variables associated with the risk of GD. RESULTS: The study found no significant difference in gender (male Vs. female) between depressed (44.0% Vs. 56.0%) and non-depressed (46.0% Vs. 54.0%) older individuals. The study revealed that malnutrition was significantly (p < 0.01) higher in depressed (56.0%) than in non-depressed (18.0%) rural older adults. The malnourished older adults had around three times (AOR = 3.155; 95% CI: 1.53-6.49, p = 0.002) more risk of having depression than the well-nourished older individuals. Older adults who were unemployed (AOR = 4.964; 95% CI: 2.361-10.440; p = 0.0001) and from lower and middle class (AOR = 3.654; 95% CI: 2.266-7.767; p = 0.001) were more likely to experience depression. Older adults having a 'poor diet' were more likely to experience depression (AOR = 3.384; 95% CI: 1.764-6.703; p = 0.0001). The rural older adults who were single (AOR = 2.368; 95% CI: 1.762-6.524; p = 0.001) and tobacco users (AOR = 2.332; 95% CI: 1.663-5.623; p = 0.003) were found more likely to experience depression. CONCLUSIONS: A significant association between malnutrition and depression was evident by the current study in the rural older individuals of Bangladesh. It will be a prolific initiative if policymakers merge malnutrition and the risk factors associated with geriatric depression in providing universal health care for better health and well-being of the rural older populations.

What factors influence the long-term survival of nursing home residents with severe disabilities?

B a c k g r o u n d / A i m: Factors influencing the survival of the nursing home population have not yet been clearly defined. The aim of the study was to investigate the impact of nutritional, mental, functional, disease and pharmacological factors on the survival of nursing home residents with severe disabilities. Material and Methods: A retrospective cohort study was conducted with a 9-year follow-up period among nursing home residents with a Barthel score ≤40. The initial assessment included the following scales: Mini Nutritional Assessment Short-Form (MNA-SF), Abbreviated Mental Test Score (AMTS), the Barthel Index, and blood pressure (BP) measurements. Comorbidities, medications and all-cause mortality were extracted from medical records. The analyzed cohort was divided into two groups: Deceased - residents who died ≤3 years and Survivors - those who survived >3 years of observation. R e s u l t s: Survivors (n = 40) and Deceased (n = 48) did not differ significantly in terms of age, sex, systolic and diastolic BP, the Barthel Index, number of diseases and medications used. Survivors had significantly higher scores in MNA-SF (p <0.001) and AMTS (p <0.003) than Deceased. Moreover, Survivors had hypertension significantly more often and took aspirin and ACE inhibitors (p <0.05). The multivariable logistic regression analysis showed that the MNA-SF score significantly affected mortality [OR = 0.62, (95%CI, 0.46-0.84), p <0.001]. C o n c l u s i o n: Higher MNA-SF scores were a factor that significantly affected the survival of nursing home residents, while functional status assessed using the Barthel Index had no effect on survival. MNA-SF was found to be a useful tool for assessing the risk of death in a nursing home.

Nutritional Status and Functional Outcomes in Older Adults Admitted to Geriatric Rehabilitations: The SAFARI Study.

Objective: Evidence about the role of nutritional status (NS) on functional outcomes (FO) after rehabilitation in older adults is scarce. Our aim was to analyze the association between NS and FO in older adults admitted to geriatric rehabilitation units. Methods: The Sarcopenia And Function in Aging Rehabilitation (SAFARI) multicenter study enrolled patients aged ≥65 years admitted to geriatric rehabilitation units in Italy and Spain. FO were absolute and relative functional gain (AFG-RFG) in Barthel Index (BI) at 1 and 3 months after admission. The association between NS (Mini Nutritional Assessment-Short Form) and FO was explored using linear regression and mixed models, adjusted for potential confounders. Analyses were then stratified for diagnosis at admission. Results: We included 415 patients (mean age 81.4 years [SD: 7.7]; 67% female; 9.4% malnourished [MN], 42.7% at risk of malnutrition [RM], and 48% well nourished [WN]). Admission diagnoses were hip fracture (39.5%), elective orthopedic surgery (EOS) (29.5%), and stroke (31%). In an adjusted linear mixed model, MN and RM participants had lower BI compared to WN (MN: ß: -8.47, p = 0.023; RM: ß: -5.22, p = 0.031), and differences between groups remained stable over time. After stratification for admission diagnosis, only MN patients admitted after EOS had worse FO, both at 30 days (AFG: ß adjusted: -13.54, p < 0.001; RFG: ß: -32, p < 0.001) and 3 months (AFG: ß adjusted: -17.79, p < 0.001; RFG: ß: -26.77, p = 0.002). Conclusions: In our sample, poor NS is associated with worse BI in older adults admitted to geriatric rehabilitation units; in patients undergoing EOS, MN is associated with worse FO. Our results documented for the first time the importance of assessing nutritional status before EOS.

