The ability of the Geriatric Nutritional Risk Index to assess the nutritional status and predict the outcome of home-care resident elderly: a comparison with the Mini Nutritional Assessment.

The Mini Nutritional Assessment (MNA) is recommended for grading nutritional status in the elderly. A new index for predicting the risk of nutrition-related complications, the Geriatric Nutritional Risk Index (GNRI), was recently proposed but little is known about its possible use in the assessment of nutritional status. Thus, we aimed to investigate its ability to assess the nutritional status and predict the outcome when compared with the MNA. Anthropometry and biochemical parameters were determined in 241 institutionalised elderly (ninety-four males and 147 females; aged 80.1 (SD 8.3) years). Nutritional risk and nutritional state were graded by the GNRI and MNA, respectively. At 6 months outcomes were: death; infections; bedsores. According to the GNRI and MNA, the prevalence of high risk (GNRI < 92)/malnutrition (MNA < 17), moderate risk (GNRI 92-98)/malnutrition at-risk (MNA 17-23.5) and no risk (GNRI > 98)/good status (MNA > 24) were 20.7/12.8%, 36.1/39% and 43.2/48.2%, respectively, with poor agreement in scoring the patient (Cohen's kappa test: kappa = 0.29; 95% CI 0.19, 0.39). GNRI categories showed a stronger association (OR) with overall outcomes than MNA classes, although no difference (P>0.05) was found between malnutrition (v. 'good status', OR 6.4; 95% CI 2.1, 71.9) and high nutritional risk (v. 'no risk', OR 9.7; 95% CI 3.0, 130). Multivariate logistic regression revealed the GNRI as an independent predictor of complications. In overall-outcome prediction, a good sensitivity was found only for GNRI < 98 (0.86 (95% CI 0.67, 0.96)). The combination of a GNRI > 98 with an MNA > 24 seemed to exclude adverse outcomes. The GNRI showed poor agreement with the MNA in nutritional assessment, but appeared to better predict outcome. In home-care resident elderly, outcome prediction should be performed by combining the suggestions from both these tools.

The association of Geriatric Nutritional Risk Index and total lymphocyte count with short-term nutrition-related complications in institutionalised elderly.

OBJECTIVE: To investigate how total lymphocyte count (TLC) and the Geriatric Nutritional Risk Index (GNRI) are associated with short-term nutritional-related complications (death, infections, bedsores) in institutionalised elderly. METHODS: 220 home-care resident elderly (age +/- SD; 80.7 +/- 7.9, range: 67-98 years) were studied (anthropometry, biochemistry, food intake) and prospectively followed over a period of 3 months for the occurrence of health complications. Nutritional risk was assessed by GNRI. Patients were categorized according to GNRI (<92, 92-98, >98) and TLC (<900, 900-1499, >or=1500/mm3). RESULTS: GNRI was significantly associated with TLC according to both simple and adjusted correlation models (p < 0.001) and to multiple stepwise regression analysis (p < 0.005). TLC < 900 revealed a higher specificity (87.8%) than sensitivity (30.6%) in identifying "at-risk" patients (GNRI < 92). Adjusted multiple logistic regression revealed a significant association between overall 3-month health outcomes and both TLC and food intake. TLC was the only significant predictor for infections, while death was independently associated with GNRI and food intake. When a GNRI < 92 and a TLC < 900 were considered together, the sensitivity was 0.83 (95% confidence interval, C.I.95%: 0.66-1.0) and 0.89 (C.I.95%: 0.68-1.00) for overall complications (Odds ratio: 22.1; C.I.95%: 5.1-96.1) and infections (Odds ratio: 20.8; C.I.95%: 2.6-168.8), respectively. The association of a GNRI > 98 with a TLC >or= 1500 was able to exclude health complications. CONCLUSIONS: In the institutionalised elderly patients, GNRI confirmed its predictive value even for short-term health complications, particularly when death was considered. However, the use of TLC might improve the evaluation of nutritional risk and the identification of patients at risk of infections. Nutrition study should be considered to confirm possible risk reduction.

Feasible use of estimated height for predicting outcome by the geriatric nutritional risk index in long-term care resident elderly.

BACKGROUND: The Geriatric Nutritional Risk Index (GNRI) is a new index recently introduced for predicting risk of nutritional-related complications in elderly patients. It combines albumin with information about body weight: GNRI = (1.489 x albumin, g/l) + (41.7 x present/ideal body weight), with ideal weight calculated according to the Lorentz formula. Because standing height (SH) is frequently difficult to obtain in older people, in Lorentz equations this parameter has been replaced by estimated height (EH) from knee height. Though, if EH is well accepted as a valid surrogate for SH, the same might not be expected for its use in ideal body weight calculation, with possible consequences in grading nutritional risk correctly. OBJECTIVE: The aim of this study was to investigate whether the use of SH rather than EH for the calculation of ideal body weight predicts similar outcomes by GNRI. METHODS: Body weight, SH and EH were obtained in 231 long-term care resident elderly (88 males and 143 females, mean age +/- SD 80.0 +/- 8.4, range 65-97 years). Blood samples were assessed for albumin concentration. Ideal body weight was derived from the Lorentz formula using both SH and EH. According to both ideal weight estimates, nutritional risk was defined by the GNRI score. RESULTS: The Pearson correlation coefficients were high for both EH (with SH; r = 0.90) and estimates of ideal body weight (r = 0.90) and all were highly significant (p < 0.0001). A statistically significant difference was found between SH and EH (p = 0.0265). Similar and expectable differences in significance have also been observed between ideal body weights (p = 0.0271). However, an accordance of 95.2% has been detected (Kendall's tau test: tau = 0.85, p < 0.0001) in grading nutritional risk by GNRI. CONCLUSION: The use of EH for ideal body weight calculation and nutritional risk assessment by GNRI is feasible. Thus, GNRI seems to have been designed in the best way and its use is really attractive, particularly when considering the low-grade participation demanded of the patient in the assessment. This simple and valid assessment tool should be taken into greater consideration.