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Değer MS, Sezerol MA, Atak M. Assessment of frailty, daily life activities, and nutrition of elderly immigrants: A household based cross-sectional study. Medicine (Baltimore) 2024; 103:e37729. [PMID: 38669436 PMCID: PMC11049769 DOI: 10.1097/md.0000000000037729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 03/05/2024] [Indexed: 04/28/2024] Open
Abstract
With the global migrant population on the rise, it's imperative to focus on the health status of more vulnerable groups within these communities. The elderly immigrants face myriad physical and psychosocial challenges that significantly impact their health and quality of life. This study aims to investigate the nutrition, daily life activities, and clinical frailty status of elderly immigrants residing in Türkiye. A cross-sectional design was employed in the Sultanbeyli District, focusing on Syrian immigrants aged 65 and over. Participants were surveyed face-to-face by interpreters proficient in Arabic. The questionnaire comprised sociodemographic details, health status, and scales like Katz Daily Life Activities, Clinical Frailty, and Mini Nutritional Assessment. The data analysis was executed using SPSS 22. Continuous variables were presented as mean ± standard deviation (SD) and median, while categorical ones were expressed in numbers and percentages (%). A significance level of P < .05 was considered for the analyses. The average age of the participants was determined as 71.64 ± 6.20 years. In the study group, 49.7% were female, 75.5% were younger than 75 years old, 47.7% had less than primary school education, 56.3% were married, 42.4% had a low income level, and 56.9% lived in the same household with 5 or more people. Among the participants in the study group, 47% had walking and balance problems, 29.1% had a history of falls in the last year, 10.6% were disabled, 69.5% complained of pain, 82.8% had a chronic illness, and 43% had polypharmacy. The median value of the KATZ Daily Living Activities scale was 6, the mean score of the Clinical Frailty Score scale was 3.25 ± 1.25, and the mean score of the Mini Nutritional Assessment scale was 12.40 ± 2.15. Among immigrant elderly individuals, 88.1% were able to sustain their lives independently, 13.9% were clinically frail, and 3.3% were at risk of malnutrition. Factors such as age, level of education, socioeconomic status, marital status, number of cohabitants in the household, BMI, neurological problems, walking-balance disorders, disability, and presence of chronic diseases are associated with daily life activities, frailty, and malnutrition status. It is believed that broader field research with greater participation would be beneficial for evaluating the nutritional status of immigrant elderly individuals.
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Affiliation(s)
- Mehmet Sait Değer
- Department of Public Health, Hitit University – Faculty of Medicine, Çorum, Türkiye
| | - Mehmet Akif Sezerol
- Department of Public Health, Istanbul Medipol University – School of Medicine, Istanbul, Türkiye
| | - Muhammed Atak
- Department of Public Health, Istanbul University – Istanbul Faculty of Medicine, Istanbul, Türkiye
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Chen TY, Rajan SI, Saito Y. Nutritional Status Predicts Injurious Falls Among Community-Dwelling Older Adults: Does Sex Matter? J Appl Gerontol 2023; 42:2207-2218. [PMID: 37340374 DOI: 10.1177/07334648231184950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
The association of poor nutritional status with falls-related injuries other than fractures is unclear. Although there are sex differences in poor nutritional status and the rate of falls-related injuries, whether the impacts of poor nutritional status on falls-related injuries differ by sex is unclear. We investigated whether baseline poor nutritional status predicted injurious falls, fall-related minor injuries, and fractures at 3-year follow-up and whether these relationships differed by sex among community-dwelling older adults (N = 3257). We found that being at risk of malnutrition at baseline significantly predicted injurious falls but not minor injuries and fractures at follow-up. Compared to older males at risk of malnutrition at baseline, females at risk of malnutrition were significantly more likely to have injurious falls and minor injuries later. Being at risk of malnutrition predicted injurious falls, especially among older females. Regular nutritional screenings among older females should be implemented to provide prompt interventions against falls.