The prevalence and health burden of malnutrition in Belgian older people in the community or residing in nursing homes: results of the NutriAction II study.

INTRODUCTION: In 2008, the NutriAction study showed that (risk of) malnutrition was highly prevalent (57%) among Belgian older people living in the community or in a nursing home. In 2013, this study was repeated to re-evaluate the occurrence of malnutrition, as well as mobility problems and dependence in activities of daily living (ADL). METHODS: Health care professionals (HCPs) associated with homecare organizations and nursing homes across Belgium were invited to screen their patients and complete an online questionnaire. Nutritional status, presence of pre-specified comorbidities, mobility, and ADL dependency were assessed. RESULTS: In total, 3299 older patients were analysed: 2480 (86.3 ± 6.3 years) nursing home (NH) residents and 819 (82.7 ± 6.1 years) community dwelling (CD). Overall, 12% was malnourished (MNA-SF score < 8) and 44% was at risk of malnutrition (MNA-SF 8-11). The highest prevalence of (risk of) malnutrition was observed in NHs (63%) and in patients with dementia (CD: 68%; NH: 82%) or depression (CD: 68%; NH: 79%). Of all malnourished individuals, 49% was recognized as malnourished by HCPs and 13% of the malnourished recognized themselves as such. Mobility (stair climbing and walking) and ADL dependency (Belgian KATZ score) were impaired in older people with (risk of) malnutrition in comparison with individuals with normal nutritional status (p < 0.001). DISCUSSION: Despite public awareness initiatives, the prevalence of malnutrition remained stable among Belgian older people seen by HCPs in the period 2008-2013. Moreover, malnutrition is not well recognized. CONCLUSION: Under-recognition of malnutrition is problematic, because associated loss of mobility and independence may accelerate the transformation of frailty into disability in older people.

Dysphagia risk, low muscle strength and poor cognition predict malnutrition risk in older adults athospital admission.

BACKGROUND: Malnutrition in patients admitted to hospital may have detrimental effects on recovery and healing. Malnutrition is preceded by a state of malnutrition risk, yet malnutrition risk is often not detected during admission. The aim of the current study was to investigate the magnitude and potential predictors of malnutrition risk in older adults, at hospital admission. METHODS: A cross-sectional was study conducted in 234 older adults (age ≥ 65 or ≥ 55 for Maori or Pacific ethnicity) at admission to hospital in Auckland, New Zealand. Assessment of malnutrition risk status was performed using the Mini Nutritional Assessment Short-Form (MNA®-SF), dysphagia risk by the Eating Assessment Tool (EAT-10), muscle strength by hand grip strength and cognitive status by the Montreal Cognitive Assessment (MoCA) tool. RESULTS: Among 234 participants, mean age 83.6 ± 7.6 years, 46.6% were identified as at malnutrition risk and 26.9% malnourished. After adjusting for age, gender and ethnicity, the study identified [prevalence ratio (95% confidence interval)] high dysphagia risk [EAT-10 score: 0.98 (0.97-0.99)], low body mass index [kg/m2: 1.02 (1.02-1.03)], low muscle strength [hand grip strength, kg: 1.01 (1.00-1.02)] and decline in cognition [MoCA score: 1.01 (1.00-1.02)] as significant predictors of malnutrition risk in older adults at hospital admission. CONCLUSION: Among older adults recently admitted to the hospital, almost three-quarters were malnourished or at malnutrition risk. As the majority (88%) of participants were admitted from the community, this illustrates the need for routine nutrition screening both at hospital admission and in community-dwelling older adults. Factors such as dysphagia, unintentional weight loss, decline in muscle strength, and poor cognition may indicate increased risk of malnutrition.

The Graz Malnutrition Screening (GMS): a new hospital screening tool for malnutrition.

