Geriatric nutritional risk index as a simple tool for assessment of malnutrition among geriatrics in Northwest of Iran: comparison with mini nutritional assessment.

BACKGROUND: Older people are more likely to develop nutritional problems and timely diagnosis of malnutrition is crucial to prevent hazardous consequences following poor nutrition. AIMS: To evaluate the efficacy of Geriatric Nutritional Risk Index (GNRI) to assess nutritional status among non-hospitalized elderly, compared to mini nutritional assessment (MNA) among Iranian seniors. METHODS: One hundred and sixty-four subjects, aged ≥ 65 years old were recruited to our cross-sectional study from various districts of Tabriz (Tabriz, Iran). Anthropometric and biochemical measurements were performed, short- and long-form MNAs and GNRI were assessed in our study subjects. Sensitivity, specificity and predictive values of the three indices, agreement between them, and their correlation with anthropometric and biochemical parameters were evaluated. Receiver-operating characteristic (ROC) curve analysis was performed to determine the optimal cut-off point for GNRI in our study population. RESULTS: GNRI had lower sensitivity (50, 57%), but optimal specificity (94, 93%) and lower negative predictive value (NPV; 68, 71%) compared to MNA-LF and MNA-SF, respectively. We found a moderate agreement between GNRI and MNA-SF (K = 0.52) and MNA-LF (K = 0.46) scores. Significant correlations were observed between re-categorized MNAs as well as GNRI scores, and age, weight, MAC, CC, WC, albumin, and pre-albumin. The cut-off point of 110.33 was obtained for GNRI, according to the ROC curve. CONCLUSIONS: Although GNRI may not be an efficient tool for screening malnutrition due to its lower sensitivity, it is moderately correlated with MNAs and also more useful when limited funding needs to target the truly malnourished seniors.

[Study of the nutritional status of patients over 65 years included in the home care program in an urban population]. / Estudio de la situación nutricional de pacientes mayores de 65 años incluidos en el programa de atención domiciliaria de una población urbana.

OBJECTIVE: To analyse the nutritional status of patients older than 65 years included in the home care program (PAD). DESIGN: Croos-sectional study. EMPLACEMENT: 3 urban health centers. PARTICIPANTS: 218 patients in the PAD. METHOD: Mini Nutritional Assessment questionnaire (MNA) was applied. Sociodemographic, anthropometric, dependency, emotional and cognitive status and analytical parameters: 57 variables were collected. Possible associations were analysed by applying the chi square and variance analysis. The level of significance was considered to be P<.05 was considered. RESULTS: The mean age was 83.9 years (SD=7.4); 34.9% were institutionalized and 80.7% were women; 21.2% of patients were malnourished and 40.1% were at risk of it. A significant association was established between poorer nutritional status and older age, lower BMI, greater dependence on basic and instrumental activities of daily living and greater cognitive impairment. The lowest mean hemoglobin, albumin, and iron levels were also associated with malnutrition and risk of malnutrition. CONCLUSIONS: More than half of PAD patients are malnourished or at risk for it, and a high proportion of them some laboratory abnormality susceptible to be corrected. Most cognitive impairment and functional dependence are closely related to malnutrition; so patients with these characteristics should receive more attention from the nutritional point of view.

Evaluation of Nutritional Status of Elderly Patients Presenting to the Family Health Center.

OBJECTIVE: Nutritional problems are one of the most common disorders encountered in aging, and malnutrition, secondary to insufficient food consumption. Failure to diagnose malnutrition can increase the risk of illnesses and death. Our objective was to evaluate the nutritional status of elderly patients aged 65 years and older through a Mini Nutritional Assessment (MNA) scale and to determine its relationship with laboratory parameters. METHODS: This is a single-center cross-sectional study which included 102 patients aged 65 years and older who presented to the Family Health Center (FHS) in the Cobanlar District in the Province of Afyon, Turkey. Anthropometric and biochemical measurements of the patients were obtained, and the MNA scale was administered to the patients using a face-to-face interview technique. In the statistical analysis of the data, categorical variables were analyzed using a Chi-square test, normally distributed data were analyzed using an analysis of variance (ANOVA), continuous variables with normal distribution comprising independent measurements were analyzed using an Independent Samples T-test, and data without normal distribution were analyzed using a Mann-Whitney Rank Sum test. RESULTS: Of the 102 patients included in this study, 45 (44.1%) were male and 57 (55.9%) were female. The mean age was 74.06±7.89 years (min-max: 65-92). Of these patients, 39 (38.2%) were found to have malnutrition, 19 (18.6%) were at high risk of malnutrition and 44 (43.1%) had a normal nutritional status. CONCLUSIONS: The findings suggest evaluating nutritional status in individuals aged 65 years and older in the population on a regular basis to reduce disease risk and mortality.

