Malnutrition risk and its association with adverse outcomes in a Belgian cohort of community-dwelling adults aged 80 years and over

The predictive value of weight evolution in screening for malnutrition in community-dwelling older persons (70+) in Antwerp

BACKGROUND

Experience and research show that screening for malnutrition in primary care mainly takes place by monitoring the weight parameter and that validated screening instruments are hardly used. In this study we examined the effectiveness and predictive value of weight evolution in screening for (risk of) malnutrition in older people living at home, in comparison with a validated screening tool, namely the Mini Nutritional Assessment Short Form (MNA-SF).

METHODS

This project was a prospective, longitudinal study with quantitative data that took place in the province of Antwerp (Belgium) from December 2020 until June 2021. The target group of this study consisted of people over 70 living at home who were visited by a home nurse on a regular basis (at least once a month). The outcome measure was the weight evolution over six months compared with the score on the MNA-SF at month six. Weight was measured and recorded once a month during 6 months. At the last weight measurement, the MNA-SF was administered. In order to assess their own nutritional state, three additional questions were asked after taking the MNA-SF.

RESULTS

A total of 143 patients gave consent to participate, of which 89 were women and 54 men. The mean age was 83.7 years (SD6.62) with a range of 70 to 100 years. Based on the MNA-SF score measured after six months, 53.1% (76/143) of participants had a normal nutritional status, 37.8% (54/143) scored risk of malnutrition and 4.9% (7/ 143) was malnourished. In order to detect people with (risk of) malnutrition, a PPV of 78.6%, a NPV of 60.7%, a sensitivity of 19.3% and a specificity of 96.0% were established with a weight evolution of ≥ 5% weight loss at six months. To detect malnutrition, our results showed respectively 33.3%, 98.4%, 71.4% and 92.3%.

CONCLUSION

In this study, weight evolution has a low sensitivity in screening for (risk of) malnutrition in people over 70 living at home compared to the MNA-SF. However, in order to detect people with malnutrition, this study demonstrated a sensitivity of 71.4% and a specificity of 92.3% for a weight loss of ≥ 5% at six months.

Health management of malnourished elderly in primary health care: a scoping review

Objectives

The aim of this study, as the first review directed at Primary Health Care, is to identify the screening practices and health outcomes related to the care provided by Family Health Teams to the malnourished elderly people/population.

Methods

Following PRISMA and PICO strategies, searches were conducted in four electronic databases (PubMed, Web of Science, Scopus & EMBASE) on observational, qualitative, quantitative, or mixed studies, written in Portuguese, Spanish and English language, with participants of 65 years old or older at a community setting. The literature selected for this study ranges from the period 2011 to 2021; additional articles were included through reference lists.

Results

From the 483 studies identified, 16 were considered eligible to use in this work. The Mini Nutritional Assessment (MNA) score appears as the main criteria of choice, however, a standardized practice in the health systems regarding the use of screening methods has not been demonstrated. Studies are more oriented towards the analysis of the relationship of mortality/morbidity and malnutrition than towards the relationship of the cost and quality of life and malnutrition of the elderly.

Discussion

Malnutrition is one of the modifiable risk factors which contributes to the vulnerable condition of the elderly, with serious effects, especially when related to other comorbidities. Yet, several authors argue that the Primary Health Care intervention can minimize the negative impacts and improve the health outcomes.

The association between low calf circumference and mortality: a systematic review and meta-analysis

PURPOSE

Low calf circumference is an important indicator of malnutrition and has been widely studied, especially among older adults. However, data on the association between low calf circumference and mortality have been inconsistent. This systematic review was aimed to quantify this association.

METHODS

The internet databases (PubMed, Embase, ScienceDirect and Cochrane Library databases) were systematically searched from inception to November 01, 2021 for studies investigating the association between low calf circumference and mortality. A random effects model was adopted to pool the relevant data.

RESULTS

Low calf circumference was associated with a higher risk of mortality than normal calf circumference, with a pooled HR of 2.42 (95% CI 1.97-2.97, I² = 74.3%). In addition, this association between low calf circumference and morality was still statistically significant in the subgroup analysis across different settings, including hospitals (pooled HR = 2.63, 95% CI 1.93-3.58), nursing homes (pooled HR = 2.49, 95% CI 1.76-3.54), and communities (pooled HR = 2.22, 95% CI 1.60-3.07). Other subgroup analyses based on different cutoffs of calf circumference showed that, compared to individual with normal calf circumference, participants with low calf circumference had an increased risk of mortality (pooled HR = 2.66, 95% CI 2.06-3.43) when using the Asian Working Group for Sarcopenia (AWGS) criterion (≤ 34 cm for males and ≤ 33 cm for females). Similar results were found when the Mini Nutritional Assessment (MNA) criterion (≤ 31 cm) was used, with a pooled HR of 2.11 (95% CI 1.59-2.81).