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Affiliation(s)
- Tuo-Yu Chen
- Master Program in Global Health and Development, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - S Irudaya Rajan
- The International Institute of Migration and Development (IIMAD), Kerala, India
| | - Yasuhiko Saito
- College of Economics, Nihon University, Chiyoda, Japan
- Economic Research Institute for ASEAN and East Asia, Jakarta, Indonesia
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Kang MG, Choi JY, Yoo HJ, Park SY, Kim Y, Kim JY, Kim SW, Kim CH, Kim KI. Impact of malnutrition evaluated by the mini nutritional assessment on the prognosis of acute hospitalized older adults. Front Nutr 2023; 9:1046985. [PMID: 36687683 PMCID: PMC9849807 DOI: 10.3389/fnut.2022.1046985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 12/15/2022] [Indexed: 01/07/2023] Open
Abstract
Background Malnutrition is prevalent among hospitalized older patients. Therefore, this study aimed to investigate the association between nutritional status [assessed using the Mini Nutritional Assessment (MNA) and serum albumin levels] and adverse outcomes in hospitalized older patients. We also aimed to compare the predictive utility of our findings. Methods This retrospective cohort study was conducted between January 2016 and June 2020. In total, 808 older patients (aged ≥ 65 years, mean age 82.8 ± 6.70 years, 45.9% male) admitted to the acute geriatric unit were included in our sample. Comprehensive geriatric assessments, including the MNA, were performed. Malnutrition and risk of malnutrition were defined as MNA < 17, albumin < 3.5 g/dL and 17 ≤ MNA ≤ 24, 3.5 g/dL ≤ albumin < 3.9 g/dL, respectively. The primary outcome was that patients could not be discharged to their own homes. The secondary outcomes were overall all-cause mortality, 3-month all-cause mortality, and incidence of geriatric syndrome, including delirium, falls, and newly developed or worsening pressure sores during hospitalization. Results Poor nutritional status was associated with older age; female sex; admission from the emergency room; high risk of pressure sores and falls; lower physical and cognitive function; higher depressive score; and lower serum albumin, protein, cholesterol, and hemoglobin levels. In the fully adjusted model, malnutrition assessed using the MNA predicted discharge to nursing homes or long-term care hospitals [odds ratio (OR) 5.822, 95% confidence interval (CI): 2.092-16.199, P = 0.001], geriatric syndrome (OR 2.069, 95% CI: 1.007-4.249, P = 0.048), and 3-month mortality (OR 3.519, 95% CI: 1.254-9.872, P = 0.017). However, malnutrition assessed using albumin levels could only predict 3-month mortality (OR 3.848, 95% CI: 1.465-10.105, P = 0.006). The MNA predicted 3-month mortality with higher precision than serum albumin levels (P = 0.034) when comparing the areas under the receiver operating characteristic curve. Conclusion Nutritional risk measured by the MNA was an independent predictor of various negative outcomes in hospitalized older patients. Poor nutritional status assessed by serum albumin levels, the most widely used biochemical marker, could predict mortality, but not the development of geriatric syndrome or discharge location reflecting functional status.
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Affiliation(s)
- Min-gu Kang
- Department of Internal Medicine, Chonnam National University Bitgoeul Hospital, Gwangju, Republic of Korea
| | - Jung-Yeon Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Hyun-Jung Yoo
- Department of Nursing, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Si-Young Park
- Department of Nursing, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Yoonhee Kim
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Ji Yoon Kim
- Department of Nutrition Care Service, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Sun-wook Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Cheol-Ho Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Kwang-il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea,*Correspondence: Kwang-il Kim,
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Mukundan M, Dhar M, Saxena V, Panda PK, Bhat NK. Nutritional assessment in hospitalized elderly patients, its sociodemographic determinants and co-relation with activities of daily life. J Family Med Prim Care 2022; 11:5082-5086. [PMID: 36505600 PMCID: PMC9731037 DOI: 10.4103/jfmpc.jfmpc_1480_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Present study was planned to identify various sociodemographic factors influencing nutritional status in elderly and impact of nutritional status on activities of daily living in them. Methods Total of 177 patients were enrolled in a prospective observational study. Nutritional status was assessed at the time of discharge by using Mini Nutritional Assessment form (MNA). Kartz Activity of Daily Living was assessed at 3 months before admission, at the time of admission, at discharge and 3 months after discharge. After written informed consent and ethics clearance patients were enrolled in the study. Analysis was done using the SPSS version 23 and Chi Square test was used to find the association between different qualitative variables. Statistical significance was set at P < 0.05. Results Mean age of the study participants was 68.64 ± 7.73 years. 40 patients (22.6%) were found to be malnourished. Higher age, living alone, high CCI score and low ADL at discharge were associated with malnutrition. Mean ADL score was 5.82 at - 3 months time point in well-nourished patients which decreased during admission and then increased to 4.94 at the 3 months after discharge. Mean ADL score was of 5.33 at -3 months time point which kept on decreasing during admission and at 3 months after discharge in malnourished group. All these changes were statistically significant (P < 0.001). Conclusion Nutritional status is a modifiable risk factor in elderly so identifying and optimizing nutritional status of elderly will optimise their functional status and improve quality of life.