Despite the significant impact of malnutrition in hospitalised patients, it is often not identified by clinical staff in daily practice. To improve nutritional support in hospitals, standardised routine nutritional screening is essential. The Graz Malnutrition Screening (GMS) tool was developed for the purpose of malnutrition risk screening in a large hospital setting involving different departments. It was the aim of the present study to validate the GMS against Nutritional Risk Screening (NRS) and Mini Nutritional Assessment-short form (MNA-sf) in a randomised blinded manner. A total of 404 randomly selected patients admitted to the internal, surgical and orthopaedic wards of the University Hospital Graz were screened in a blinded manner by different raters. Concurrent validity was determined by comparing the GMS with the NRS and in older patients (70+ years) with the MNA-sf additionally. According to GMS, 31·9 or 28·5% of the admitted patients were categorised as at 'risk of malnutrition' (depending on the rater). According to the reference standard of NRS, 24·5% of the patients suffered from malnutrition. Pearson's r values of 0·78 compared with the NRS and 0·84 compared with the MNA showed strong positive correlations. Results of accuracy (0·85), sensitivity (0·94), specificity (0·77), positive predictive value (0·76) and negative predictive value (0·95) of GMS were also very high. Cohen's κ for internal consistency of the GMS was 0·82. GMS proves to be a valid and reliable instrument for the detection of malnutrition in adult patients in acute-care hospitals.

Factors Influencing Nutritional Status in Hospitalized Individuals Aged 70 and Above.

BACKGROUND: Older adults are vulnerable to malnutrition due to physical, psychological, and social factors. Malnutrition, a prevalent and modifiable issue in this population, is associated with an elevated risk of adverse clinical outcomes. The purpose of the study is to assess the nutritional status of older adult individuals admitted to a general hospital and examine its correlation with socio-health and demographic variables. METHODS: The study included 239 individuals aged 70 and above, employing a cross-sectional descriptive observational approach with a convenience sampling method. Sociodemographic information was gathered, and variables such as cognitive impairment, functional capacity, comorbidities, medication consumption, and nutritional status were evaluated. Statistical analysis involved descriptive calculations, bivariate analysis, and multivariate analysis, utilizing binary logistic regression. RESULTS: Approximately half of the sample were at risk of malnutrition, with a more notable prevalence among women. Factors such as age (OR = 1.04), cognitive impairment (OR = 1.06), functional dependence (OR = 0.96), and comorbidities (OR = 1.08) were linked to an elevated risk of malnutrition. In our regression model, age, cognitive impairment, and drug consumption emerged as significant predictors of malnutrition risk. CONCLUSIONS: Individuals aged 70 and above have a notably high prevalence of malnutrition risk, particularly among those experiencing functional dependence and cognitive impairment. In our sample, cognitive impairment in older adults, coupled with above-median drug consumption, emerges as the primary predictor for malnutrition risk.

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

BACKGROUND: Long-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. METHODS: A 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. RESULTS: MNA-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. CONCLUSIONS: Both 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.

Malnutrition and Polypharmacy in Older Adult Patients Receiving Home Care Nursing Services: A Cross-sectional Study.

OBJECTIVE: We studied the nutritional status of older adult adults receiving home nursing care using demographic data, household category, polypharmacy, and potentially inappropriate medications (PIMs). DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: Two Norwegian municipalities during 2017-2019; home nursing service clients aged ≥70 years. METHODS: Inclusion of patients and data collection were done by nurses working in the home services. Recorded data were participants' age, sex, living alone or with others, nutritional status (Mini Nutritional Assessment-Short Form and body mass index), regular prescription drugs, and potentially inappropriate medications (PIMs) according to the Norwegian General Practice Nursing home (NORGEP-NH) criteria. Descriptive statistics and logistic regression were used. RESULTS: Of the 270 patients (mean age 84.2 years; 64.8% females; 188 living alone), 25 (9.3%) were malnourished and 154 (57%) at risk of malnutrition; in addition, 14.8% had a BMI <21 and 27.8% had lost weight in the previous 3 months. The odds for being at malnutrition risk was higher if living with others vs living alone: adjusted odds ratio (OR) 2.23 (1.20-4.13). Female sex, older age, and better mobility was associated with living alone. The mean number of regular drugs was 7.3. Overall, 43.3% of the participants used at least 1 PIM. Using 0 to 5 drugs vs ≥6 drugs (polypharmacy) was associated with higher odds for malnutrition risk: adjusted OR 1.97 (1.04-3.75). Compared with well-nourished patients, those at risk for or who were malnourished used fewer cardiovascular and musculoskeletal drugs. Exposure to PIMs was not associated with nutritional status. CONCLUSIONS AND IMPLICATIONS: Two-thirds of home nurse clients were either malnourished or at risk for malnutrition. Living with others or using fewer daily drugs implied increased risk for malnourishment, probably reflecting differences in morbidity and possible inappropriateness of medication use. Future research on nutritional status and medication use should aim for including more clinical data than simple drug counts.

