Validation of the nutrition screening tool 'Seniors in the Community: Risk Evaluation for Eating and Nutrition, version II' among octogenarians

Is the Utility of the GLIM Criteria Used to Diagnose Malnutrition Suitable for Bicultural Populations? Findings from Life and Living in Advanced Age Cohort Study in New Zealand (LiLACS NZ)

OBJECTIVES

To investigate associations between nutrition risk (determined by SCREEN-II) and malnutrition (diagnosed by the GLIM criteria) with five-year mortality in Māori and non-Māori of advanced age.

DESIGN

A longitudinal cohort study.

SETTING

Bay of Plenty and Lakes regions of New Zealand.

PARTICIPANTS

255 Māori; 400 non-Māori octogenarians.

MEASUREMENTS

All participants were screened for nutrition risk using the Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN-II). Those at high nutrition risk (SCREEN-II score <49) had the Global Leadership Initiative in Malnutrition (GLIM) criteria applied to diagnose malnutrition or not. Demographic, physical and health characteristics were obtained by trained research nurses using a standardised questionnaire. Five-year mortality was calculated from Government data. The association of nutrition risk (SCREEN-II) and a malnutrition diagnosis (GLIM) with five-year mortality was examined using logistic regression and cox proportional hazard models of increasing complexity.

RESULTS

56% of Māori and 46% of non-Māori participants had low SCREEN-II scores indicative of nutrition risk. The prevalence of GLIM diagnosed malnutrition was lower for both Māori and non-Māori (15% and 19% of all participants). Approximately one-third of participants (37% Māori and 32% non-Māori) died within the five-year follow-up period. The odds of death for both Māori and non-Māori was significantly lower with greater SCREEN II scores (better nutrition status), (OR (95% CI); 0.58 (0.38, 0.88), P < 0.05 and 0.53 (0.38, 0.75), P < 0.001, respectively). GLIM diagnosed malnutrition was not significantly associated with five-year mortality for Māori (OR (95% CI); 0.88 (0.41, 1.91), P >0.05) but was for non-Māori. This association remained significant after adjustment for other predictors of death (OR (95% CI); 0.50 (0.29, 0.86), P< 0.05). Reduced food intake was the only GLIM criterion predictive of five-year mortality for Māori (HR (95% CI); 10.77 (4.76, 24.38), P <0.001). For non-Māori, both aetiologic and phenotypic GLIM criteria were associated with five-year mortality.

CONCLUSION

Nutrition risk, but not malnutrition diagnosed by the GLIM criteria was significantly associated with mortality for Māori. Conversely, both nutrition risk and malnutrition were significantly associated with mortality for non-Māori. Appropriate phenotypic criteria for diverse populations are needed within the GLIM framework.

Needs of patients with parkinsonism and their caregivers: a protocol for the PRIME-UK cross-sectional study

INTRODUCTION

People with parkinsonism are a highly heterogeneous group and the disease encompasses a spectrum of motor and non-motor symptoms which variably emerge and manifest across the disease course, fluctuate over time and negatively impact quality of life. While parkinsonism is not directly the result of ageing, it is a condition that mostly affects older people, who may also be living with frailty and multimorbidity. This study aims to describe the broad range of health needs for people with parkinsonism and their carers in relation to their symptomatology, disability, disease stage, comorbidities and sociodemographic characteristics.

METHODS AND ANALYSIS

In this single site cross-sectional study, people with parkinsonism will be sent a study information pack for themselves and their primary informal caregiver, if relevant. Data are collected via questionnaire, with additional support, if required, to maximise participation. A specific strategy has been developed to target and proactively recruit patients lacking capacity to consent, including those in residential care settings, with input from a personal consultee prior to completion of a bespoke questionnaire by a representative. Caregivers are also recruited to look at various health outcomes. Results will be displayed as descriptive statistics and regression models will be used to test simple associations and interactions.

ETHICS AND DISSEMINATION

This protocol was approved by the London-Brighton & Sussex Research Ethics Committee (REC reference 20/LO/0890). The results of this protocol will be disseminated through publication in an international peer-reviewed journal; presentation at academic meetings and conferences; and a lay summary uploaded to the PRIME-Parkinson website.