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Affiliation(s)
- Megha Mukundan
- Department of Internal Medicine, AIIMS Risihikesh, Uttarakhand, India
| | - Minakshi Dhar
- Department of Internal Medicine, AIIMS Risihikesh, Uttarakhand, India,Address for correspondence: Dr. Minakshi Dhar, Department of Internal Medicine, AIIMS Risihikesh, Uttarakhand, India. E-mail:
| | - Vartika Saxena
- Department of Community and Family Medicine, AIIMS Risihikesh, Uttarakhand, India
| | - Prasan K. Panda
- Department of Internal Medicine, AIIMS Risihikesh, Uttarakhand, India
| | - Nowneet K. Bhat
- Department of Pediatrics, AIIMS Risihikesh, Uttarakhand, India
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Hegendörfer E, VanAcker V, Vaes B, Degryse JM. Malnutrition risk and its association with adverse outcomes in a Belgian cohort of community-dwelling adults aged 80 years and over. Acta Clin Belg 2021; 76:351-358. [PMID: 32134709 DOI: 10.1080/17843286.2020.1737779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objectives: To investigate the prevalence of malnutrition risk and its association with adverse outcomes in a Belgian cohort of community-dwelling adults aged ≥80 years, a worldwide growing age-group.Methods: In the BELFRAIL cohort, malnutrition risk was evaluated with the Mini Nutritional Assessment (MNA total score <24) and prealbumin levels (<20 mg/dl). Agreement between them was assessed with Kohen's kappa coefficient. Association with first unplanned hospitalization (3.0 ± 0.25 years follow-up) and mortality (5.1 ± 0.25 years follow-up) was investigated with survival analysis and Cox multivariate regression.Results: Out of 567 BELFRAIL participants, 556 (98.1%) had MNA and 545 (96.1%) prealbumin levels. Sixty-eight (12.2%) were at risk of malnutrition based on MNA and 69 (12.7%) based on prealbumin, with very poor agreement between them (Kappa = 0.024, 95% CI -0.064, 0.112). For both MNA and prealbumin, participants with malnutrition risk had lower physical and cognitive performance tests' scores. They had no higher risk for first hospitalization compared to those without malnutrition risk, but higher risk for all-cause mortality even after adjustment for multimorbidity, inflammation, physical and mental functioning (HR 1.35 95%CI 0.92-1.97 for MNA; HR 1.46; 95%CI 1.01-2.12 for prealbumin).Conclusion: Malnutrition risk based on MNA or prealbumin was low in a Belgian cohort of community-dwelling adults aged ≥80 years. Physical and cognitive performance was lower in those with malnutrition risk, but malnutrition risk was not independently associated with hospitalization and mortality (except for malnutrition risk by prealbumin). Further research needs to investigate the best tool to assess malnutrition risk in this age group.