Mini Nutritional Assessment (MNA) is Rather a Reliable and Valid Instrument to Assess Nutritional Status in Iranian Healthy Adults and Elderly with a Chronic Disease.

This study aimed to evaluate the usefulness of the Mini Nutritional Assessment (MNA) to assess nutritional status of Iranian population and to compare its psychometric properties between patients suffering from a chronic disease, healthy elderly and younger adults. As a group of elderly with a chronic disease, 143 Parkinson's disease (PD) patients and as the control group, 467 healthy persons were enrolled. The Persian-translated version of MNA was filled-up through interviews together with anthropometric measurements. Cronbach's α coefficient of entire MNA was 0.66 and 0.70 in healthy individuals and PD patients, respectively. The total MNA score could significantly discriminate the ones with BMI ≥ 24kg/m(2) in both groups. In general, MNA was a valid and reliable tool for nutritional assessment. We acknowledge study limitations including lack of serum measurements and a selection bias towards mild-to-moderate PD. MNA is a more reliable tool in older healthy individuals and rather younger elderly with PD.

Comparative analysis of Sarcopenia in hospitalized elderly: exploring the impact of liver cirrhosis.

The progressive aging of the population has led to a rise in geriatric pathologies, with sarcopenia, characterized by muscle mass and function loss, becoming a crucial prognostic indicator. This study investigates sarcopenia in elderly hospitalized patients with advanced chronic liver disease (cirrhotic) and non-liver disease patients, comparing their prevalence and exploring correlations with anthropometric and biochemical factors. The cohort of 115 patients, including 50 cirrhotic and 65 non-cirrhotic individuals, exhibited significant comorbidities and a mean age of 78.4 years. Cirrhotic patients presented distinct laboratory parameters indicating liver damage. Applying European Working Group on Sarcopenia in Older People criteria, probable sarcopenia prevalence was similar in cirrhotic (62%) and non-cirrhotic (63%) patients. Stratifying probable sarcopenia into confirmed sarcopenia and dynapenia revealed no significant differences between populations. Correlation analyses demonstrated positive associations between Appendicular Skeletal Muscle Mass (ASM) and anthropometric parameters, malnutrition risk, and grip strength. In cirrhotic patients, muscle mass inversely correlated with liver damage. Odds ratio analysis highlighted the Mini Nutritional Assesment's (MNA) significant predictive capability for sarcopenia. ROC curve analysis affirmed MNA and biochemical markers' combined use, such as transferrin, albumin, total cholesterol, lymphocyte count and C-reactive protein as a strong predictor. Despite limitations, such as a small sample size, this study underscores the significance of thorough sarcopenia screening in elderly hospitalized patients, especially those with cirrhosis. Indeed, individuals with end-stage liver disease are particularly susceptible to sarcopenia. A more personalized approach utilizing tools like MNA and biochemical markers could prove beneficial. Further research is warranted to validate these findings and inform clinical interventions.

Burden of frailty and its correlates among the elderly: a cross-sectional study in a rural community of West Bengal.

Context: With the ageing of Indian society, providing a healthy life among older people is a public health precedence. Therefore, beforehand discovery and possible forestalment of frailty may help promote healthy ageing and dwindle the social, mental and financial burden of their families and caregivers. Aims: The study aimed to assess the proportion of frailty and its associated factors among the elderly aged 65 years and above in a rural community of West Bengal. Settings and Design: A community-based cross-sectional study was conducted among 270 elderlies selected from 15 villages out of a total 64 villages of Singur under the Hooghly District of West Bengal from January 2019 to February 2020. Materials and Methods: Cluster sampling technique was used. Data was collected using a pre-designed, pre-tested structured schedule including Fried frailty phenotype (FFP), geriatric depression scale short form (GDS 15) and mini nutritional assessment (MNA) tool. Statistical Analysis Used: Associated factors of frailty were assessed by univariate and multivariable logistic regression using SPSS version 16 software and MS Excel 2019. Results: The proportion of frailty was observed to be 23.7% and that of prefrailty 40.7%. Frailty was significantly associated with increasing age [AOR(CI) 1.2(1.1-1.3)], decreasing years of schooling [AOR(CI) 1.3(1.1-1.5)], loss of spouse [AOR(CI) 4.2(1.2-15.2)], financial dependency [AOR(CI) 19.3(2.7-139.0)], staying at home [AOR(CI) 16.3(2.7-98.2)], presence of anaemia [AOR(CI) 3.6(1.3-9.5)], at risk of malnutrition [AOR(CI) 6.5(1.9-22.3)], increasing number of falls in the last 1 year [AOR(CI) 4.3(1.2-15.6)], presence of 3 or more chronic diseases [AOR(CI) 154.7(12.1-1981.9)] and depression [AOR(CI) 8.3(2.5-27.0)]. Conclusion: The burden of frailty among the study population is relatively high. It's an intimidating situation that needs bettered screening provisions for early discovery with special stress on nutritive upliftment. Screening for depression should also be done regularly.