TRIAL REGISTRATION NUMBER

ISRCTN11452969; Pre-results.

Differentiation of the Nutritional Risk of Polish Elderly People According to Selected Demographic Characteristics and Declared Socioeconomic Status

Nutritional risk screening in older people can help to not only identify health risks but also to treat them effectively. The aim of this work was to assess the relationship between the demographic characteristics (age, gender and place of residence) and socioeconomic status of older people in the community and nutritional risk. The Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN-14) questionnaire was used to evaluate the nutritional risk. The study was conducted in 417 people (312 women and 105 men) between 60 and 95 years old (70.8 ± 6.73 years). Multivariate correspondence analysis (MCA) was used to determine the relationships between the categories of variables describing the level of nutritional risk, demographic characteristics and the value of the socioeconomic status (SES) index. To assess the relationship between identified nutritional risks, demographics and SES index variables, we used logistic regression analysis. Based on these studies, nutritional risk factors for older people in Poland were identified. It has been shown that larger cities and low socioeconomic status are closely linked to higher nutritional risk. At the same time, age and gender were not significant factors influencing nutritional risk. Identifying the factors that increase the nutritional risk of older people can help to improve their quality of life.

Screening Community-Living Older Adults for Protein Energy Malnutrition and Frailty: Update and Next Steps

Protein-energy malnutrition (PEM)/undernutrition and frailty are prevalent, overlapping conditions impacting on functional and health outcomes of older adults, but are frequently unidentified and untreated in community settings in the United States. Using the World Health Organization criteria for effective screening programs, we reviewed validity, reliability, and feasibility of data-driven screening tools for identifying PEM and frailty risk among community-dwelling older adults. The SCREEN II is recommended for PEM screening and the FRAIL scale is recommended as the most promising frailty screening tool, based on test characteristics, cost, and ease of use, but more research on both tools is needed, particularly on predictive validity of favorable outcomes after nutritional/physical activity interventions. The Malnutrition Screening Tool (MST) has been recommended by one expert group as a screening tool for all adults, regardless of age/care setting. However, it has not been tested in US community settings, likely yields large numbers of false positives (particularly in community settings), and its predictive validity of favorable outcomes after nutritional interventions is unknown. Community subgroups at highest priority for screening are those at increased risk due to prior illness, certain demographics and/or domiciliary characteristics, and those with BMI < 20 kg/m² or < 22 if > 70 years or recent unintentional weight loss > 10% (who are likely already malnourished). Community-based health professionals can better support healthy aging by increasing their awareness/use of PEM and frailty screening tools, prioritizing high-risk populations for systematic screening, following screening with more definitive diagnoses and appropriate interventions, and re-evaluating and revising screening protocols and measures as more data become available.

Comparison of Seniors in the Community: Risk Evaluation for Eating and Nutrition, version II and Mini Nutritional Assessment - Short Form in detecting nutritional risk among community-dwelling seniors in Bosnia and Herzegovina

OBJECTIVE

The aim of the current study is to compare Seniors in the Community: Risk Evaluation for Eating and Nutrition, version II (SCREEN II) and Mini Nutritional Assessment - Short Form (MNA-SF), where each is used to identify nutritional risk prevalence among community-dwelling people aged 65 years and above in Bosnia and Herzegovina.

DESIGN

A cross-sectional study. Nutritional risk assessed using the nutritionist's risk rating, anthropometric measurements, functional indicators, cognitive parameters, SCREEN II and MNA-SF.

SETTING

The municipalities of Foca, East Sarajevo and Bijeljina, Bosnia and Herzegovina.

PARTICIPANTS

Eight hundred twenty-one community-dwelling individuals aged ≥65 years.

