Predictive ability of the Mini Nutritional Assessment Short Form (MNA-SF) in a free-living elderly population: a cross-sectional study.

BACKGROUND: Various scales have been used to perform a quick and first level nutritional assessment, and the MNA is one of the most used and recommended by experts in the elderly in all areas. This scale has a short form, the MNA-SF, revised and validated in 2009, which has two versions: the BMI-MNA-SF contains the first six items of the full scale including Body Mass Index while the CC-MNA-SF includes Calf Circumference instead of BMI. OBJECTIVE: To evaluate the predictive ability for nutritional status of the two versions of the MNA-SF against the MNA in free-living elderly in the province of Valencia. METHODS: Cross-sectional study of 660 free-living elderly in the province of Valencia selected in 12 community centres using stratified sampling by blocks. Inclusion criteria: being aged 65 or over, living at home, having functional autonomy, residing in the province of study for more than one year, regularly attending community centres and voluntarily wanting to take part. RESULTS: Of the 660 subjects studied, 319 were men (48.3%) and 341 (51.7%) women with a mean age of 74.3 years (SD = 6.6). In terms of nutritional assessment, using the BMI-MNA-SF and the CC-MNA-SF we found that 26.5% and 26.2% were at risk of malnutrition and 0.9% and 1.5% were malnourished respectively. With the full MNA, 23.3% were at risk of malnutrition. Spearman's rank correlation coefficients indicate a high association between the full MNA score and the MNA-SFs scores (BMI-MNA-SF: ρ = 0.78p < 0.001; CC-MNA-SF: ρ = 0.78p < 0.001). In addition we obtained a very high correlation between the two MNA-SFs (ρ = 0.96p < 0.001). We evaluated the agreement between the full MNA and the MNA-SFs classification in three nutritional categories (normal nutritional status, risk of malnutrition, malnutrition) with Cohen's kappa coefficients (BMI-MNA-SF: κ = 0.54p < 0.001; CC-MNA-SF: κ = 0.52p < 0.001). These values indicate moderate agreement with the full MNA. There is very good agreement between the BMI-MNA-SF and CC-MNA-SF (κ = 0.88p < 0.001). In order to determine the ability of both MNA-SFs to identify subjects not requiring any nutritional intervention, we considered the dichotomised categorisation of the full MNA and the MNA-SFs as "normal nutritional status" vs. "malnutrition and risk of malnutrition" Areas under the ROC curves using MNA as the gold standard indicate moderately high prognostic accuracy (BMI-MNA-SF: AUC = 0.88p < 0.001; CC-MNA-SF: AUC = 0.87 p < 0.001). Both versions of the MNA-SF showed similar sensitivity, specificity and diagnostic effectiveness (BMI-MNA-SF: 73.4%, 86.6%, 83.5%; CC-MNA-SF 73.4%, 86.2%, 83.2%). CONCLUSIONS: In its two versions the MNA-SF presents useful predictive ability against the MNA. The advantage of the CC-MNA-SF is that using it requires fewer resources and less time in primary care, although always the characteristics of the population must take into account to make the right decision based on the MNA-SF scales.

[Nutrition-related risk factors in autonomous non-institutionalized adult elderly people]. / Factores asociados al riesgo nutricional en adultos mayores autónomos no institucionalizados.

OBJECTIVES: To determine factors related to nutritional riskin autonomous non-institutionalized adult elder people. METHODS: Cross-sectional study including 660 autonomous non-institutionalized adult elder people. Participants were assessed in 12 social centres (province of Valencia) and selected using stratified sampling by blocks. INCLUSION CRITERIA: age 65 or over, living at home, functionally autonomous, having lived for more than 1 year in the province of Valencia, regularly visiting social centres and voluntary participation in the study. MNA is used for nutritional assessment and factors associated to nutritional status are collected by means of an ad-hoc survey. RESULTS: Out of the 660 study subjects, 48.33% are male and 51.67% are female, mean age is 74.3±6,57. 23.33% show malnutrition risk. Independent factors associated to malnutrition risk -with adjusted prevalence odds ratioare: absence of academic education (OR=2.29), feeling lonely (OR=2.34), following controlled diets (OR=0.55), reduced appetite (OR=2.56), number of fractions in daily intake (OR=0.66), suffering from xerostomia (OR=1.72), swallowing difficulties (OR=2.30), number of chronic diseases (OR=1.38) and having suffered from acute diseases during the last year (OR=2.03). An increase in BMI is associated with a good nutritional status (OR=0.85). These factors have allowed an accurate classification of 80% of the surveyed patients. CONCLUSIONS: Numerous chronic diseases, recent acute diseases, non-controlled diets, xerostomia and swallowing difficulties, eating few times a day and little appetite, feelling lonely and lacking from academic education are factors allowing the prediction of malnutrition risk in adult elder people.

