Population-specific Mini Nutritional Assessment can improve mortality-risk-predicting ability in institutionalised older Taiwanese.

AIM AND OBJECTIVES: The study determined whether a new version of the Mini Nutritional Assessment that adopted population-specific anthropometric cut-points would improve the mortality-predicting ability in institutionalised Taiwanese older people. BACKGROUND: Routine screening is the key for detecting emerging malnutrition, but the tool must be simple, reliable and easy-to-use to be well accepted. The Mini Nutritional Assessment can meet these requirements, but for non-Western populations, modifications based on anthropometric considerations are needed. DESIGN: The study purposively sampled 208 residents, aged >65 years, of a long-term care institution in Central Taiwan. Subjects were free of acute infection/disease and able to communicate. A university human-subject-study ethics committee approved the protocol. METHODS: The study included biochemical measurements and a structured questionnaire for eliciting personal data and answers to questions in the Mini Nutritional Assessment. Follow-up survival/mortality was tracked for two consecutive six-month periods and analysed according to nutritional statuses graded with the original or a modified Mini Nutritional Assessment. The modified version adopted population-specific anthropometric cut-points and was without body mass index. RESULTS: The modification improved the mortality-predictive ability. Mortality rates for the first six months were 8·7, 3·9 and 0% according to the original Mini Nutritional Assessment and 10·6, 3·4 and 0% according to the modified version for subjects rated malnourished, at risk of malnutrition and normal, respectively. The mortality-predictive ability of both versions weakened after six months. CONCLUSION: Both versions can predict follow-up mortality, but the modified version has improved ability. For best results, the tool should be applied every six months or less (shorter for more frail older people) to screen for new cases of at-risk individuals. RELEVANCE TO CLINICAL PRACTICE: The Mini Nutritional Assessment that adopts population-specific anthropometric cut-points may have improved nutritional-risk and mortality-risk predictive abilities. The tool can help care-workers detect emerging nutritional problems and enable timely intervention. Routine use of the tool may help improve the quality of care.

Roles of testicular orphan nuclear receptors 2 and 4 in early embryonic development and embryonic stem cells.

The testicular orphan nuclear receptors (TRs) 2 and 4 act as either transcriptional activators or regulatory proteins of other nuclear receptor superfamily members. With no identified cognate ligands, their physiological roles remain unclear. Here we showed the phenotypes of TR2(-/-):TR4(-/-) mutant embryos, which reveal that the loss of TR2 and TR4 causes early embryonic lethality and increased cell death. We also found that TR2 and TR4 are expressed in blastocysts and embryonic stem (ES) cells, and can act as transcriptional activators in ES cells. The results on further investigating the roles of TR2 and TR4 in ES cells showed that TR2 and TR4 were differentially expressed when ES cells were induced into different specialized cell types, and their expression is regulated by retinoic acid. Knocking down TR2 and TR4 mRNAs decreased the expression of Oct-3/4 and Nanog genes. Mechanism dissection suggests that TR2 and TR4 may affect the Oct-3/4 gene by binding to a direct repeat-1 element located in its promoter region, which is influenced by retinoic acid. Together, our findings highlight possible roles for TR2 and TR4 in early embryonic development by regulating key genes involved in stem cell self-renewal, commitment, and differentiation.

Population-specific Mini Nutritional Assessment effectively predicts the nutritional state and follow-up mortality of institutionalized elderly Taiwanese regardless of cognitive status.

The study was conducted to determine the effectiveness of a modified Mini Nutritional Assessment (MNA) for assessing the nutritional status and predicting follow-up mortality of institutionalized elderly Taiwanese. The study was conducted in a large long-term care centre in central Taiwan. Trained interviewers assisted by the caregivers elicited sociodemographic data, healthcare and disease history, and answers to the MNA screen from each subject. One researcher performed all subjects' anthropometric measurements. Plasma albumin and cholesterol concentrations were determined. Results showed that the MNA without BMI, modified according to population-specific mid-arm circumference and calf circumference cut-points, effectively predicted the nutritional risk status of the elderly regardless of cognitive status. Substituting caregiver's assessments for self-viewed nutrition and health status (questions O and P of MNA) improved the predicting power of the tool in cognition-normal subjects. Results showed that 21.9% of the elderly were malnourished, 59.2% were at risk of malnutrition and 18.9% were normal according to self-assessment whereas 14.2% were malnourished, 59.2% were at risk of malnutrition, and 26.6% were normal according to caregiver's evaluation. The tool was also effective in predicting 12- and 6-month follow-up mortality in cognition-normal and cognition-impaired elderly, respectively. Results indicate that a population-specific MNA can effectively predict the nutritional status and 6-month follow-up mortality of elderly Taiwanese regardless of cognitive condition. Easier and wider application of the tool will enable early detection of emerging nutritional problems and timely intervention to prevent the development of severe malnutrition in the elderly.