RESULTS

The prevalence of high nutritional risk per nutritionist's risk rating, SCREEN II and MNA-SF was 26, 60, and 7 %, respectively. With the nutritionist's rating score ≥5 as the criterion, the MNA-SF cut-off point of ≤11 (indicating any possible risk) had poor sensitivity (55·7 %), specificity (46·6 %) and AUC (0·563; P = 0·024). When the criterion of >7 was applied, good sensitivity (95·3 %) and specificity (88·9 %) were obtained for the MNA-SF cut-off score of ≤7. AUC for this comparison was 0·742 (considered fair). Cut-off points of <54 (AUC = 0·816) and <50 (AUC = 0·881) for SCREEN II (indicating moderate to high risk) corresponded with good sensitivity (82·2 %; 80·9 %) and fair specificity (72·1 %; 75·0 %).

CONCLUSION

MNA-SF may have a limited role in nutritional risk screening among community-dwelling seniors in Bosnia and Herzegovina. SCREEN II has promising results in regard to validity, but further studies are warranted.

What do screening tools measure? Lessons learned from SCREEN II and SNAQ65

BACKGROUND

Over the last decade, different screening tools for malnutrition have been developed. Within these tools, a distinction can be made between tools that assess nutritional risk and tools that assess protein energy malnutrition. Insights in differences in characteristics of participants at risk and in differences in prevalence rates will aid in deciding which tool(s) to use in daily practice.

METHODS

Dutch community-dwelling older adults (n = 200, 78.2 ± 6.9 years), not known to have specific nutrition problems, were recruited to participate in this cross-sectional study. SNAQ⁶⁵⁺ (low risk vs moderate/high risk) was used to assess risk of protein energy malnutrition and SCREEN II was used to assess nutrition risk (score <54 out of 64). Chi-square tests were used to test associations between demographic, health, physical and social factors and outcome of SNAQ⁶⁵⁺ and SCREEN II.

RESULTS

Of all participants 69.0% were at nutrition risk (SCREEN II), while 13.5% were at risk of protein energy malnutrition (SNAQ⁶⁵⁺). Agreement between the two tools was poor (kappa < 0.20). Gender, BMI, living status, income, activity level and protein/energy intake were associated with SCREEN II; age, BMI, comorbidities, medication use, help at home, activity level and low basic mobility were associated with SNAQ⁶⁵⁺.

CONCLUSION

SCREEN II and SNAQ⁶⁵⁺ measure different concepts of malnutrition and therefore identify different persons at risk. SCREEN II is more inclusive and comprises both undernutrition and overnutrition as well as different determinants that can impact on food intake, while SNAQ⁶⁵⁺ is solely focused on protein-energy malnutrition.

Self-reported Swallowing and Nutrition Status in Community-Living Older Adults

More New Zealanders are forecast to grow older in the community, ranging in levels of abilities and needs. Many health conditions can affect swallowing function or nutrition status in older age. However, older adults may not be aware of risk factors and when to seek help. A nationwide survey was conducted of self-reported swallowing ability and nutrition status in community-living New Zealanders aged 65 years and older to assess whether undisclosed swallowing and nutrition problems exist. Respondents completed an amalgamated questionnaire including two validated screening tools: Eating Assessment Tool (EAT-10) and Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN-II). A convenience sample of 1020 adults aged 65-96 years old was obtained. Mean EAT-10 score was 2.15 (SD = 4.3); 22.1% scored above the normative score (3 or more). Mean SCREEN-II score was 48.50 (SD = 6.5); 46.9% scored below normal (< 50 for adults under 85 years old, < 49 for adults over 84 years old). EAT-10 scores significantly correlated with SCREEN-II scores (p < 0.001). Scores did not correlate with age or differ between age groups. Significantly more respondents with medical history associated with dysphagia disclosed swallowing and nutrition problems (p < 0.001). This data suggest increased prevalence of swallowing difficulties in older age is attributed to health conditions and medications, rather than ageing itself. Swallowing complaints from community-living older adults should not be ignored or attributed to the normal ageing process. This study supports routine nutrition screening in older adults.

Validity of Nutritional Screening Tools for Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis

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.

A review of the validity of malnutrition screening tools used in older adults in community and healthcare settings - A MaNuEL study

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.