The Impact of Malnutrition on Chronic Obstructive Pulmonary Disease (COPD) Outcomes: The Predictive Value of the Mini Nutritional Assessment (MNA) versus Acute Exacerbations in Patients with Highly Complex COPD and Its Clinical and Prognostic Implications.

BACKGROUND: Current management of COPD is predominantly focused on respiratory aspects. A multidimensional assessment including nutritional assessment, quality of life and disability provides a more reliable perspective of the true complexity of COPD patients. METHODS: This was a prospective observational study of 120 elderly COPD patients at high risk of acute exacerbations. The Mini Nutritional Assessment (MNA) was administered in addition to the usual respiratory assessment. The primary outcome was a composite of moderate or severe acute exacerbations during 52 weeks of follow-up. RESULTS: The median MNA Short Form (SF) score was 11 (8-12), 39 participants (32.50%) had a normal nutritional status, 57 (47.5%) were at risk of malnutrition and 24 (20%) were malnourished. Our multivariate linear regression models showed that the MNA score was associated with dyspnea and respiratory symptom severity, assessed by the Modified British Medical Research Council (mMRC) scale and the COPD Assessment Test (CAT) score, with spirometric variables, in particular with the severity of airflow limitation based on the value of FEV1, and with poorer QoL, as assessed by the EQ-5D-3 questionnaire. Competing risk analysis according to nutritional status based on the MNA Total Score showed that COPD participants "at risk of malnutrition" and "malnourished" had a higher risk of moderate to severe acute exacerbations with sub-hazard ratios of 3.08 (1.40-6.80), p = 0.015, and 4.64 (1.71-12.55), p = 0.0002, respectively. CONCLUSION: Our study confirms the importance of assessing nutritional status in elderly COPD patients and its prognostic value.

Nutritional status, gender and marital status in patients with chronic obstructive pulmonary disease.

AIM AND OBJECTIVES: To describe and compare nutritional status, pulmonary function, gender and marital status in patients with chronic obstructive pulmonary disease. BACKGROUND: Chronic obstructive pulmonary disease is a chronic illness that can lead to poor nutritional status due to an increased energy requirements related to laboured breathing. Inadequate nutritional intake has often been described in this patient group. Nutritional support for patients with chronic obstructive pulmonary disease who suffer from nutritional problems is essential, both for their sense of well-being and for their survival with chronic obstructive pulmonary disease. DESIGN: The study design was descriptive and comparative. METHODS: Quantitative data collection was carried out among 81 patients with chronic obstructive pulmonary disease (47 women and 34 men) with an average age of 65 years (SD 3·5). The Mini Nutritional Assessment was used to assess nutritional status. RESULTS: Participants who lived alone had worse nutritional status than those who did not live alone, and female participants had worse nutritional status than their male counterparts. No significant correlation was found between pulmonary function and nutritional status. CONCLUSIONS: This study contributes knowledge of a potential correlation between nutritional status, gender and marital status in patients with chronic obstructive pulmonary disease. Women with chronic obstructive pulmonary disease may be at an increased risk of malnutrition. Despite the previous results showing malnutrition and underweight to be common, the present study found that many of the participants were overweight, which may reflect a global health trend regardless of disease. RELEVANCE TO CLINICAL PRACTICE: Early identification of patients at risk of malnutrition is important. Registered nurses should be aware that patients with chronic obstructive pulmonary disease who are female or who live alone may be at an increased risk of nutritional problems. Patients with chronic obstructive pulmonary disease must be offered information and support for individually adapted measures at an early stage in order to avoid nutritional problems, regardless of under- and overweight.

Nutritional assessment with different tools in leukemia patients after hematopoietic stem cell transplantation.

