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Cano-García L, Redondo-Rodríguez R, Mena-Vázquez N, Manrique-Arija S, García-Studer A, Ortiz-Marquez F, Borregón-Garrido P, Fernández-Nebro A. Severity and impact of digestive impairment perceived by patients with systemic sclerosis: a cross-sectional study. BMJ Open 2024; 14:e083419. [PMID: 38684244 PMCID: PMC11086412 DOI: 10.1136/bmjopen-2023-083419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 04/09/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVES To describe the severity and impact of gastrointestinal involvement in patients with systemic sclerosis (SSc) and identify associated factors. PATIENTS AND METHODS Non-controlled cross-sectional study of patients with SSc (2013 American College of Rheumatology/European League Against Rheumatism criteria). The main variables were severity of gastrointestinal involvement according to the University of California, Los Angeles Scleroderma Clinical Trials Consortium Gastrointestinal Tract 2.0 instrument (UCLA SCTC GIT 2.0) and dysphagia according to the Eating Assessment Tool-10 (EAT-10). We evaluated reflux, distension, diarrhoea, faecal soilage, constipation, emotional well-being and social functioning, as well as dysphagia. Clinical and epidemiological data were collected using the Mini Nutritional Assessment Short Form (MNA-SF) and the EuroQol-5D-3L. The degree of skin fibrosis was assessed using the modified Rodnan skin score (mRSS). Multivariate models were constructed to analyse factors associated with gastrointestinal involvement and dysphagia. RESULTS Of the 75 patients with SSc included, 58.7% had moderate, severe or very severe reflux, 57.4% had constipation according to UCLA SCTC GIT 2.0 and 49.7% had abdominal distension. Gastrointestinal symptoms interfered significantly with social functioning (42.7%) and emotional well-being (40.0%). Dysphagia (EAT-10≥3) was recorded in 52% of patients, and according to MNA-SF poor nutrition in 30.7%, and clear malnutrition requiring a nutritional intervention in 5.3%. Multivariate adjustment revealed an association between severity of gastrointestinal symptoms according to the mRSS (β=0.249; p=0.002) and Visual Analogue Scale 3-Level EuroQol-5D (VAS-EQ-5D-3L) (β=-0.302; p=0.001), whereas presence of dysphagia was associated with the mRSS (OR=2.794; p=0.015), VAS-EQ-5D-3L (OR=0.950; p=0.005) and malnutrition (MNA-SF≤7; OR=3.920; p=0.041). CONCLUSIONS Patients with SSc frequently present severe gastrointestinal symptoms. These are associated with poor quality of life, more severe skin involvement and malnutrition.
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Affiliation(s)
- Laura Cano-García
- Reumatología, Hospital Regional Universitario de Málaga, Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Pataforma BIONAND, Málaga, Spain
| | - Rocío Redondo-Rodríguez
- Reumatología, Hospital Regional Universitario de Málaga, Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Pataforma BIONAND, Málaga, Spain
| | - Natalia Mena-Vázquez
- Reumatología, Hospital Regional Universitario de Málaga, Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Pataforma BIONAND, Málaga, Spain
| | - Sara Manrique-Arija
- Reumatología, Hospital Regional Universitario de Málaga, Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Pataforma BIONAND, Málaga, Spain
- Departamento de Medicina, Universidad de Málaga, Málaga, Spain
| | - Aimara García-Studer
- Reumatología, Hospital Regional Universitario de Málaga, Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Pataforma BIONAND, Málaga, Spain
- Departamento de Medicina, Universidad de Málaga, Málaga, Spain
| | - Fernando Ortiz-Marquez
- Reumatología, Hospital Regional Universitario de Málaga, Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Pataforma BIONAND, Málaga, Spain
- Departamento de Medicina, Universidad de Málaga, Málaga, Spain
| | - Paula Borregón-Garrido
- Reumatología, Hospital Regional Universitario de Málaga, Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Pataforma BIONAND, Málaga, Spain
| | - Antonio Fernández-Nebro
- Reumatología, Hospital Regional Universitario de Málaga, Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Pataforma BIONAND, Málaga, Spain
- Departamento de Medicina, Universidad de Málaga, Málaga, Spain
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Vidaña-Espinoza HJ, López-Teros MT, Esparza-Romero J, Rosas-Carrasco O, Luna-López A, Alemán Mateo H. Association between the risk of malnutrition and sarcopenia at 4.2 years of follow-up in community-dwelling older adults. Front Med (Lausanne) 2024; 11:1363977. [PMID: 38476442 PMCID: PMC10929268 DOI: 10.3389/fmed.2024.1363977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 02/13/2024] [Indexed: 03/14/2024] Open
Abstract
Introduction Currently, there is only scarce evidence of a causal association between risk of malnutrition (RM) by the mini-nutritional assessment (MNA) and the incidence of sarcopenia. This study was designed to assess such an association at 4.2 years of follow-up in community-dwelling subjects over 60 years old. Methods The data used were from the FraDySMex cohort study. The exposition variables were RM diagnosed by the long forma of the MNA (MNA-LF) and short form (MNA-SF). The last one included the body mass index and calf circumference at baseline, while sarcopenia was diagnosed by the EWGSOP2 at follow-up and taken as the response variable. Several covariates involved in the association were also considered. A multiple logistic regression analysis was performed to test the association. Results At baseline, 27.0 and 37.9% of subjects had RM by the MNA-LF and MNA-SF, respectively. The incidence of sarcopenia was 13.7%. The fat mass variable significantly modified the association, so it was tested in each stratum. Two independent models showed that subjects with RM by the MNA-LF in the normal fat mass stratum were at a higher risk for developing sarcopenia at follow-up than those without RM (OR 9.28; IC 95% 1.57-54.76) after adjusting for age, sex, and waist circumference. No association was found for the excess fat mass stratum subjects. Subjects with RM by the MNA-SF in the excess fat mass stratum were more likely to develop sarcopenia at follow-up than those without RM by the MNA-SF (OR 3.67; IC 95% 1.29-10.43). This association was not found in the subjects in the normal fat mass stratum. Conclusion The association was dependent on the variable fat mass. The two forms of the MNA should not be applied indistinctly with older adults. Based on these results, it is clear that the risk of malnutrition precedes the onset of sarcopenia.