Improving Nutritional Status Was Associated with Decreasing Disease Severity and Shortening of Negative Conversion Time of PCR Test in Non-ICU Patients with COVID-19.

Background: Nutrition is an important prevention in old patients with COVID-19. However, in China, there are few studies on the correlation between nutrition and COVID-19. Methods: A total of 148 hospitalized COVID-19 (65.7 ± 16.0 [range: from 21 to 101] years old) patients were enrolled in this study. The information of demographic, biochemical results, vaccination doses, types of COVID-19, PCR test negative conversion time, and scores of Mini Nutritional Assessment Short Form (MNA-SF) for evaluating nutritional status were recorded. We first explored the relationships between MNA-SF performance and the severities of COVID-19 in the groups with non-vaccinated, vaccinated, and all the patients using multivariable ordinal logistic regression. Further, we explored the relationships between performance of MNA-SF and the time of negative conversion of PCR in the groups with non-vaccinated, vaccinated, and all the patients using COX proportional hazards survival regression. Results: Group of patients with malnutrition or at risk of malnutrition group was associated with older of the age, those who had not been vaccinated, in fewer people who were asymptomatic type and in more people who showed longer of the negative conversion time of PCR, lower of the BMI, and the lower of the hemoglobin level. Each additional increase of one point of MNA-SF was associated with a 17% decrease in the odds of a worse type of COVID-19 in all patients, and the significant result exists in non-vaccinated patients. One point increase of MNA-SF was associated with increased 11% of hazard ratios of turning negative of PCR and well-nourished group was associated with increased 46% of hazard ratio of turning negative of PCR. Conclusion: Higher nutrition is associated with less severity of COVID-19, especially in the non-vaccinated group. Higher nutrition is also associated with shorter time of turning negative of PCR in non-ICU COVID-19 patients.

Malnutrition, Frailty, and Health-Related Quality of Life Among Rural Older Adults in Vietnam: A Cross-Sectional Study.

Purpose: Rural older adults are more likely to be malnourished than urban older adults, particularly those living in lower-middle-income countries like Vietnam. Therefore, this study aimed to address the prevalence of malnutrition and its association with frailty and health-related quality of life in older rural Vietnamese adults. Participants and Methods: This cross-sectional study was conducted on community-dwelling older adults (aged ≥ 60 years) living in a rural province in Vietnam. Nutritional status was determined using the Mini Nutritional Assessment Short Form (MNA-SF), and frailty was evaluated using the FRAIL scale. The 36-Item Short Form Survey (SF-36) was used to evaluate health-related quality of life. Results: Among the 627 participants, 46 (7.3%) were malnourished (MNA-SF score <8), and 315 (50.2%) were at risk of malnutrition (MNA-SF score: 8-11). Individuals with malnutrition had significantly higher rates of impairments in instrumental activities of daily living and activities of daily living than those without malnutrition (47.8% vs 27.4% and 26.1% vs 8.7%, respectively). The prevalence of frailty was 13.5%. Risk of malnutrition and malnutrition were associated with high risks of frailty, with odds ratios of 2.14 (95% confidence interval [CI]: 1.16-3.93) and 4.78 (1.86-12.32), respectively. Furthermore, the MNA-SF score was positively correlated with eight domains of the health-related quality of life among rural older adults. Conclusion: The prevalence rates of malnutrition, risk of malnutrition, and frailty were high among older adults in Vietnam. A strong association was observed between nutritional status and frailty. Therefore, this study reinforces the importance of screening for malnutrition and risk of malnutrition among older rural individuals. Further studies should explore whether early nutritional intervention reduces the risk of frailty among older adults and increase their health-related quality of life in the Vietnamese population.

Mini Nutrition Assessment-Short Form score is associated with sarcopenia even among nourished people - A result of a feasibility study of a registry.