Objetivos: Determinar factores asociados al riesgo nutricional en adultos mayores autónomos no institucionalizados. Métodos: Estudio transversal realizado en 660 adultos mayores autónomos, no institucionalizados. Los participantes fueron evaluados en 12 centros sociales (provincia de Valencia) seleccionados mediante un muestreo estratificado por bloques. Criterios de inclusión: tener 65 años o más, vivir en el domicilio, poseer autonomía funcional, residir más de un año en la provincia de Valencia, acudir periódicamente a los centros sociales y colaborar voluntariamente en el estudio. Se usa el MNA para la valoración nutricional y se recogen factores asociados al estado nutricional en una encuesta adhoc. Resultados: De los 660 sujetos estudiados, el 48,33% son hombres y el 51,67% mujeres, la edad media es de 74,3±6,57 años. El 23,33% presentan riesgo de malnutrición. Los factores independientes asociados al riesgo de malnutrición, con el odds de prevalencia ajustada, son: no poseer estudios (OR=2,29), sentir soledad (OR=2,34), mantener dietas controladas (OR=0,55), un apetito escaso (OR=2,56), número de fracciones en la ingesta diaria (OR=0,66), sufrir xerostomía (OR=1,72), tener dificultades para deglutir (OR=2,30), el número de enfermedades crónicas (OR=1,38) y haber sufrido enfermedades agudas en el último año (OR=2,03). Un incremento en el IMC se asocia a un buen estado nutricional (OR=0,85). Estos factores nos han permitido clasificar correctamente a un 80% de los pacientes encuestados. Conclusiones: Tener numerosas enfermedades crónicas, haber sufrido enfermedades agudas recientes, mantener dietas sin control, sufrir xerostomía y dificultad para deglutir, comer pocas veces al día y con escaso apetito, sentirse solo y no tener estudios son factores que, permiten predecir el riesgo de malnutrición en los adultos mayores.

[Study on the nutritional risk of autonomous non-institutionalized adult elder people]. / Estudio del riesgo nutricional en adultos mayores autónomos no institucionalizados.

OBJECTIVES: To assess the nutritional status of autonomous, non-institutionalized, elder adults in social centers by means of the MNA scale and to analyze their distribution according to socio-demographical variables: gender, age, civil status, living with other people, educational level, and rural/urban setting. METHODS: Cross-sectional study performed in 660 autonomous, non-institutionalized elder adults in social center of the province of Valencia. The subjects were assessed at 12 social centers selected though stratified sample sets. The inclusion criteria were: being 65 years of older, living at home, having functional autonomy, residing for more than one year in the province of Valencia, attending periodically the social center, and willing to participate. The MNA scale was used for nutritional assessment. RESULTS: Of the 660 included subjects, 48.33% were males and 51.6% females; the mean age was 74.3 ± 6.57 years. 23.3% of the participants were at risk for malnutrition. The prevalence of malnutrition odds ratio was higher in: females as compared to men (OR = 1.43), subjects ≥ 85 years as compared to the 65-69 years group (OR = 2.27), widowed subjects as compared to those with a stable companion (OR = 1.82) and people with the lowest educational level as compared to those with some educational level (OR = 1.73). CONCLUSIONS: The prevalence of malnutrition risk in autonomous, non-institutionalized elder adults at social centers of the province of Valencia reaches one out of four people, being higher in widowed subjects (mostly elder women living alone) and in uneducated people.

Objetivos: Valorar el estado nutricional en adultos mayores autónomos, no institucionalizados, en centros sociales, mediante la escala MNA y analizar su distribución según las variables sociodemográficas: sexo, edad, estado civil, convivencia, estudios y ámbito rural o urbano. Métodos: Estudio transversal realizado en 660 adultos mayores autónomos, no institucionalizados en centros sociales de la provincia de Valencia. Los sujetos fueron evaluados en 12 centros sociales seleccionados mediante un muestreo estratificado por bloques. Los criterios de inclusión en el estudio fueron: tener 65 años o más, vivir en el domicilio, tener autonomía funcional, residir más de un año en la provincia de Valencia, acudir periódicamente a centros sociales y querer colaborar. Se usó el MNA para la valoración nutricional. Resultados: De los 660 sujetos incluidos en el estudio, el 48,33% son hombres y el 51,6% mujeres, la edad media es de 74,3 ± 6,57 años. El 23,3% de los encuestados presenta riesgo de malnutrición. El odds de prevalencia del riesgo de malnutrición es mayor en: mujeres respecto a hombres (OR = 1,43), personas ≥?85 años respecto al grupo de 65-69 años (OR = 2,27), personas viudas respecto a casadas o con pareja estable (OR = 1,82) y en personas sin estudios respecto a las que disponen de algún nivel de estudios (OR = 1,73). Conclusiones: La prevalencia de riesgo nutricional en adultos mayores autónomos, no institucionalizados en centros sociales de la provincia de Valencia alcanza a una de cada cuatro personas, siendo más elevada en personas viudas (en su mayor parte mujeres mayores, que viven solas) y en personas sin estudios.