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Affiliation(s)
- Helen J. Vidaña-Espinoza
- Coordinación de Nutrición, Centro de Investigación en Alimentación y Desarrollo (CIAD), A.C., Hermosillo, Sonora, Mexico
| | - Miriam T. López-Teros
- Centro de Evaluación del Adulto Mayor, Departamento de Salud, Universidad Iberoamericana Ciudad de México, Ciudad de México, Mexico
| | - Julián Esparza-Romero
- Coordinación de Nutrición, Centro de Investigación en Alimentación y Desarrollo (CIAD), A.C., Hermosillo, Sonora, Mexico
| | - Oscar Rosas-Carrasco
- Centro de Evaluación del Adulto Mayor, Departamento de Salud, Universidad Iberoamericana Ciudad de México, Ciudad de México, Mexico
| | - Armando Luna-López
- Dirección de Investigación, Instituto Nacional de Geriatría, Ciudad de México, Mexico
| | - Heliodoro Alemán Mateo
- Coordinación de Nutrición, Centro de Investigación en Alimentación y Desarrollo (CIAD), A.C., Hermosillo, Sonora, Mexico
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Cezón-Serrano N, Arnal-Gómez A, Arjona-Tinaut L, Cebrià I Iranzo MÀ. Functional and emotional impact of COVID-19 lockdown on older adults with sarcopenia living in a nursing home: A 15-month follow-up. Nurs Health Sci 2023; 25:597-608. [PMID: 37705366 DOI: 10.1111/nhs.13050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 07/26/2023] [Accepted: 08/28/2023] [Indexed: 09/15/2023]
Abstract
This study aimed to detect the functional and emotional impact of COVID-19 lockdown on institutionalized older adults with sarcopenia during a 15-month follow-up. A prospective longitudinal cohort study was conducted in a nursing home. Participants were screened for sarcopenia, and those with a score of ≥4 points according to SARC-F questionnaire were included. Assessments were performed pre-lockdown (T1), 12 months (T2) after, and at a 15-month follow-up (T3). Functional measurements included chair stand test, handgrip, biceps brachii and quadriceps femoris strengths, appendicular skeletal mass, gait speed, Short Physical Performance Battery, and Timed Up-and-Go test. Emotional assessments included Short-Form Health Survey, Geriatric Depression Scale-Short Form, and the Mini-Mental State Examination. The analyzed sample showed a reduction in bicep strength, and other upper and lower limb strength variables showed a decreasing trend with no changes regarding muscle mass. Physical performance showed a change, specifically a deterioration in the subtest related to balance. Cognitive and emotional components were affected and quality of life was decreased. It is of paramount importance to focus on sarcopenic older adults since their characteristics can deteriorate when isolation measures are conducted.
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Affiliation(s)
- Natalia Cezón-Serrano
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
- Physiotherapy in Motion, Multi-specialty Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Anna Arnal-Gómez
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
- Physiotherapy in Motion, Multi-specialty Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Laura Arjona-Tinaut
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Maria Àngels Cebrià I Iranzo
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
- Physiotherapy in Motion, Multi-specialty Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
- Physical Medicine and Rehabilitation Service, La Fe Hospital in Valencia, La Fe Health Research Institute (IISLAFE), Valencia, Spain
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Cano-García L, Redondo-Rodríguez R, Manrique-Arija S, Domínguez-Quesada C, Crisóstomo Vacas J, Armenteros-Ortiz P, Ruiz-Vilchez D, Martín-Martín JM, García-Studer A, Ortiz-Márquez F, Mena-Vázquez N, Fernández-Nebro A. Prevalence of Malnutrition and Associated Factors in Older Patients with Rheumatoid Arthritis: A Cross-Sectional Study. Nutrients 2023; 15:3500. [PMID: 37630691 PMCID: PMC10460011 DOI: 10.3390/nu15163500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVE To describe the frequency of malnutrition in older patients with rheumatoid arthritis (RA) and investigate associated risk factors. METHODS This multicenter, cross-sectional study included participants aged ≥65 years who met the 2010 ACR/EULAR criteria for RA. Nutritional status was assessed using the Mini Nutritional Assessment Short Form (MNA-SF) and based on variables, such as albumin level, the Geriatric Nutritional Risk Index (GNRI), and vitamin D. Data were also collected on epidemiological variables, inflammatory disease activity, quality of life, physical function, and frailty. Multivariate models were used to study factors associated with nutritional status. RESULTS The study population comprised 76 RA patients aged ≥65 years, of whom 68.4% had a normal nutritional status, and 31.5% had an impaired nutritional status: 28.9% were at risk of malnutrition, and 2.6% were malnourished. Additionally, 10% had albumin levels <3.8 g/L. Patients with impaired nutritional status had poorer quality of life and physical function. The factors associated with compromised nutritional status (OR [95% CI]) were age (1.0 [1.0-1.1]; p = 0.035), DAS28-ESR (1.8 [1.0-3.2]; p = 0.024), and EuroQoL-5D-5L (0.9 [0.9-0.9]; p = 0.040). Furthermore, the GNRI was associated with the MNA score (0.06 [0.0-0.1]; p = 0.014). CONCLUSIONS Approximately one-third of older patients with RA have impaired nutritional status. Older age, higher inflammatory disease activity, and decreased quality of life are associated with impaired nutritional status. The MNA and GNRI are valuable tools for assessing the nutritional status of patients with RA.
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Affiliation(s)
- Laura Cano-García
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, 29010 Málaga, Spain; (L.C.-G.); (R.R.-R.); (S.M.-A.); (A.G.-S.); (F.O.-M.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
| | - Rocío Redondo-Rodríguez
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, 29010 Málaga, Spain; (L.C.-G.); (R.R.-R.); (S.M.-A.); (A.G.-S.); (F.O.-M.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
- Departamento de Medicina, Universidad de Málaga, 29010 Málaga, Spain
| | - Sara Manrique-Arija
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, 29010 Málaga, Spain; (L.C.-G.); (R.R.-R.); (S.M.-A.); (A.G.-S.); (F.O.-M.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
- Departamento de Medicina, Universidad de Málaga, 29010 Málaga, Spain
| | | | - Juan Crisóstomo Vacas
- UGC de Reumatología, Hospital Universitario Reina Sofía de Córdoba, 14004 Córdoba, Spain; (J.C.V.); (P.A.-O.); (D.R.-V.)
| | - Pedro Armenteros-Ortiz
- UGC de Reumatología, Hospital Universitario Reina Sofía de Córdoba, 14004 Córdoba, Spain; (J.C.V.); (P.A.-O.); (D.R.-V.)