Objectives: This study aims to identify a new barrier to the use of the Mini-Nutrition Assessment Short-Form (MNA-SF), which is a malnutrition assessment tool for the risk assessment of sarcopenia in a nourished population. Methods: The MNA-SF was completed, and individuals with a score of > 11 were considered nourished in this cross-sectional feasibility study of a registry. Sarcopenia was assessed in 766 healthy, nourished adults (33.4% men, 64.9 ± 7.1 years) based on the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). Results: The MNA-SF scores for non-sarcopenia, pre-, confirmed, and severe sarcopenia were 13.59 ± 0.69, 13.73 ± 0.60, 12.64 ± 0.74, and 12.5 ± 0.71, respectively. The higher MNA-SF score association with pre-sarcopenia [odds ratio (OR): 1.41, 95% confidence interval (CI): 1.06-1.86, P = 0.02], confirmed sarcopenia (OR = 0.25, 95% CI: 0.13-0.49, P < 0.001), and severe sarcopenia (OR = 0.20, 95% CI: 0.09-0.46, P < 0.001) was as significant as in the MNA-SF categories. Individuals with a score = 13 (compared with 14), had a higher risk of confirmed sarcopenia (OR = 10.07, 95% CI: 1.92-52.71, P = 006) and severe sarcopenia (OR = 12.09, 95% CI: 1.24-117.50, P = 0.032). Individuals with a score of 12 had a higher risk of confirmed sarcopenia (OR = 30.94, 95% CI: 4.25-103.02, P < 0.001) and severe sarcopenia (OR = 35.90, 95% CI: 4.25-303.07, P = 0.001) compared with subjects with a score of 14. The models also showed that MNA-SF < 13 could predict sarcopenia. Conclusion: There was a significant association between MNA-SF and confirmed and severe sarcopenia in nourished people. Sarcopenia assessment in people with MNA-SF < 13 can be beneficial. Developing a tool to identify the risk of malnutrition and sarcopenia at the same time based on MNA-SF can be considered.

Development and validation of a chemotherapy tolerance prediction model for Chinese multiple myeloma patients: The TM frailty score.

Objective: The physical fitness of older individuals is heterogeneous, making it difficult to know their chemotherapy tolerance. The toxicities may offset the benefits of anti-myeloma therapy in frail patients. The accurate evaluation of frailty status before chemotherapy is essential. We aimed to explore the applicability of the IMWG GA and develop a new frailty screening tool more suitable for Chinese MM patients. Cases and methods: We performed the IMWG GA and the full CGA in 167 MM patients and validated the applicability of the IMWG GA to chemotherapy and prognosis. The CGA domains were screened for their predictive value to improve IMWG GA and develop new frailty screening tools. Results: The results showed that the IMWG GA had limitations in distinguishing the risk of grade ≥3 adverse events (AEs) between fit and int-fit patients. Of the CGA domains, TUG and MNA-SF were independent prognostic factors for grade ≥3 AEs and OS and further stratified the risk of grade ≥3 AEs in the IMWG GA int-fit subgroup (P< 0.05). We combined TUG and MNA-SF to construct the TM frailty score. The frail subgroup had a higher proportion of adverse outcomes, a higher hazard ratio (HR) in Cox regression and a higher Harrell's C-index for distinguishing the risk of grade ≥3 AEs and OS than the IMWG GA frail subgroup. Conclusion: The TM frailty score is more suitable than the IMWG GA for evaluating chemotherapy tolerance and prognosis in the Chinese population.

Diagnostic performance of nutritional indicators in patients with heart failure.

AIMS: The aim of this study was to compare the diagnostic performance of the nutritional indicators, the mini nutritional assessment-short form (MNA-SF), the geriatric nutritional risk index (GNRI), and the controlling nutritional status (CONUT), in heart failure (HF) patients. METHODS AND RESULTS: Nutritional status was prospectively assessed by the aforementioned three nutritional indicators in 150 outpatients with HF who were then followed for 1 year. The prevalence of patients with the nutritional risk as assessed by the MNA-SF, GNRI, and CONUT scores was 50.0%, 13.3%, and 54.0%, respectively. There was slight agreement of nutritional risk assessment between the MNA-SF and GNRI scores (κ coefficient = 0.16), as well as the GNRI and CONUT scores (κ = 0.11), but poor agreement between the MNA-SF and CONUT scores (κ = -0.09). The CONUT score had the lowest area under the curve (AUC) for the identification of low body weight, low muscle mass, and low physical function among the three indicators (all P < 0.05). Compared with the MNA-SF score, both the GNRI and CONUT scores had lower AUCs for the identification of reduced dietary intake and weight loss (all P < 0.05). There was no significant difference in predicting all-cause mortality or HF rehospitalization among the three indicators. The prescription of statins reduced the diagnostic performance of the CONUT score, as the CONUT score includes cholesterol level assessment. CONCLUSIONS: Of the three indicators, the diagnostic ability of the MNA-SF score was the highest, and that of the CONUT score was the lowest, for the assessment of HF patient nutritional status. The CONUT score may misrepresent nutritional status, particularly in patients receiving statins.