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Affiliation(s)
- Eralda Hegendörfer
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven (Kuleuven), Leuven, Belgium
- Institute of Health and Society, Université Catholique de Louvain (Uclouvain), Louvain, Belgium
| | - Veronika VanAcker
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven (Kuleuven), Leuven, Belgium
| | - Bert Vaes
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven (Kuleuven), Leuven, Belgium
| | - Jean-Marie Degryse
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven (Kuleuven), Leuven, Belgium
- Institute of Health and Society, Université Catholique de Louvain (Uclouvain), Louvain, Belgium
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Sukkriang N, Somrak K. Correlation Between Mini Nutritional Assessment and Anthropometric Measurements Among Community-Dwelling Elderly Individuals in Rural Southern Thailand. J Multidiscip Healthc 2021; 14:1509-1520. [PMID: 34177268 PMCID: PMC8219300 DOI: 10.2147/jmdh.s315652] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/26/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose The Mini Nutritional Assessment (MNA) can be applied to assess nutrition status among community-dwelling elderly individuals by health care professionals. This study aimed to evaluate the correlation of MNA score and anthropometric measurements, gait speed, and handgrip strength among elderly community members. The secondary outcome was to compare the performance of the MNA-SF with the full MNA. Materials and Methods The study was a cross-sectional study with 176 elderly individuals aged ≥60 years living in rural southern Thailand. The MNA-SF and full MNA scores were obtained by using the standard form in the Thai version of the MNA. We collected anthropometric measurements, gait speed, handgrip strength, and MNA data. Results There was a significant positive correlation between body weight, BMI, waist circumference, hip circumference, waist-to-height ratio, waist-to-hip ratio, mid-upper arm circumference, calf circumference, triceps skinfold thickness, handgrip strength and full MNA total score using the partial correlation coefficient after controlling for age and sex. The MNA-SF had sensitivity of 78.79%, specificity of 81.82%, PPV of 50%, NPV of 94.35%, LR+ of 4.33, LR- of 0.26, accuracy of 81.25% and AUC 0.901 when using the full MNA as a reference standard. Conclusion The MNA correlated with many anthropometric measurements. The MNA-SF had a high specificity, NPV and accuracy of more than 80% when compared with the full MNA.
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Affiliation(s)
- Naparat Sukkriang
- School of Medicine, Walailak University, Nakhon Si Thammarat, 80160, Thailand.,Walailak University Hospital, Nakhon Si Thammarat, 80160, Thailand
| | - Kamlai Somrak
- Walailak University Hospital, Nakhon Si Thammarat, 80160, Thailand.,School of Nursing, Walailak University, Nakhon Si Thammarat, 80160, Thailand
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Govind R, Rajeev J, Bhatt AN. Malnutrition among community dwelling older adults in a rural block area of South India. J Family Med Prim Care 2021; 9:5982-5987. [PMID: 33681030 PMCID: PMC7928154 DOI: 10.4103/jfmpc.jfmpc_1248_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/13/2020] [Accepted: 09/28/2020] [Indexed: 11/10/2022] Open
Abstract
Background: Kerala state has highest proportion of older adults in India. There is paucity of information on burden of malnutrition (under-nutrition) among them in the state. This study aimed to measure prevalence and associated factors of malnutrition among older adults in a rural community of Kerala. Methods: A community based cross-sectional study was conducted in 2018, among randomly selected 245 older persons (age ≥ 60 years) across rural area of Nemom block panchayath in Thiruvananthapuram district of Kerala. Nutritional status was determined by Mini Nutritional Assessment tool. Other components of the interviewer-administered questionnaire were Barthel Index, Geriatric Depression Scale-15, socio-demography, morbidity and substance abuse details. Chi Square test and binary logistic regression were done appropriately. Results: Prevalence of malnutrition was 14.3% (95% CI – 9.9% to 18.7%) and 44.1% (95% CI – 37.9% to 50.3%) were at risk of malnutrition. Older-old (70-79 years), oldest-old (≥80 years), unmarried or widowed, those with chewing and swallowing difficulties, those who screened positive for depression and those who had higher grade of dependency in any activities of daily living were more likely to be malnourished (p < 0.05). Older-old age (aOR – 3.358), depression (aOR – 4.859) and higher grade of dependency in activities of daily living (aOR – 2.940) were the attributes independently associated with malnutrition after adjusting for other factors. Conclusions: The older persons in the rural area of Kerala had high burden of malnutrition. Older-old, dependent and depressed individuals are more likely to be affected.