OBJECTIVE: Correct nutritional assessment is essential for leukemia patients after hematopoietic stem cell transplantation (HSCT). This study aimed to investigate the best nutritional assessment method for leukemia patients after HSCT, and find the possible nutritional risk of the patients during the transplantation process in order to intervene in the patients with nutritional risks and undernourished patients timely, so that the entire transplantation process could be successfully completed. METHODS: A prospective study was performed in 108 leukemia patients after HSCT, and different nutritional assessment methods, including nutritional risk screening 2002 (NRS2002), mini nutritional assessment (MNA), subjective globe assessment (SGA) and malnutritional universal screening tools (MUST), were used. The associations between nutritional status of these patients and nutritional assessment methods were analyzed. RESULTS: A total of 108 patients completed SGA, and 99 patients completed NRS2002, MNA and MUST. During the treatment process, 85.2% of the patients lost weight, wherein, 50% lost weight greater than 5%, and 42.6% had significantly reduced food intake. For nutritional risk assessment, the positive rates of NRS2002, MNA and MUST were 100%, 74.7% and 63.6%, respectively. There was a significant difference (P<0.05) among the positive rates of NRS2002, MNA and MUST. In undernutrition assessment, the positive rate of SGA (83.3%) was significantly higher than that of MNA (17.2%) (P<0.05), and the incidence rate of nutritional risk among leukemia patients ≤30 years old was greater than that of patients >30 years old (P<0.05). CONCLUSIONS: Patients with leukemia were in poor nutritional status during and after HSCT. The leukemia patients ≤30 years old had a greater incidence rate of nutritional risk. As nutritional risk screening tool, the specificity of NRS2002 is not high, but it can be used for evaluating nutritional deficiencies. MNA is a good nutritional risk screening tool, but not an adequate tool for nutritional assessment. If assessment of undernutrition is necessary, the combination of all these screening tools and clinical laboratory indicators should be applied to improve accuracy.

Nutritional Status among Portuguese and Turkish Older Adults Living in the Community: Relationships with Sociodemographic, Health and Anthropometric Characteristics.

Malnutrition is widespread among older adults, and its determinants may differ between countries. We compared Portuguese and Turkish non-institutionalized older adults regarding nutritional status, sociodemographic, health and anthropometric characteristics and studied the relationships between nutritional status and those characteristics. This cross-sectional study analyzed data from 430 Portuguese and 162 Turkish non-institutionalized older adults regarding sociodemographics, health conditions, the Mini-Nutritional Assessment (MNA-FF) and anthropometry. Turkish older adults were more likely to be malnourished or at risk of malnutrition and had lower average BMI but a higher calf circumference. A higher proportion of the Portuguese sample had tooth loss, diabetes, hypertension, oncologic diseases, kidney diseases, osteoarticular problems or eye problems, while less had anemia. A better nutritional status (higher MNA-FF score) was found among the Portuguese, males, people using dentures, those without tooth loss, hypertension, cardiovascular diseases, anemia or oncological diseases and was related to younger age, higher BMI and a higher calf circumference. Malnutrition and its risk were higher among older adults from Turkey, despite Portuguese older adults presenting a higher prevalence of chronic diseases. Being female, older age, tooth loss, hypertension, anemia, CVD or oncological disorders and having a lower BMI or CC were associated with higher rates of malnutrition among older adults from Portugal and Turkey.

Comprehensive Geriatric Assessment: Application and correlations in a real-life cross-sectional study.

Background: The assessment process of elderly people considers all aspects of an individual's life, including physical, mental, and social aspects. Frailty refers to a decline in physiological functions or strengths leading to increased vulnerability to stressors and decreased ability to cope with them. Comprehensive Geriatric Assessment (CGA) is a validated and useful tool in this context to holistically study elderly people. The primary aim of this study was to determine the prevalence of impaired health status in a large geriatric population turning to outpatient service, based on the components of the CGA, and thus to describe its usefulness in real-life clinical practice. The secondary aim of this study was the evaluation of the association between nutritional status, assessed with Mini Nutritional Assessment (MNA)-within the CGA-and cognitive-affective and functional capacities, and multimorbidity. Materials and methods: This real-life, retrospective cross-sectional study included subjects consecutively evaluated from January 2009 to December 2020 at the Geriatric Outpatient Service, University Hospital of Monserrato, Cagliari, Italy. A sum of 3,260 patients were subjected to CGA. Results: Only a small proportion of the sample (2.24%) showed an absence of impairment in cognitive-affective, functional, and nutritional domains. Moderate correlations were found between MNA and several other CGA variables, namely, Geriatric Depression Scale (GDS; ϱ = -0.41, p < 0.0001), Barthel Index of Independence in Activities of Daily Living (ADL) (ϱ = 0.51, p < 0.0001), Instrumental Activities of Daily Living (IADL) (ϱ = 0.43, p < 0.0001), and Performance-Oriented Mobility Assessment (ϱ = 0.44, p < 0.0001). A multiple regression also highlighted these variables as significant regressors of MNA. Finally, malnutrition showed a significant association with depression (odds ratio [OR]: 4.97), dependence on ADL (OR: 19.8) and IADL (OR: 7.04), and falling risk (OR: 5.16). Conclusion: This study has figured out the complex situation in which geriatric care finds itself the complexity and severe impairment of elderly people. The possibilities of intervention are often limited, but the literature confirms the benefits of good nutritional status on the general health status. The data that emerged from our study fit into this assumption, highlighting the close association between the nutritional domain and the other CGA domains.