Prevalence and Determinants of Undernutrition in A Sample of Dutch Community-Dwelling Older Adults: Results from Two Online Screening Tools

To stimulate undernutrition screening among Dutch community-dwelling adults, a website was developed with general information on healthy eating for healthy aging and self-tests. Based on cross-sectional data obtained from the self-tests, we studied nutritional risk factors (early determinants) as well as risk of undernutrition (late symptoms). SCREEN II (n = 2470) was used to asses nutritional risk factors. This tool consists of 16 items regarding nutritional intake, perception of body weight, appetite, oral health and meal preparation. An adjusted SNAQ65+ (n = 687) was used to assess risk of undernutrition. This four-item tool contains questions on weight loss, appetite, walking stairs and body mass index. Differences between age-groups (65-74, 75-84, ≥85) were tested by logistic regression. Overall prevalence of nutritional risk factors was 84.1%, and increased risk of undernutrition was 56.8%. Participants aged ≥85 scored worst on almost all items of the SCREEN II and the SNAQ65+. In conclusion: A large proportion of older adults reported early determinants for increased nutrition risk, while a smaller, yet remarkable proportion scored positive on undernutrition risk. Internet screening may be a useful, contemporary, and easy, accessible way to reach older adults who are at nutritional risk and may thus contribute to early identification and prevention of undernutrition.

Nutrition Risk Measured Online in Community-Living Older Australians

Many community-living older adults experience the condition of malnutrition and the causes are complex and multi-factorial. This study examined nutrition risk in a sample of community-living older Australians (n = 77, age ≥65 years) using an online, self-administered survey consisting of two validated questionnaires (SCREEN II and SF-12). We found a significant relationship between health status and nutrition risk; those with higher self-rated health status had lower nutrition risk. Forty percent of the participants were categorized at high nutritional risk, 26% at moderate nutritional risk and 34% not at nutritional risk. The most common nutrition risk factors were: (i) weight perception (perceiving weight to be more than it should); (ii) food avoidance; (iii) low intake of milk, milk products and alternatives; and (iv) finding meal preparation a chore. Many nutrition-risk factors were consistent with population survey data highlighting the need for greater awareness of nutritional requirements for healthy ageing.

High nutrition risk related to dietary intake is associated with an increased risk of hospitalisation and mortality for older Māori: LiLACS NZ

OBJECTIVES

To investigate the association between domains of nutrition risk with hospitalisations and mortality for New Zealand Māori and non-Māori in advanced age.

METHODS

Within LiLACS NZ, 256 Māori and 399 non-Māori octogenarians were assessed for nutrition risk using the Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN II) questionnaire according to three domains of risk. Sociodemographic and health characteristics were established. Five years from inception, survival analyses examined associations between nutrition risk from the three domains of SCREEN II with all-cause hospital admissions and mortality.

RESULTS

For Māori but not non-Māori, lower nutrition risk in the Dietary Intake domain was associated with reduced hospitalisations and mortality (Hazard Ratios [HR] [95%CI] 0.97 [0.95-0.99], p=0.009 and 0.91 [0.86-0.98], p=0.005, respectively). The 'Factors Affecting Intake' domain was associated with mortality (HR, [95%CI] 0.94 [0.89-1.00], p=0.048), adjusted for age, gender, socioeconomic deprivation, education, previous hospital admissions, comorbidities and activities of daily living.

CONCLUSION

Improved dietary adequacy may reduce poor outcomes for older Māori. Implications for public health: Nutrition risk among older Māori is identifiable and treatable. Effort is needed to engage relevant community and whānau (family) support to ensure older Māori have food security and cultural food practices are met.

Dysphagia risk, low muscle strength and poor cognition predict malnutrition risk in older adults athospital admission

BACKGROUND

Malnutrition in patients admitted to hospital may have detrimental effects on recovery and healing. Malnutrition is preceded by a state of malnutrition risk, yet malnutrition risk is often not detected during admission. The aim of the current study was to investigate the magnitude and potential predictors of malnutrition risk in older adults, at hospital admission.

METHODS

A cross-sectional was study conducted in 234 older adults (age ≥ 65 or ≥ 55 for Māori or Pacific ethnicity) at admission to hospital in Auckland, New Zealand. Assessment of malnutrition risk status was performed using the Mini Nutritional Assessment Short-Form (MNA®-SF), dysphagia risk by the Eating Assessment Tool (EAT-10), muscle strength by hand grip strength and cognitive status by the Montreal Cognitive Assessment (MoCA) tool.