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain
| | - Desiree Ruiz-Vilchez
- UGC de Reumatología, Hospital Universitario Reina Sofía de Córdoba, 14004 Córdoba, Spain; (J.C.V.); (P.A.-O.); (D.R.-V.)
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain
| | - José María Martín-Martín
- UGC de Reumatología, Hospital Universitario Nuestra Señora de la Candelaria, 38010 Santa Cruz de Tenerife, Spain;
| | - Aimara García-Studer
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, 29010 Málaga, Spain; (L.C.-G.); (R.R.-R.); (S.M.-A.); (A.G.-S.); (F.O.-M.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
| | - Fernando Ortiz-Márquez
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, 29010 Málaga, Spain; (L.C.-G.); (R.R.-R.); (S.M.-A.); (A.G.-S.); (F.O.-M.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
| | - Natalia Mena-Vázquez
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, 29010 Málaga, Spain; (L.C.-G.); (R.R.-R.); (S.M.-A.); (A.G.-S.); (F.O.-M.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
| | - Antonio Fernández-Nebro
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, 29010 Málaga, Spain; (L.C.-G.); (R.R.-R.); (S.M.-A.); (A.G.-S.); (F.O.-M.); (A.F.-N.)
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
- Departamento de Medicina, Universidad de Málaga, 29010 Málaga, Spain
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Totland TH, Krogh HW, Smedshaug GB, Tornes RA, Bye A, Paur I. Harmonization and standardization of malnutrition screening for all adults - A systematic review initiated by the Norwegian Directorate of Health. Clin Nutr ESPEN 2022; 52:32-49. [PMID: 36513471 DOI: 10.1016/j.clnesp.2022.09.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/05/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND & AIMS The Norwegian Directorate of Health has identified a need to harmonize and standardize the malnutrition screening practice in Norwegian hospitals and primary health care settings, in order to provide a seamless communication of malnutrition screening along the patient pathway. Our aim was to perform a systematic review of the validity and reliability of screening tools used to identify risk of malnutrition across health care settings, diagnoses or conditions and adult age groups, as a first step towards a national recommendation of one screening tool. METHODS A systematic literature search for articles evaluating validity, agreement, and reliability of malnutrition screening tools, published up to August 2020, was conducted in: MEDLINE, Embase, APA PsycInfo, Cinahl, Cochrane Databases, Web of Science, Epistemonikos, SveMed+, and Norart. The systematic review was registered in PROSPERO (CRD42022300558). For critical appraisal of each included article, the Quality Criteria Checklist by The Academy of Nutrition and Dietetics was used. RESULTS The review identified 105 articles that fulfilled the inclusion and exclusion criteria. The most frequently validated tools were Mini Nutritional Assessment short form (MNA), Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST), and Nutritional Risk Screening 2002 (NRS-2002). MNA, MST and NRS-2002 displayed overall moderate validity, and MUST low validity. All four tools displayed low agreement. MST and MUST were validated across health care settings and age groups. In general, data on reliability was limited. CONCLUSIONS The screening tools MST and NRS-2002 displayed moderate validity for the identification of malnutrition in adults, of which MST is validated across health care settings. In addition, MNA has moderate validity for the identification of malnutrition in adults 65 years or older.
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Affiliation(s)
- Torunn Holm Totland
- Department of Non-Communicable Diseases, Division of Prevention and Public Health, Norwegian Directorate of Health, Oslo, Norway; Department of Physical Health and Ageing, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.
| | - Henriette Walaas Krogh
- Department of Non-Communicable Diseases, Division of Prevention and Public Health, Norwegian Directorate of Health, Oslo, Norway
| | - Guro Berge Smedshaug
- Department of Non-Communicable Diseases, Division of Prevention and Public Health, Norwegian Directorate of Health, Oslo, Norway
| | | | - Asta Bye
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway; European Palliative Care Research Centre (PRC), Dept. of Oncology, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingvild Paur
- Department of Non-Communicable Diseases, Division of Prevention and Public Health, Norwegian Directorate of Health, Oslo, Norway; Norwegian Advisory Unit on Disease-related Undernutrition, Oslo University Hospital, Oslo, Norway; Dept. of Clinical Services, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
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An extended version of the MNA-SF increases sensitivity in identifying malnutrition among community living older adults. Results from the PRONUTRISENIOR project. Clin Nutr ESPEN 2021; 46:167-172. [PMID: 34857191 DOI: 10.1016/j.clnesp.2021.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 06/23/2021] [Accepted: 10/20/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND & AIMS The Mini Nutritional Assessment (MNA) is the most used tool to assess malnutrition and/or its risk among older adults. Its Screening section was proposed as a short form (MNA-SF) but studies comparing the two forms present controversial results. Our main aims were to study the agreement between MNA-SF and its full form (MNA-FF) among Portuguese older adults living in the community and to develop a more sensible version of the MNA-SF. MATERIAL AND METHODS This cross-sectional study used a convenience sample of 456 older adults (54.2% females) aged 65-92 years (mean = 73; SD = 6). Data analyzed included: nutritional status (MNA), social support (Fillenbaum's Social Network Index), level of independency in daily activities (Lawton e Brody's scale) and eating-related quality of life. Both MNA-FF and MNA-SF classify participants as malnourished, at risk of malnutrition or with normal nutrition status. Anthropometric assessments (weight, height, arm and calf perimeters) were carried out and BMI was computed. RESULTS The agreement between the two classifications is 82.7%, but Cohen's k shows a weak agreement (weighted Cohen's k = 0.497; p < 0,001), and the sensitivity of the MNA-SF to detect malnutrition or its risk (as assessed by the MNA-FF) was 42.6% (despite a specificity of 98.8%). Participants classified as normal using the MNA-SF despite at risk using the MNA-FF present lower scores in two items from the Assessment section (number of full meals eaten daily and amount of fluid consumed per day). These were included in MNA-SF to obtain an extended short-version (MNA-SF8). The difference between the ROC curves for MNA-SF and MNA-SF8 justifies the preferential use of the MNA-SF8 with an estimated cut-off of 14 points, which showed high sensitivity (91.8%) and specificity (79.9%). CONCLUSIONS The addition of two items to the MNA-SF provides a more sensible tool to detect the risk of malnutrition among older adults. General eating-related questions seem relevant to assess malnutrition in this age group.