Dietary-Physical Activity Patterns in the Health Context of Older Polish Adults: The 'ABC of Healthy Eating' Project.

The study aimed to analyze the dietary-physical activity patterns (D-PAPs) in the health context of Polish people aged 60+ years. A total of 418 respondents across Poland were recruited; however, the final analysis included 361 women and men aged 60-89 years old. D-PAPs were derived using a principal component analysis (PCA); input variables were the frequency of consumption of 10 food groups and physical activity. Finally, three D-PAPs were identified: 'Pro-healthy eating and more-active', 'Sweets, fried foods and sweetened beverages', and 'Juices, fish and sweetened beverages'. We developed the Functional Limitations Score (FLS) using the Mini Nutritional Assessment (MNA®). A logistic regression was applied to verify the association between the D-PAPs and health-condition outcomes. Older adults were more likely to adhere to the upper tertile of the 'Pro-healthy eating and more-active' pattern, with good/better self-reported health status in comparison with their peers (OR = 1.86) or with good/very good self-assessed appetite (OR = 2.56), while this was less likely for older adults with malnutrition risk (OR = 0.37) or with a decrease in food intake (OR = 0.46). Subjects with a decrease in food intake (OR = 0.43), who declared a recent weight loss (OR = 0.49), or older adults in the upper tertile of the FLS (OR = 0.34) were less likely to adhere to the upper tertile of the 'Sweets, fried foods and sweetened beverages' pattern. The decrease in food intake due to a loss of appetite or chewing or swallowing difficulties was inversely associated with the 'Pro-healthy eating and more-active' pattern characterized by a relatively high frequency of consumption of vegetables, fruit, water, dairy, and grains and a high physical activity. In the interest of the good nutritional status and health of older adults, special attention should be paid to removing limitations in meal consumption, including improved appetite.

Association of Oral Health and Mini Nutritional Assessment in Older Adults: A Systematic Review with Meta-analyses.

PURPOSE: To evaluate whether poor oral health is associated with a higher risk of malnutrition based on the Mini Nutritional Assessment (MNA) or MNA-SF (short form) in older adults. STUDY SELECTION: For this meta-analysis, cohort and cross-sectional studies with adults 65 years and older, reporting oral health outcomes (i.e. edentulism, number of teeth) and either the MNA or MNA-SF were selected. Four electronic databases were searched (Medline via PubMed, Web of Science, Cochrane Library and EMBASE) through June 2020. Risk of bias was assessed with the checklist by the Agency for Healthcare Research and Quality scale. RESULTS: A total of 928 abstracts were reviewed with 33 studies, comprising 27,559 participants, aged ≥65 being ultimately included. Meta-analyses showed that the lack of daily oral hygiene (teeth or denture cleaning), chewing problems and being partially/fully edentulous, put older adults at higher risk of malnutrition (p<0.05). After adjustment for socio-demographic variables, the included studies reported lack of autonomy for oral care, poor/moderate oral health, no access to the dentist and being edentulous with either no dentures or only one denture were risk factors significantly associated with a higher risk of malnutrition (p<0.05). CONCLUSION: These findings may imply that once elders become dependent on others for assistance with oral care, have decreased access to oral healthcare, and lack efficient chewing capacity, there is increased risk of malnourishment. Limitations of the study include heterogeneity of oral health variables and the observational nature of the studies. Further studies are needed to validate our findings.

Malnutrition and its relation with diabetic foot ulcer severity and outcome: a review.