Body mass index and Mini Nutritional Assessment-Short Form as predictors of in-geriatric hospital mortality in older adults with COVID-19.

BACKGROUND & AIMS: Overweight and obesity have been consistently reported to carry an increased risk for poorer outcomes in coronavirus disease 2019 (COVID-19) in adults. Existing reports mainly focus on in-hospital and intensive care unit mortality in patient cohorts usually not representative of the population with the highest mortality, i.e. the very old and frail patients. Accordingly, little is known about the risk patterns related to body mass and nutrition in very old patients. Our aim was to assess the relationship between body mass index (BMI), nutritional status and in-geriatric hospital mortality among geriatric patients treated for COVID-19. As a reference, the analyses were performed also in patients treated for other diagnoses than COVID-19. METHODS: We analyzed up to 10,031 geriatric patients with a median age of 83 years of which 1409 (14%) were hospitalized for COVID-19 and 8622 (86%) for other diagnoses in seven geriatric hospitals in the Stockholm region, Sweden during March 2020-January 2021. Data were available in electronic hospital records. The associations between 1) BMI and 2) nutritional status, assessed using the Mini-Nutritional Assessment - Short Form (MNA-SF) scale, and short-term in-geriatric hospital mortality were analyzed using logistic regression. RESULTS: After adjusting for age, sex, comorbidity, polypharmacy, frailty and the wave of the pandemic (first vs. second), underweight defined as BMI<18.5 increased the risk of in-hospital mortality in COVID-19 patients (odds ratio [OR] = 2.30; confidence interval [CI] = 1.17-4.31). Overweight and obesity were not associated with in-hospital mortality. Malnutrition; i.e. MNA-SF 0-7 points, increased the risk of in-hospital mortality in patients treated for COVID-19 (OR = 2.03; CI = 1.16-3.68) and other causes (OR = 6.01; CI = 2.73-15.91). CONCLUSIONS: Our results indicate that obesity is not a risk factor for very old patients with COVID-19, but emphasize the role of underweight and malnutrition for in-hospital mortality in geriatric patients with COVID-19.

GLIM in nursing homes; practical implications.

BACKGROUND: Only very few papers have described malnutrition prevalence rates according to the Global Leadership Initiative on Malnutrition (GLIM) criteria in nursing homes, likely due to practical reasons such as missing data on body composition, dietary intake, or acute disease/inflammation. METHODS: Data was collected in 5 different nursing homes. Food intake measurements took place over 3 days of observations, and intakes below 90% of energy or protein requirements were regarded as insufficient. The GLIM diagnosis was based on body weight loss and/or low BMI in combination with insufficient food intake. Additionally, we also studied the sensitivity of GLIM with the question from the Mini Nutritional Assessment Short Form (MNA-SF) on insufficient food intake (GLIMMNA) versus GLIM with measured food intake. RESULTS: Out of 176 participants, 21.0% were categorized as malnourished according to GLIM. Observations revealed an insufficient food intake in 81.3% (N = 143) of residents; only 39% of those (N = 56) scored positive on the MNA-SF question regarding low food intake. GLIMMNA diagnosed 17.0% of residents as malnourished. Sensitivity of GLIMMNA for GLIM was 62.2%, and specificity 95.0% (kappa = 0.61). CONCLUSION: Twenty-one percent of nursing home residents were diagnosed malnourished based on a limited set of GLIM criteria. The MNA question on insufficient food intake missed ∼60% of residents with a truly low food intake. Herewith, malnutrition prevalence rates with GLIMMNA decreased to 17%. We advise measuring food intake for studies, and to be aware of too low prevalence rates of GLIM when an estimate of reduced food intake is applied.