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Eroles-Busquets M, García-Cerdán MR, Mejías-Serrano MT, Giner-Nogueras R, Vázquez-González I, Reinoso-Iñiguez JI. Study of the prevalence of the risk of malnutrition in the non-institutionalized population over 65 years old attended in a health center in Barcelona. ENFERMERIA CLINICA 2021; 31:71-81. [PMID: 33358680 DOI: 10.1016/j.enfcli.2020.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 10/02/2020] [Accepted: 10/25/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To know the prevalence of risk of malnutrition in community-dwelling elderly (defined as aged >65) attended in a Primary Care Center, to find the main factors associated to malnutrition risk and to evaluate the Mini Nutritional Assessment Questionnaire (MNA) MNA Short Form vs. MNA Full Test. METHOD Design: Cross-Sectional study. SETTING Primary Care Center. SUBJECTS 337 participants visited in the Community Care Center. Mini Nutritional Assessment Questionnaire (MNA) was applied; sociodemographic and Health variables were collected as well as functional evaluation tests (Short Portable Mental Status Questionnaire and Lawton & Brody Instrumental Activities of Daily Living Scale). Clinical history information was taken from the Medical Records. Using MNA Full Test (MNA-FT) as the gold standard, sensitivity, specificity and predictive values of MNA Short Form (MNA-SF) were evaluated. RESULTS prevalence according MNA-FT was 0.6% for malnutrition and 7.7% for malnutrition risk. No gender differences were found. The average age was higher in the population with malnutrition or at risk for malnutrition (p=0.016). Significant association of malnutrition with having carer (p<0.0001) or being more dependent (p<0.0001) was found. MNA-SF showed an acceptable sensitivity (67.9%) and good specificity (92.6%). CONCLUSIONS Compared with other studies this data showed a low prevalence of malnutrition risk in community-living elderly using the MNA test. It is recommended to use the MNA-FT in order to avoid under diagnosing malnutrition with MNA-SF.
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Affiliation(s)
- Montserrat Eroles-Busquets
- Equipo de Atención Primaria (EAP) Camps Blancs, Institut Català de la Salut, Sant Boi de Llobregat, Barcelona, España; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España.
| | - M Rosa García-Cerdán
- Equipo de Atención Primaria (EAP) Camps Blancs, Institut Català de la Salut, Sant Boi de Llobregat, Barcelona, España; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España
| | - M Trinidad Mejías-Serrano
- Equipo de Atención Primaria (EAP) Camps Blancs, Institut Català de la Salut, Sant Boi de Llobregat, Barcelona, España; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España
| | - Roser Giner-Nogueras
- Equipo de Atención Primaria (EAP) Camps Blancs, Institut Català de la Salut, Sant Boi de Llobregat, Barcelona, España; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España
| | - Inés Vázquez-González
- Equipo de Atención Primaria (EAP) Camps Blancs, Institut Català de la Salut, Sant Boi de Llobregat, Barcelona, España; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España
| | - Jana Isabel Reinoso-Iñiguez
- Equipo de Atención Primaria (EAP) Camps Blancs, Institut Català de la Salut, Sant Boi de Llobregat, Barcelona, España; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España
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Skipper A, Coltman A, Tomesko J, Charney P, Porcari J, Piemonte TA, Handu D, Cheng FW. Adult Malnutrition (Undernutrition) Screening: An Evidence Analysis Center Systematic Review. J Acad Nutr Diet 2020; 120:669-708. [DOI: 10.1016/j.jand.2019.09.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Indexed: 01/09/2023]
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Tang SK, Tse MMY, Leung SF, Fotis T. The effectiveness, suitability, and sustainability of non-pharmacological methods of managing pain in community-dwelling older adults: a systematic review. BMC Public Health 2019; 19:1488. [PMID: 31703654 PMCID: PMC6842175 DOI: 10.1186/s12889-019-7831-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 10/22/2019] [Indexed: 11/17/2022] Open
Abstract
Background Pain is common in older adults. To maintain their quality of life and promote healthy ageing in the community, it is important to lower their pain levels. Pharmacological pain management has been shown to be effective in older adults. However, as drugs can have various side effects, non-pharmacological pain management is preferred for community-dwelling older adults. This systematic review evaluates the effectiveness, suitability, and sustainability of non-pharmacological pain management interventions for community-dwelling older adults. Methods Five databases, namely, CINHAL, Journals@Ovid, Medline, PsycInfo, and PubMed, were searched for articles. The criteria for inclusion were: full-text articles published in English from 2005 to February 2019 on randomized controlled trials, with chronic non-cancer pain as the primary outcome, in which pain was rated by intensity, using non-pharmacological interventions, and with participants over 65 years old, community-dwelling, and mentally competent. A quality appraisal using the Jadad Scale was conducted on the included articles. Results Ten articles were included. The mean age of the older adults was from 66.75 to 76. The interventions covered were acupressure, acupuncture, guided imagery, qigong, periosteal stimulation, and Tai Chi. The pain intensities of the participants decreased after the implementation of the intervention. The net changes in pain intensity ranged from − 3.13 to − 0.65 on a zero to ten numeric rating scale, in which zero indicates no pain and ten represents the worst pain. Conclusions Non-pharmacological methods of managing pain were effective in lowering pain levels in community-dwelling older adults, and can be promoted widely in the community.
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Affiliation(s)
- Shuk Kwan Tang
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong.