BACKGROUND: Malnutrition has a detrimental effect on wound healing; hence, it might influence the outcome in people with a diabetic foot ulcer (DFU).The aim of this manuscript is to overview studies that describe the prevalence of malnutrition in DFU patients and assess the relation between malnutrition, DFU severity, and outcome. METHODS: A literature review was performed. Malnutrition had to be defined by anthropometry and/or validated screening and assessment tools. RESULTS: Five papers were included: one RCT, three prospective cohort studies and one retrospective observational study. A substantial number of patients were at risk for malnutrition (49%-70%) or were malnourished (15%-62%). In one study, nutritional status was related to DFU severity. Three authors demonstrated a negative influence of malnutrition on outcome. Two studies examined the prevalence of malnutrition after six months, but did not detect a decline in malnutrition rates. CONCLUSIONS: Despite a large heterogeneity, all papers indicated that malnutrition is highly prevalent among DFU patients. Notwithstanding the lack of unequivocal evidence, malnutrition might have a negative influence on DFU outcome. Therefore, clinicians should pay attention to the nutritional status of people with a DFU.Abbreviations: BMI: Body Mass Index; DFU: Diabetic Foot Ulcer; DM: Diabetes Mellitus; GNRI: Geriatric Nutritional Risk Index; HbA1c: Glycated Hemoglobin; IWGDF: International Working Group on the Diabetic Foot; LEA: Lower Extremity Amputation; MNA: Mini Nutritional Assessment; MNA-SF: Mini Nutritional Assessment-Short Form; MUST: Malnutrition Universal Screening Tool; NRS-2002: Nutritional Risk Screening-2002; PAD: Peripheral Arterial Disease; RCT: randomized controlled trial; SGA: Subjective Global Assessment.

Socioeconomic, Eating- and Health-Related Limitations of Food Consumption among Polish Women 60+ Years: The 'ABC of Healthy Eating' Project.

The study aimed at identifying the socioeconomic, eating- and health-related limitations and their associations with food consumption among Polish women 60+ years old. Data on the frequency of consumption of fruit, vegetables, dairy, meat, poultry, fish, legumes, eggs, water and beverages industrially unsweetened were collected with the Mini Nutritional Assessment (MNA®) and were expressed in the number of servings consumed per day or week. Three indexes: the Socioeconomic Status Index (SESI), the Eating-related Limitations Score (E-LS) and the Health-related Limitations Score (H-LS) were developed and applied. SESI was created on the base of two variables: place of residence and the self-reported economic situation of household. E-LS included: difficulties with self-feeding, decrease in food intake due to digestive problems, chewing or swallowing difficulties, loss of appetite, decrease in the feeling the taste of food, and feeling satiety, whereas H-LS included: physical function, comorbidity, cognitive function, psychological stress and selected anthropometric measurements. A logistic regression analysis was performed to assess the socioeconomic, eating-, and health-related limitations of food consumption. Lower socioeconomic status (vs. higher) was associated with a lower chance of consuming fruit/vegetables ≥ 2 servings/day (OR = 0.25) or consuming dairy ≥ 1 serving/day (OR = 0.32). The existence of multiple E-LS limitations (vs. few) was associated with a lower chance of consuming fruit/vegetables ≥ 2 servings/day (OR = 0.72), consuming dairy ≥ 1 serving/day (OR = 0.55) or consuming water and beverages industrially unsweetened ≥6 cups/day (OR = 0.56). The existence of multiple H-LS limitations was associated with a lower chance of consuming fruit/vegetables ≥ 2 servings/day (OR = 0.79 per 1 H-LS point increase) or consuming dairy ≥ 1 serving/day (OR = 0.80 per 1 H-LS point increase). Limitations found in the studied women were related to insufficient consumption of selected groups of food, which can lead to malnutrition and dehydration. There is a need for food policy actions, including practical educational activities, to eliminate barriers in food consumption, and in turn to improve the nutritional and health status of older women.

Disease-related malnutrition in hospitalized chronic patients with complex needs.