RESULTS

Among 234 participants, mean age 83.6 ± 7.6 years, 46.6% were identified as at malnutrition risk and 26.9% malnourished. After adjusting for age, gender and ethnicity, the study identified [prevalence ratio (95% confidence interval)] high dysphagia risk [EAT-10 score: 0.98 (0.97-0.99)], low body mass index [kg/m²: 1.02 (1.02-1.03)], low muscle strength [hand grip strength, kg: 1.01 (1.00-1.02)] and decline in cognition [MoCA score: 1.01 (1.00-1.02)] as significant predictors of malnutrition risk in older adults at hospital admission.

CONCLUSION

Among older adults recently admitted to the hospital, almost three-quarters were malnourished or at malnutrition risk. As the majority (88%) of participants were admitted from the community, this illustrates the need for routine nutrition screening both at hospital admission and in community-dwelling older adults. Factors such as dysphagia, unintentional weight loss, decline in muscle strength, and poor cognition may indicate increased risk of malnutrition.

Body Composition Assessment and Nutritional Status Evaluation in Men and Women Portuguese Centenarians

OBJECTIVES

To assess body composition, nutritional status and its differences between genders in a sample of Portuguese centenarians.

DESIGN

Observational cross-sectional study.

SETTING

Centenarians recruited in Portugal, able to give informed consent.

PARTICIPANTS

A total of 252 subjects, with a median age of 100 years, mostly women (77.8%) who accepted to participate in the study, during the period of 2012 to 2014.

MEASUREMENTS

Anthropometric data collected (weight, height, BMI, waist circumference, hip and waist/hip ratio) were evaluated according to WHO criteria. A portable tetrapolar bioimpedance analyzer was used to calculate body composition and to assess resting metabolism. Nutritional status was evaluated according to three different criteria: BMI, waist circumference and body fat percentage using anthropometric equations and bioimpedance.

RESULTS

We observed an overall mean weight of 51.02±11.03Kg, height of 1.55±0.07m and a BMI of 21.07±3.69Kg/m2. For most of the evaluated parameters, we found substantial differences between genders. The prevalence of underweight and overweight were 25.3% and 13.3%, respectively. Only 5 subjects were obese. Overweight subjects were mostly men (W=10.6% vs. M=22.6%), whereas women were more underweight (W=28.7% vs. M=13.2%). When considering the waist circumference, 26.5% were above the cut-off value. Most of centenarians (72.9%) had a healthy level of visceral fat. This measurement was highly correlated with waist circumference (r= 0.687, p<0.001). The mean of body fat mass was 10.69±6.50Kg, fat-free mass 40.87±7.60Kg and total body water 27.54±6.25Kg. According to body fat mass criteria assessed by bioimpedance, the prevalence of obesity in study population was 6.0% with no gender differences (p = 0.225). Obesity prevalence using anthropometric equations was higher (Deurenberg: 77.7% and Gallagher: 42.8%) than the obtained value by bioimpedance analysis, although according to Bland-Altman analysis both equations showed a good agreement (Deurenberg: 95.8% and Gallagher: 97%) with bioimpedance method. The prevalence of hypohydration (12.9%) was tendentiously higher in women compared to men (W= 15.4% vs. M= 5.0%, p=0.087). Despite the frequency of osteoporosis was higher in women (W = 71.85% vs. M = 28.15%), 95% of men revealed criteria for osteoporosis. Resting metabolic rate (RMR) was significantly different between genders using bioimpedance analysis (W= 1123.33± 173.91; M= 1350.10± 188.88; p<0.001) or Harris Benedict equation (W= 934.92± 102.60; M= 1018.85± 171.68; p=0.001). Bland- Altman analysis between methods indicate that there was an agreement of 97.6%. The overall mean metabolic age obtained was 83.52±1.11 years, well below the chronologic age (p<0.001).