| | - Mimi Mun Yee Tse
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Sau Fong Leung
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Theofanis Fotis
- School of Health Sciences, University of Brighton, Westlain House, Village Way, Brighton, BN1 9PH, UK
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Validity of Nutritional Screening Tools for Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2019; 20:1351.e13-1351.e25. [PMID: 31409560 DOI: 10.1016/j.jamda.2019.06.024] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/23/2019] [Accepted: 06/24/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The aim of this systematic review was to summarize the validity of nutritional screening tools to detect the risk of malnutrition in community-dwelling older adults. DESIGN A systematic review and meta-analysis. The protocol for this systematic review was registered in the PROSPERO database (CRD42017072703). SETTING AND PARTICIPANTS A literature search was performed in PubMed, EMBASE, CINAHL, and Cochrane using the combined terms "malnutrition," "aged," "community-dwelling," and "screening." The time frame of the literature reviewed was from January 1, 2001, to May 18, 2018. Older community-dwellers were defined as follows: individuals with a mean/median age of >65 years who were community-dwellers or attended hospital outpatient clinics and day hospitals. All nutritional screening tools that were validated in community-dwelling older adults against a reference standard to detect the risk of malnutrition, or with malnutrition, were included. MEASURES Meta-analyses were performed on the diagnostic accuracy of identified nutritional screening tools validated against the Mini Nutritional Assessment-Long Form (MNA-LF). The symmetric hierarchical summary receiver operating characteristic models were used to estimate test performance. RESULTS Of 7713 articles, 35 articles were included in the systematic review, and 9 articles were included in the meta-analysis. Seventeen nutritional screening tools and 10 reference standards were identified. The meta-analyses showed average sensitivities and specificities of 0.95 (95% confidence interval [CI] 0.75-0.99) and 0.95 (95% CI 0.85-0.99) for the Mini Nutritional Assessment-Short Form (MNA-SF; cutoff point ≤11), 0.85 (95% CI 0.80-0.89) and 0.87 (95% CI 0.86-0.89) for the MNA-SF-V1 (MNA-SF using body mass index, cutoff point ≤11), 0.85 (95% CI 0.77-0.89) and 0.84 (95% CI 0.79-0.87) for the MNA-SF-V2 (MNA-SF using calf circumference instead of body mass, cutoff point ≤11), respectively, using MNA-LF as the reference standard. CONCLUSIONS AND IMPLICATIONS The MNA-SF, MNA-SF-V1, and MNA-SF-V2 showed good sensitivity and specificity to detect community-dwelling older adults at risk of malnutrition validated against the MNA-LF. Clinicians should consider the use of the cutoff point ≤11 on the MNA-SF, MNA-SF-V1, and MNA-SF-V2 to identify community-dwelling older adults at risk of malnutrition.
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Power L, Mullally D, Gibney ER, Clarke M, Visser M, Volkert D, Bardon L, de van der Schueren MAE, Corish CA. A review of the validity of malnutrition screening tools used in older adults in community and healthcare settings - A MaNuEL study. Clin Nutr ESPEN 2019; 24:1-13. [PMID: 29576345 DOI: 10.1016/j.clnesp.2018.02.005] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 02/16/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Older adults are at increased risk of malnutrition compared to their younger counterparts. Malnutrition screening should be conducted using a valid malnutrition screening tool. An aim of the Healthy Diet for a Healthy Life (HDHL) Joint Programming Initiative (JPI) 'Malnutrition in the Elderly Knowledge Hub' (MaNuEL) was to review the reported validity of existing malnutrition screening tools used in older adults. METHODS A literature search was conducted to identify validation studies of malnutrition screening tools in older populations in community, rehabilitation, residential care and hospital settings. A database of screening tools was created containing information on how each tool was validated. RESULTS Seventy-four articles containing 119 validation studies of 34 malnutrition screening tools used in older adults were identified across the settings. Twenty-three of these tools were designed for older adults. Sensitivity and specificity ranged from 6 to 100% and 12-100% respectively. Seventeen different reference standards were used in criterion validation studies. Acceptable reference standards were used in 68 studies; 38 compared the tool against the Mini Nutritional Assessment-Full Form (MNA-FF), 16 used clinical assessment by a nutrition-trained professional and 14 used the Subjective Global Assessment (SGA). Twenty-five studies used inappropriate reference standards. Predictive validity was measured in 14 studies and was weak across all settings. CONCLUSIONS Validation results differed significantly between tools, and also between studies using the same tool in different settings. Many studies have not been appropriately conducted, leaving the true validity of some tools unclear. Certain tools appear to be more valid for use in specific settings.
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Affiliation(s)
- Lauren Power
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland; UCD Institute of Food and Health, University College Dublin, Dublin, Ireland.
| | - Deirdre Mullally
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland; UCD Institute of Food and Health, University College Dublin, Dublin, Ireland.
| | - Eileen R Gibney
- UCD Institute of Food and Health, University College Dublin, Dublin, Ireland; School of Agriculture and Food Science, University College Dublin, Dublin, Ireland.
| | - Michelle Clarke
- UCD Institute of Food and Health, University College Dublin, Dublin, Ireland; School of Agriculture and Food Science, University College Dublin, Dublin, Ireland.
| | - Marjolein Visser
- Department of Nutrition and Dietetics, VU University Medical Centre, Amsterdam, The Netherlands; Department of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Institute, Amsterdam, The Netherlands.
| | - Dorothee Volkert
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.
| | - Laura Bardon
- UCD Institute of Food and Health, University College Dublin, Dublin, Ireland; School of Agriculture and Food Science, University College Dublin, Dublin, Ireland.
| | - Marian A E de van der Schueren
- Department of Nutrition and Dietetics, VU University Medical Centre, Amsterdam, The Netherlands; Department of Nutrition and Health, HAN University of Applied Sciences, Nijmegen, The Netherlands.
| | - Clare A Corish
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland; UCD Institute of Food and Health, University College Dublin, Dublin, Ireland.
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Dietary Support in Elderly Patients with Inflammatory Bowel Disease. Nutrients 2019; 11:nu11061421. [PMID: 31238597 PMCID: PMC6627086 DOI: 10.3390/nu11061421] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/20/2019] [Accepted: 06/21/2019] [Indexed: 02/06/2023] Open
Abstract
Ageing of the human population has become a big challenge for health care systems worldwide. On the other hand, the number of elderly patients with inflammatory bowel disease (IBD) is also increasing. Considering the unique clinical characteristics of this subpopulation, including many comorbidities and polypharmacy, the current therapeutic guidelines for the management of IBD should be individualized and applied with caution. This is why the role of non-pharmacological treatments is of special significance. Since both IBD and older age are independent risk factors of nutritional deficiencies, appropriate dietary support should be an important part of the therapeutic approach. In this review paper we discuss the interrelations between IBD, older age, and malnutrition. We also present the current knowledge on the utility of different diets in the management of IBD. Considering the limited data on how to support IBD therapy by nutritional intervention, we focus on the Mediterranean and Dietary Approaches to Stop Hypertension diets, which seem to be the most beneficial in this patient group. We also discuss some new findings on their hypothetical anti-inflammatory influence on the course of IBD.