BACKGROUND AND AIMS: Disease-related malnutrition is a prevalent condition that can be associated with multimorbidity. The purposes of this study were to assess the prevalence of disease-related malnutrition in a cohort of chronic patients with complex needs (CPCN) admitted to two University hospitals, and to evaluate the impact of malnutrition in their hospitalization outcomes. METHODS: All CPCN admitted on a previously agreed day in non-critical services of two University hospitals in Catalonia were included. Nutritional risk was evaluated with Mini-Nutritional Assessment Tool and Nutritional Risk Screening 2002. Hospitalization outcome data were evaluated, including length of the hospital stay, mortality during admission and placement when discharged. After five months, a new evaluation was performed to assess mortality and readmissions. RESULTS: A total of 101 patients were included, 83% of which were at nutritional risk when screened with NRS-2002; when using MNA, 86% of them were found to be either at nutritional risk or malnourished. Malnourished patients had a greater need for home care/intermediate care hospital at discharge (41.8% vs 22.9%, p < 0.01), and a higher mortality rate during admission (16.7% vs 1.6%, p < 0.01). Mortality at 5 months was also higher in the malnourished group (30.5% vs 9.8%, p < 0.01). Factors associated with malnutrition were BMI and gender (malnutrition was more prevalent in women). In our cohort, malnutrition was the sole independent predictor of mortality at 5 months. CONCLUSIONS: The prevalence of both malnutrition and risk of malnutrition is very high in hospital-admitted CPCN, and has a profound impact on placement at discharge and mortality. This high prevalence is not explained by the multimorbidity pattern. Other factors need to be evaluated in this group of high-need, high-cost patients.

Geriatric Nutrition Risk Index is comparable to the mini nutritional assessment for assessing nutritional status in elderly hospitalized patients.

BACKGROUND & AIMS: Malnutrition is common among hospitalized elderly patients, and the prevalence is increasing not only in Malaysia but also in the rest of the world. The Geriatric Nutrition Risk Index (GNRI) and the Mini Nutritional Assessment (MNA) were developed to identify malnourished individuals among this group. The MNA was validated as a nutritional assessment tool for the elderly. The GNRI is simpler and more efficient than the MNA, but studies on the use of the GNRI and its validity among the Malaysian population are absent. This study aimed to determine the prevalence of malnourished hospitalized elderly patients and assess the criterion validity of the GNRI and MNA among the geriatric Malaysian population against the reference standard for malnutrition, the Subjective Global Assessment (SGA), and determine whether the optimal cutoff value of the GNRI is suitable for the Malaysian population and determine the optimal tool for use in this population. METHODS: A cross-sectional study was conducted among 134 geriatric patients with a mean age of 68.9 ± 8.4 who stayed at acute care wards in Hospital Tuanku Ampuan Rahimah, Klang from July 2017 to August 2017. The SGA, MNA, and GNRI were administered through face-to-face interviews with all the participants who gave their consent. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the GNRI and MNA were analyzed against the SGA. Receiver-operating characteristic (ROC) curve analysis was used to obtain the area under the curve (AUC) and suitable optimal cutoff values for both the GNRI and MNA. RESULTS: According to the SGA, MNA, and GNRI, 26.9%, 42.5%, and 44.0% of the participants were malnourished, respectively. The sensitivity, specificity, PPV, and NPV for the GNRI were 0.622, 0.977, 0.982, and 0.558, respectively, while those for the MNA were 0.611, 0.909, 0.932, and 0.533, respectively. The AUC of the GNRI was comparable to that of the MNA (0.831 and 0.898, respectively). Moreover, the optimal malnutrition cutoff value for the GNRI was 94.95. CONCLUSIONS: The prevalence of malnutrition remains high among hospitalized elderly patients. Validity of the GNRI is comparable to that of the MNA, and use of the GNRI to assess the nutritional status of this group is proposed with the new suggested cutoff value (GNRI ≤ 94.95), as it is simpler and more efficient. Underdiagnosis of malnutrition can be prevented, possibly reducing the prevalence of malnourished hospitalized elderly patients and improving the quality of the nutritional care process practiced in Malaysia.

Comprehensive comparison of malnutrition and its associated factors between nursing home and community dwelling elderly: A case-control study from Northwestern Iran.

BACKGROUND & AIMS: Only a limited number of studies have compared nursing home and community residing elderly in terms of health-related issues. The present study aimed to compare nutritional status and its associated factors between nursing home residents and community-dwelling seniors. METHODS: In this case-control, age- and gender-matched study in Tabriz (East Azarbaijan, Iran), elderly subjects aged 65 years and older were recruited from nursing homes (n = 76) and community (n = 88). Anthropometric, blood pressure and dietary intake measurements, as well as biochemical assays were performed. Nutritional status (Mini Nutritional Assessment: MNA), cognitive function (Mini Mental State Examination: MMSE) and physical performance (Barthel Index) were assessed and compared between the two settings. RESULTS: Nursing home residents had significantly lower body mass index (BMI), limbs, waist and hip circumferences, and diastolic blood pressure. Caloric and protein intake of the groups were similar, while nursing home residents received lower amounts of many micronutrients and saturated fats and higher polyunsaturated fats. MNA, MMSE and Barthel index scores were significantly different between the groups, all of them in favor of the free living elderly (p < 0.001, p < 0.001 and p = 0.014, respectively). Laboratory tests revealed significantly lower levels of hemoglobin, folate, fasting blood sugar, insulin, albumin, prealbumin, creatinine and uric acid in the nursing home group; however, mean cell volume (MCV) and HDL-cholesterol were higher in this group. CONCLUSION: Elderly people living in nursing homes have lower BMI, suffer from many nutritional deficiencies and are predisposed to malnutrition, impaired cognition and deteriorating physical performance, compared to community dwelling seniors.