CONCLUSION

Calf circumference, which is simple and convenient to measure, could be used to stratify the high-risk group, as low calf circumference was significantly associated with mortality among patients. Interventions, including exercise and nutrition programs, could be conducted promptly once low calf circumference is detected.

Cognitive Frailty in Thai Community-Dwelling Elderly: Prevalence and Its Association with Malnutrition

Cognitive frailty (CF) is defined by the coexistence of physical frailty and mild cognitive impairment. Malnutrition is an underlying factor of age-related conditions including physical frailty. However, the evidence associating malnutrition and cognitive frailty is limited. This cross-sectional study aimed to determine the association between malnutrition and CF in the elderly. A total of 373 participants aged 65-84 years were enrolled after excluding those who were suspected to have dementia and depression. Then, 61 CF and 45 normal participants were randomly selected to measure serum prealbumin level. Cognitive function was assessed using the Montreal Cognitive Assessment-Basic (MoCA-B). Modified Fried's criteria were used to define physical frailty. Nutritional status was evaluated by the Mini Nutritional Assessment-short form (MNA-SF), serum prealbumin, and anthropometric measurements. The prevalence of CF was 28.72%. Malnourished status by MNA-SF category (aOR = 2.81, 95%CI: 1.18-6.67) and MNA-SF score (aOR = 0.84, 95%CI = 0.74-0.94) were independently associated with CF. However, there was no correlation between CF and malnutrition assessed by serum prealbumin level and anthropometric measurements. Other independent risk factors of CF were advanced age (aOR = 1.06, 95%CI: 1.02-1.11) and educational level below high school (aOR = 6.77, 95%CI: 1.99-23.01). Malnutrition was associated with CF among Thai elderly. High-risk groups who are old and poorly educated should receive early screening and nutritional interventions.

Malnutrition According to GLIM Criteria and Adverse Outcomes in Community-Dwelling Chinese Older Adults: A Prospective Analysis

OBJECTIVES

The Global Leadership Initiative on Malnutrition (GLIM) has proposed a consensus scheme for classifying malnutrition. This study examined the prevalence of malnutrition according to GLIM criteria and evaluated if these criteria were associated with adverse outcomes in community-dwelling older adults.

DESIGN

This was a prospective cohort study.

SETTING AND PARTICIPANTS

Community-dwelling Chinese men and women aged ≥65 years in Hong Kong.

METHODS

A health check including questionnaire interviews and physical measurements was conducted at baseline and 14-year follow-up. Participants were classified as malnourished at baseline according to the GLIM criteria based on 2 phenotypic components (low body mass index and reduced muscle mass) and 1 etiologic component (inflammation). Adverse outcomes including sarcopenia, frailty, falls, mobility limitation, hospitalization, and mortality were assessed at 14-year follow-up. Adjusted multiple logistic regression and Cox proportional hazards model were performed to examine the associations between malnutrition and adverse outcomes and presented as odds ratio (OR) or hazard ratio (HR) and 95% confidence interval (CI).

RESULTS

Data of 3702 participants [median age: 72 years (IQR 68-76)] were available at baseline. Malnutrition was present in 397 participants (10.7%). Malnutrition was significantly associated with higher risk of sarcopenia (n = 898, OR 2.25; 95% CI 1.04-4.86), frailty (Fried (n = 971, OR 2.83; 95% CI 1.47-5.43), FRAIL scale (n = 985, OR 2.30; 95% CI 1.06-4.98)) and all-cause mortality (n = 3702, HR: 1.62; 95% CI 1.39-1.89). There was no significant association between malnutrition and falls (n = 987, OR 1.09; 95% CI 0.52-2.31), mobility limitation (n = 989, OR 0.98; 95% CI 0.36-2.67), and hospitalization (n = 989, OR 1.37; 95% CI 0.67-2.77).

CONCLUSIONS AND IMPLICATIONS

Among community-dwelling Chinese older adults, malnutrition according to selected GLIM criteria was a predictor of sarcopenia, frailty, and mortality at 14-year follow-up; whereas no association was found for falls, mobility limitation, and hospitalization. Clinicians may consider applying the GLIM criteria to identify malnourished community-dwelling older adults.