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Julio MPM, Clavero AE, Soler MLM. Nutritional status and factors associated with non-institutionalized people over 75 years of age. Rev Bras Enferm 2018; 71:1007-1012. [PMID: 29924162 DOI: 10.1590/0034-7167-2017-0207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 05/20/2017] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE to determine the factors related to the risk of malnutrition in a non-institutionalized population over 75 years of age. METHOD a cross-sectional study was conducted using a questionnaire in a sample of 326 individuals over 75 years of age in Castellón (Spain), during 2015, and selected through intentional sampling. RESULTS Malnutrition prevalence was 2.8%. 26.9% of the individuals were at risk of malnutrition, whereas women presented a higher rate (31.5%). Women with a good overall health status showed a lower rate than men, 55% and 69%, respectively. Individuals that showed a lower risk of malnutrition are those with a positive perception than those who have a good overall health. Frail elderly people showed a higher risk of malnutrition (57.5%) compared to non-frail subjects (20.2%) p< 0.001. CONCLUSION Frail women, self-assessed health, overall health, and use of health care services (nursing consultation) were related to a higher risk of malnutrition.
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Montejano Lozoya R, Martínez-Alzamora N, Clemente Marín G, Guirao-Goris SJA, Ferrer-Diego RM. Predictive ability of the Mini Nutritional Assessment Short Form (MNA-SF) in a free-living elderly population: a cross-sectional study. PeerJ 2017; 5:e3345. [PMID: 28533984 PMCID: PMC5438591 DOI: 10.7717/peerj.3345] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 04/22/2017] [Indexed: 11/20/2022] Open
Abstract
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.
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Affiliation(s)
- Raimunda Montejano Lozoya
- La Fe School of Nursing, University of Valencia, Valencia, España.,Health Research Institute La Fe (IIS La Fe), Valencia, España
| | - Nieves Martínez-Alzamora
- Department of Applied Statistics and Operational Research and Quality, Polytechnic University of Valencia, Valencia, España
| | - Gonzalo Clemente Marín
- Department of Applied Statistics and Operational Research and Quality, Polytechnic University of Valencia, Valencia, España
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Evaluation of the effect of an intervention on the nutritional status of hospitalized patients. Med Clin (Barc) 2016; 148:291-296. [PMID: 27993407 DOI: 10.1016/j.medcli.2016.10.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 10/13/2016] [Accepted: 10/20/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND OBJECTIVES To compare the nutritional status of a population of hospitalized patients, divided into 2 different groups, both at admission and hospital discharge, and to assess the influence of nutritional alteration during the hospital stay. MATERIAL AND METHODS Quasi-experimental study comprising 2 groups of patients (N=581); an intervention group (n=303), in which nurses received specific training on managing care methodology, and a control group (n=278), in which nurses continued their usual dynamics. Each group was made up of 2 care units with patients from both surgical and medical specialties. INCLUSION CRITERIA patients admitted to the selected units with a minimum stay of 5 days. The sample selection was performed prospectively and consecutively after implementing the training. RESULTS Of the 581 patients studied, 49.4% were women and 50.6% were men. Mean patient age was 68.29 (SD 16.23) years. In the intervention group, the odds ratio (OR) associated with good nutritional status was multiplied by 1.7 (OR=1.67) compared to the control group in the first evaluation and by 1.4 times (OR=1.43) at hospital discharge. The average stay in days was higher in the control group (13.71, SD 10.19) than in the intervention group (10.89, SD 7.49) (P<.001). CONCLUSION The systematic methodology-based intervention in the chosen units was positive. Patients admitted to the intervention units had a lower nutritional alteration and a shorter hospital stay than those admitted to the control units.
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Umegaki H, Asai A, Kanda S, Maeda K, Shimojima T, Nomura H, Kuzuya M. Risk Factors for the Discontinuation of Home Medical Care among Low-functioning Older Patients. J Nutr Health Aging 2016; 20:453-7. [PMID: 26999247 DOI: 10.1007/s12603-015-0606-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Older patients receiving home medical care often have declining functional status and multiple disease conditions. It is important to identify the risk factors for care transition events in this population in order to avoid preventable transitions. In the present study, therefore, we investigated the factors associated with discontinuation of home medical care as a potentially preventable care transition event in older patients. METHODS Baseline data for participants in the Observational study of Nagoya Elderly with HOme MEdical (ONEHOME) study and data on the mortality, institutionalization, or hospitalisation of the study participants during a 2-year follow-up period were used. Discontinuation of home care was defined as admission to a hospital for any reason, institutionalization, or death. Univariate and multivariate Cox hazard models were used to assess the association of each of the factors with the discontinuation of home care during the observational period. The covariates included in the multivariate analysis were those significantly associated with the discontinuation of home care at the level of P<0.05 in the univariate analysis. RESULTS The univariate Cox hazard model revealed that a low hemoglobin level (< 11g/dL), low serum albumin level (< 3g/dL), higher Charlson Comorbidity Index score, and low Mini Nutritional Assessment Short Form score (< 7) were significantly associated with the discontinuation of home care. A multivariate Cox hazard model including these four factors demonstrated that all four were independently associated with home-care discontinuation. CONCLUSIONS The present results demonstrated that anemia, hypoalbuminemia, malnourishment, and the presence of serious comorbidities were associated with the discontinuation of home medical care among low-functioning older patients.
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Affiliation(s)
- H Umegaki
- Hiroyuki Umegaki, Nagoya University Graduate School of Medicine, Department of Community Healthcare and Geriatrics, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan, Phone: +81-52-744-2364; Fax: +81-52-744-2371; Email address:
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Health determinants of nutritional status in community-dwelling older population: the VERISAÚDE study. Public Health Nutr 2016; 19:2220-8. [PMID: 26975221 DOI: 10.1017/s1368980016000434] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Malnutrition is a common and relevant syndrome in elderly people due to its influence on quality of life. The main aim of the present study was to identify health determinants of malnutrition or risk of malnutrition. DESIGN Cross-sectional study collecting information on sociodemographic and health factors (co-morbidity, cognitive or affective problems, prescription medication use, frailty status, self-rated health) as determinants of nutritional status, assessed by the short form of the Mini Nutritional Assessment. SETTING Forty-three senior centres from Galicia (north-western Spain) participated to recruit participants. SUBJECTS A representative community-dwelling sample of 749 elderly people aged ≥65 years. RESULTS Of the total participants, 14·3 % were malnourished/at risk of malnutrition. Presence of overweight or obesity, depressive symptoms, polypharmacy (use of five or more prescription medications), presence of pre-frailty or frailty status and poor self-rated health showed the strongest relationship to malnutrition/risk of malnutrition. This model predicted 86·0 % of the cases correctly. The best determinants for women were polypharmacy and poor self-rated health, reaching 82·8 % of cases of malnourishment/risk of malnutrition predicted correctly. In men, the main determinants were overweight or obesity, depressive symptomatology and polypharmacy, with 89·8 % of cases of malnourishmen/risk of malnutrition predicted correctly. CONCLUSIONS Screening for nutritional status and its determinant factors should be included as part of comprehensive assessments to ensure an early screening of malnutrition and to propose possible intervention strategies that would be important for both elderly people and the health-care system.