[Not Available]. / Food consumption and risk of malnutrition in community-dwelling very old Spanish adults (≥ 80 years).

INTRODUCTION: There are few studies assessing overall diet and food patterns of the oldest population. OBJECTIVES: To examine food groups consumption (grams and servings) and their compliance with the dietary guidelines in community-dwelling very old Spanish adults. The relationship with the risk of malnutrition was also studied. METHODS: Within the cross-sectional health study of elderly people of Villanueva de la Cañada (Madrid, Spain), in 98 non-institutionalized elders aged ≥ 80 years (66% women) food consumption was calculated from a 24-hour dietary recall and nutritional risk was assessed by Mini Nutritional Assessment (MNA). Statistical significance was evaluated at 95% confidence level (p < 0.05). RESULTS: Men consumed significantly higher amounts of snacks/pickles and alcoholic beverages. The consumption of cereals/grain products (2 servings/day), vegetables (1.5 servings/day) and meat, fish, eggs (1.4 servings/day), was below desirable levels. As nutritional status got worse, fruit consumption was significantly smaller (p = 0.039). Relatively weak but highly significant correlations were found between MNA and oils/fats, fruits and alcoholic beverages. After adjustment for energy intake, oils and fats and fruits associations disappeared whereas a negative association between milk/dairy products and MNA was found. CONCLUSIONS: Dietary patterns of the elderly population of Villanueva are departing from the traditional Mediterranean diet and though adequate consumption of fruits, milk/dairy products, oils/fats and sugar/confectionery has been achieved, cereals/grain products, vegetables and the meat, fish, eggs group consumption was below the desirable levels. Deterioration of the nutritional status coincided with a reduction in the consumption of all food groups except for ready meals and milk/dairy products whose consumption increased. Further research on the influence of fruit, milk/dairy products, wine and olive oil consumption on nutritional status is required.

Nutritional status in older persons according to healthcare setting: A systematic review and meta-analysis of prevalence data using MNA®.

BACKGROUND & AIMS: Old persons are more likely to suffer from malnutrition, which may result in higher dependency in activities of daily living. We aimed to provide a quantitative synthesis of prevalence data on malnutrition and its risk as assessed by the Mini Nutritional Assessment across different healthcare settings. The association between nutritional status and setting-related level of dependence was also investigated. METHODS: Non-interventional studies published as full-text articles in English up to 31th December 2014 were searched for in PubMed and by reviewing references of eligible articles. Meta-analysis and meta-regression of potential sources of heterogeneity were conducted. RESULTS: A total of 240 studies/795 citations - providing 258 setting-specific prevalence estimates (113,967 subjects) - fulfilled inclusion criteria for meta-analysis. Prevalence of malnutrition differed significantly across the healthcare settings considered: community, 3.1% (95%CI, 2.3-3.8); outpatients, 6.0% (95%CI, 4.6-7.5); home-care services, 8.7% (95%CI, 5.8-11.7); hospital, 22.0% (95%CI, 18.9-22.5); nursing homes, 17.5% (95%CI, 14.3-20.6); long-term care, 28.7% (95%CI, 21.4-36.0); rehabilitation/sub-acute care, 29.4% (95%CI, 21.7-36.9). For every setting significant heterogeneity in individual study results was observed (I2 ≥80%, P < 0.001) and meta-regression showed that study quality was the most important determinant. Finally, meta-regression of all the studies included showed that both malnutrition and its risk were directly associated with the setting-related level of dependence (P < 0.001). However, despite multiple adjustments, residual heterogeneity remained high. CONCLUSION: We provided updated estimates of malnutrition and its risk in different healthcare settings. Although the level of dependence appears to be an important determinant, heterogeneity in individual study results remained substantially unexplained. The cause-effect relationship between nutritional status and level of dependence deserves further investigation.