CONCLUSION

In Portuguese centenarians, clinical and nutritional approach should be improved on the gender basis. In relation to nutritional status, centenarians were more frequently underweight than overweight. The thinness could be a natural process, contributing for the longevity being rather overweight a reducing factor in life expectancy. BMI and waist circumference showed a good correlation with body fat percentage. Despite the results of Bland- Altman analysis, Deurenberg and Gallagher equations are not suitable to evaluate obesity prevalence in centenarians. Harris Benedict equation seems to be a good option to measure RMR in centenaries, when BIA is not available. Body composition and nutritional characterization of Portuguese centenarians are relevant contribution in scientific evidence production for the action plan of healthy ageing in Europe (2012-2020) and also for clinical practice.

Screening for Malnutrition in Community Dwelling Older Japanese: Preliminary Development and Evaluation of the Japanese Nutritional Risk Screening Tool (NRST)

BACKGROUND

Early and effective screening for age-related malnutrition is an essential part of providing optimal nutritional care to older populations.

OBJECTIVE

This study was performed to evaluate the adaptation of the original SCREEN II questionnaire (Seniors in the Community: Risk Evaluation for Eating and Nutrition, version II) for use in Japan by examining its measurement properties and ability to predict nutritional risk and sarcopenia in community-dwelling older Japanese people. The ultimate objective of this preliminary validation study is to develop a license granted full Japanese version of the SCREEN II.

PARTICIPANTS

The measurement properties and predictive validity of the NRST were examined in this cross-sectional study of 1921 community-dwelling older Japanese people.

MEASUREMENTS

Assessments included medical history, and anthropometric and serum albumin measurements. Questions on dietary habits that corresponded to the original SCREEN II were applied to Nutritional Risk Screening Tool (NRST) scoring system. Nutritional risk was assessed by the Geriatric Nutrition Risk Index (GNRI) and the short form of the Mini-Nutritional Assessment (MNA-SF). Sarcopenia was diagnosed according to the criteria of the European Working Group on Sarcopenia in Older People.

RESULTS

The nutritional risk prevalences determined by the GNRI and MNA-SF were 5.6% and 34.7%, respectively. The prevalence of sarcopenia was 13.3%. Mean NRST scores were significantly lower in the nutritionally at-risk than in the well-nourished groups. Concurrent validity analysis showed significant correlations between NRST scores and both nutritional risk parameters (GNRI or MNA-SF) and sarcopenia. The areas under the receiver operating characteristic curves (AUC) of NRST for the prediction of nutritional risk were 0.635 and 0.584 as assessed by GNRI and MNA-SF, respectively. AUCs for the prediction of sarcopenia were 0.602 (NRST), 0.655 (age-integrated NRST), and 0.676 (age and BMI-integrated NRST).

CONCLUSIONS

These results indicate that the NRST is a promising screening tool for the prediction of malnutrition and sarcopenia in community-dwelling older Japanese people. Further development of a full Japanese version of the SCREEN II is indicated.

Construct Validation of Three Nutrition Questions Using Health and Diet Ratings in Older Canadian Males Living in the Community

Brief nutrition screening tools are desired for research and practice. Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN-II, 14 items) and the abbreviated version SCREEN-II-AB (8 items) are valid and reliable nutrition screening tools for older adults. This exploratory study used a retrospective cross-sectional design to determine the construct validity of a subset of 3 items (weight loss, appetite, and swallowing difficulty) currently on the SCREEN-II and SCREEN-II-AB tools. Secondary data on community-dwelling senior males (n = 522, mean ± SD age = 86.7 ± 3.0 years) in the Manitoba Follow-up Study (MFUS) study were available for analysis. Participants completed the mailed MFUS Nutrition Survey that included SCREEN-II items and questions pertaining to self-rated health, diet healthiness, and rating of the importance of nutrition towards successful aging as the constructs for comparison. Self-perceived health status (F = 14.7, P < 0.001), diet healthiness (ρ = 0.17, P = 0.002) and the rating of nutrition's importance to aging (ρ = 0.10, P = 0.03) were correlated with the 3-item score. Inferences were consistent with associations between these construct variables and the full SCREEN-II. Three items from SCREEN-II and SCREEN-II-AB demonstrate initial construct validity with self-perceived health status and diet healthiness ratings by older males; further exploration for criterion and predictive validity in more diverse samples is needed.