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Hamirudin AH, Charlton K, Walton K. Outcomes related to nutrition screening in community living older adults: A systematic literature review. Arch Gerontol Geriatr 2016; 62:9-25. [DOI: 10.1016/j.archger.2015.09.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 09/18/2015] [Accepted: 09/20/2015] [Indexed: 01/04/2023]
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Lilamand M, Kelaiditi E, Cesari M, Raynaud-Simon A, Ghisolfi A, Guyonnet S, Vellas B, van Kan GA. Validation of the Mini Nutritional Assessment-Short Form in a Population of Frail Elders without Disability. Analysis of the Toulouse Frailty Platform Population in 2013. J Nutr Health Aging 2015; 19:570-4. [PMID: 25923488 DOI: 10.1007/s12603-015-0457-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess the validity of the Mini Nutritional Assessment-Short Form (MNA-SF) in elderly patients from the Toulouse Frailty Platform. PARTICIPANTS Overall, 267 patients aged 65 and over, without severe cognitive impairment (i.e. Mini Mental Status Examination > 20 and CDR<1), no physical disability (i.e. Activities of Daily Living ≥ 5) and no active cancer history (over the past 12 months) were included in 2013. MEASUREMENTS Receiver operating characteristic (ROC) analyses were used to assess the predictive validity of the French version of the MNA-SF for good nutritional status (defined as a full MNA score≥24/30). Analyses were conducted in the overall sample and then in subgroups of frail and pre-frail subjects according to the frailty phenotype. Optimal cut-off points were determined to obtain the best sensitivity/specificity ratio and the highest number of correctly classified subjects. RESULTS Among 267 patients, mean age=81.5±5.8; women=67.0%; 138 (51.7%) were frail, 98 (36.7%) were pre-frail and 31 (11.6%) were robust. Given their MNA-SF scores, 201 (75.3%) had a good nutritional status, 61 (22.8%) were at risk of malnutrition and 5 (1.9%) were malnourished. In the overall sample, but also in subgroups of pre-frail or frail elders, the areas under ROC curves were 0.954, 0.948 and 0.958 respectively. The 11 points cut-off provided the best correct classification ratio (91.4%); sensitivity=94.0%, specificity=83.3%. CONCLUSION The MNA-SF appeared to be a validated and effective tool for malnutrition screening in frail elders. Implementing this tool in clinical routine should contribute to improving the screening of malnourished frail individuals.
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Affiliation(s)
- M Lilamand
- Matthieu Lilamand, MD MSc. Institut du Vieillissement, 37 Allées Jules Guesde. 31000 Toulouse France. Phone: +33 (0)5 61145657. Fax: +33 (0)5 61145640
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Krzymińska-Siemaszko R, Mossakowska M, Skalska A, Klich-Rączka A, Tobis S, Szybalska A, Cylkowska-Nowak M, Olszanecka-Glinianowicz M, Chudek J, Wieczorowska-Tobis K. Social and economic correlates of malnutrition in Polish elderly population: the results of PolSenior study. J Nutr Health Aging 2015; 19:397-402. [PMID: 25809803 DOI: 10.1007/s12603-014-0572-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the prevalence of malnutrition in Polish elderly population and analyse its social and economic correlates based on the data from the PolSenior project, the first large-scale study of a representative group of Polish seniors. DESIGN A cross-sectional population-based study. SETTING All territorial provinces in Poland. PARTICIPANTS 4482 community-dwelling respondents aged 65 years or above (women: n=2142, age=79.0±8.4 years; men: n=2340, age= 78.3±8.6 years). MEASUREMENTS The nutritional status of participants was assessed through the Mini Nutritional Assessment Short Form (the revised MNA-SF). Out of social and economic correlates we evaluated age, sex, level of education, marital status, place of residence, living conditions and economic status. Economic status of the respondents was determined on the basis of questions on how well they could manage their own budgets. Those who could afford only the cheapest food or clothes were considered the group of self-reported poverty. RESULTS Frequency of malnutrition in the PolSenior population accounted for 7.5% (in 5.0% men and 9.0% women; p<0.001). The risk of malnutrition was present in 38.9% (33.3% men and 42.4% women; p<0.001). In our study female sex, older age, unmarried status, living in a rural area and self-reported poverty were independent correlates of malnutrition. CONCLUSIONS Our data showed high prevalence of malnutrition and the risk of its development among the community-dwelling elderly people in Poland. Screening with MNA-SF should focus in particular on unmarried, poorly educated individuals, in late old age, living in rural areas and self-reporting a poor financial state, especially women.
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Affiliation(s)
- R Krzymińska-Siemaszko
- Roma Krzymińska-Siemaszko, Department of Palliative Medicine, Poznan University of Medical Sciences, os. Rusa 25a, Poznan, Poland, Phone/fax: +48 618738303, e-mail:
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Kostka J, Borowiak E, Kostka T. Validation of the modified mini nutritional assessment short-forms in different populations of older people in Poland. J Nutr Health Aging 2014; 18:366-71. [PMID: 24676316 DOI: 10.1007/s12603-013-0393-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the usefulness in different populations of elderly people in Poland of both modified versions of Mini Nutritional Assessment Short-Forms (MNA-SFs) with a three-category scoring classification: one using BMI (MNA-SF-BMI) and another using calf circumference (MNA-SF-CC). SETTING AND PARTICIPANTS A group of 932 community-dwelling subjects from the urban environment, 812 subjects from the rural environment and 859 subjects from an institutional environment (nursing homes). MEASUREMENTS Agreement between both MNA-SFs and the MNA full form. RESULTS MNA-SF-BMI correctly classified 84.12%, 82.51% and 81.84% of subjects from urban, rural and institutional environment, respectively. For MNA-SF-CC those values were 82.4%, 71.8% and 76.6%, respectively. The sensitivity and specificity of MNA-SF-BMI and MNA-SF-CC against full MNA in screening for "at risk/malnutrition" and "malnutrition" were generally very high, except for relatively lower sensitivity (74.1%) when screening for "malnutrition" with MNA-SF-CC in nursing homes. CONCLUSION Both MNA-SFs can be recommended as screening tools in assessing the nutritional state of the community-dwelling and institutionalised elderly in Poland. The full version of the MNA confirmed the results of MNA-SFs in this group. The "classic" MNA-SF using BMI was found to perform better than the MNA-SF-CC. The MNA-SF-CC should be used only when measuring BMI is not possible. While using MNA-SF-CC in nursing homes, a higher MNA-SF-CC cut-point of eleven should be rather used in this population to screen for "at risk/malnutrition".
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Affiliation(s)
- J Kostka
- T. Kostka, Department of Geriatrics, Medical University, Pl. Hallera 1, 90-647 Lodz, Poland.
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Kiesswetter E, Pohlhausen S, Uhlig K, Diekmann R, Lesser S, Uter W, Heseker H, Stehle P, Sieber CC, Volkert D. Prognostic Differences of the Mini Nutritional Assessment Short Form and Long Form in Relation to 1-Year Functional Decline and Mortality in Community-Dwelling Older Adults Receiving Home Care. J Am Geriatr Soc 2014; 62:512-7. [DOI: 10.1111/jgs.12683] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Eva Kiesswetter
- Institute for Biomedicine of Aging; Friedrich-Alexander-Universität Erlangen-Nürnberg; Nürnberg Germany
| | - Stefanie Pohlhausen
- IEL-Nutritional Physiology; Rheinische Friedrich-Wilhelms-Universität Bonn; Bonn Germany
| | - Katrin Uhlig
- Institute of Nutrition, Consumption and Health; Universität Paderborn; Paderborn Germany
| | - Rebecca Diekmann
- Institute for Biomedicine of Aging; Friedrich-Alexander-Universität Erlangen-Nürnberg; Nürnberg Germany
| | - Stephanie Lesser
- IEL-Nutritional Physiology; Rheinische Friedrich-Wilhelms-Universität Bonn; Bonn Germany
| | - Wolfgang Uter
- Institute for Medical Informatics, Biometrics und Epidemiology; Friedrich-Alexander-Universität Erlangen-Nürnberg; Erlangen Germany
| | - Helmut Heseker
- Institute of Nutrition, Consumption and Health; Universität Paderborn; Paderborn Germany
| | - Peter Stehle
- IEL-Nutritional Physiology; Rheinische Friedrich-Wilhelms-Universität Bonn; Bonn Germany
| | - Cornel C. Sieber
- Institute for Biomedicine of Aging; Friedrich-Alexander-Universität Erlangen-Nürnberg; Nürnberg Germany
| | - Dorothee Volkert
- Institute for Biomedicine of Aging; Friedrich-Alexander-Universität Erlangen-Nürnberg; Nürnberg Germany
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Serrano-Urrea R, Garcia-Meseguer MJ. Malnutrition in an elderly population without cognitive impairment living in nursing homes in Spain: study of prevalence using the Mini Nutritional Assessment test. Gerontology 2013; 59:490-8. [PMID: 23949114 DOI: 10.1159/000351763] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 04/30/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The prevalence of malnutrition in institutionalized elderly people is generally high. A good nutritional status is related to a decrease in mortality and costs of morbidity treatments. Therefore, it is essential to know the nutritional status in order to establish action policies. However, there are not enough studies about malnutrition in institutionalized elderly in Spain. OBJECTIVES The objectives of this survey were to assess the prevalence of malnutrition and risk of malnutrition in elderly people living in nursing homes in the province of Albacete (Spain) using the Mini Nutritional Assessment (MNA®) test, to analyze their distribution according to age, gender and different nursing home features, and to identify the MNA items that best predict the MNA total score. METHODS A cross-sectional study was conducted with data collected from 895 elders living in 34 nursing homes all over the province of Albacete, including facilities located in the main city, towns and villages. Prevalence of malnutrition and risk of malnutrition were assessed using the MNA full form test. Groups of malnutrition were compared by using mean MNA scores. Stepwise linear regression analyses were used to identify the items in the MNA which best predicted the MNA total scores. RESULTS According to the MNA, the prevalence of malnutrition among elderly people staying in Albacete province nursing homes was 2.8%, and the prevalence of being at risk of malnutrition was 37.3%. MNA total score was significantly higher in men (24.3 ± 2.9) than in women (23.7 ± 3.3) and significantly higher in residents living in nursing homes located in towns and villages (24.2 ± 2.8) than in those who were living in institutions placed in the main city (23.7 ± 3.4). The MNA score was found to decrease with increasing age, except for individuals aged 90 years or older. CONCLUSIONS The prevalence of malnutrition and risk of malnutrition was 40.1%. Female gender and living in institutions located in the main city were identified as malnutrition risk factors. In general, an increase in malnutrition with age was detected, except for people in the last years of their lives. The MNA questions that best predicted the nutritional status were the ones relating to the anthropometrical and self-assessments.
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Affiliation(s)
- R Serrano-Urrea
- Department of Mathematics, Faculty of Computer Science Engineering, University of Castilla-La Mancha, Albacete, Spain
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[Nutritional assessment with Mini Nutritional Assessment]. Med Clin (Barc) 2013; 140:94-5. [PMID: 23026720 DOI: 10.1016/j.medcli.2012.06.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 06/21/2012] [Indexed: 11/24/2022]
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Respuesta. Med Clin (Barc) 2013; 140:95. [DOI: 10.1016/j.medcli.2012.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 07/20/2012] [Accepted: 07/29/2012] [Indexed: 11/21/2022]
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Abstract
PURPOSE OF REVIEW To summarize recent evidences and advances on the implementation and the use of the Mini Nutritional Assessment (MNA). RECENT FINDINGS Despite being introduced and validated for clinical use about 20 years ago, the MNA has recently received new attention in order to more widely disseminate among healthcare professionals the practice of a systematic nutritional screening and assessment of the old patient. Particularly, the structure has been implemented to face the difficulties in having the patients contributing to the assessment and to reduce further the time required to complete the evaluation. Recent data also confirm that in older populations prevalence of malnutrition by this tool is associated with the level of dependence. The rationale of nutritional assessment is to identify patients candidate to nutritional support. However, the sensitivity of the MNA is still debated because it has been associated with a high-risk 'overdiagnosis' and the advantages of a positive screening need to be assessed both in terms of outcome and money saving. SUMMARY The MNA is a simple and highly sensitive tool for nutritional screening and assessment. The large mass of data collected and the diffusion among healthcare professionals clearly support its use. However, the cost-effectiveness of interventions based on its scoring deserves investigation.
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Affiliation(s)
- Emanuele Cereda
- Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
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