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Affiliation(s)
- Ragasree Govind
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, India.,District Epidemiologist (IDSP), District Medical Office, Alappuzha, India
| | - Jayalakshmi Rajeev
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, India
| | - Arun N Bhatt
- Department of Community Medicine, Pushpagiri Institute Of Medical Sciences, Thiruvalla, Kerala, India
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Lin TK, Chang YY, Chen NC, Liou CW, Lan MY, Chen YF, Tsai CL. Nutritional Status Associated with Molecular Biomarkers, Physiological Indices, and Clinical Severity in Parkinson's Disease Patients. Int J Environ Res Public Health 2020; 17:E5727. [PMID: 32784774 DOI: 10.3390/ijerph17165727] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/26/2020] [Accepted: 08/04/2020] [Indexed: 12/11/2022]
Abstract
This study is intended to explore the associations between nutritional status and molecular biomarkers and the clinical severity of Parkinson's disease (PD), as well as to examine the differences in related factors between PD patients with normal nutrition and those with at risk for malnutrition. A cross-sectional assessment of 82 consecutive outpatients with PD was conducted using the mini nutritional assessment (MNA), Unified Parkinson's Disease Rating Scale (UPDRS), and the Hoehn and Yahr scale to determine the nutritional status, the clinical severity of PD, and the stage of the disease. Recordings of blood samples collected after 12 h of overnight fasting were also assessed in terms of serum levels of glycated hemoglobin (HbA1c), blood urea nitrogen (BUN), creatinine, cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), hemoglobin (Hgb), folate, and vitamin B12. All participants were divided into normal nutrition and malnutrition risk groups via the MNA scores to compare the above-mentioned parameters. The results showed that the total MNA score was significantly correlated with some parts of the UPDRS scale (e.g., Sections 1 and 2) and the levels of HbAlc in PD patients and those with risk for malnutrition, with significantly lower weight and body mass index (BMI), and with lower levels of Hgb and HDL. Higher levels of cholesterol were observed in the malnutrition risk group as compared with the normal nutrition group. The findings suggest that the clinical severity of PD is associated with nutritional status. Body weight, BMI, and the levels of Hgb, cholesterol, and HDL could be, at least partially, important biological markers to monitor malnutrition and the progression of the disease.
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Mastronuzzi T, Grattagliano I. Nutrition as a Health Determinant in Elderly Patients. Curr Med Chem 2019; 26:3652-3661. [PMID: 28545376 DOI: 10.2174/0929867324666170523125806] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 03/16/2017] [Accepted: 04/16/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND An adequate caloric intake is a major determinant for the health status especially when degenerative conditions become a predominant risk for difficult-to-treat diseases as in aging. METHODS A structured search of literature on the major databases was performed using terms as nutrition, elderly and malnutrition. RESULTS According to most referenced articles, it appears to be unquestionable that both organic and social risk factors [economic hardship, loneliness, institutionalization] are important as determining causes of protein-caloric malnutrition. Some anthropometric, clinical and laboratory parameters can help to make diagnosis and quantify malnutrition. However, most of them are not cheap or are not simple to perform especially in the setting of General Practice. The application of a simple questionnaire [Mini Nutritional Assessment, MNA] allows to obtain in a fast, easy and non-invasive way a valid assessment of the nutritional status in geriatric patients. The maintenance of the nutritional status is the best measure to counteract the risk of proteincaloric malnutrition and its complications which often sneakily affects elderly population and in particular frail patients. CONCLUSION This review, based on updated concepts, examines all the above mentioned points together with some aspects associated with malnutrition as an indicator of disease severity and health costs in the elderly population. Finally, the impact of nutritional intervention and nutrients supplementation on general indices of malnutrition are discussed as a promising strategy.
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Komici K, Vitale DF, Mancini A, Bencivenga L, Conte M, Provenzano S, Grieco FV, Visaggi L, Ronga I, Cittadini A, Corbi G, Trimarco B, Morisco C, Leosco D, Ferrara N, Rengo G. Impact of Malnutrition on Long-Term Mortality in Elderly Patients with Acute Myocardial Infarction. Nutrients 2019; 11:E224. [PMID: 30678180 DOI: 10.3390/nu11020224] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 01/08/2019] [Accepted: 01/15/2019] [Indexed: 11/18/2022] Open
Abstract
Background: Malnutrition is a frequent condition in the elderly, and is associated with prolonged hospitalization and increased mortality. However, the impacts of malnutrition among elderly patients with acute myocardial infarction have not been clarified yet. Methods and Results: We enrolled 174 patients aged 65 years and over, admitted with the diagnosis of acute myocardial infarction (AMI), who underwent evaluation of nutritional status by Mini Nutritional Assessment (MNA) and evaluation of mortality risk by GRACE Score 2.0. All-cause mortality was the outcome considered for this study. Over a mean follow-up of 24.5 ± 18.2 months, 43 deaths have been registered (24.3%). Non-survivors were more likely to be older, with worse glomerular filtration rate, lower systolic blood pressure, lower albumin and MNA score, higher prevalence of Killip classification III-IV grade, and higher Troponin I levels. Multivariate Cox proportional analysis revealed that GRACE Score and MNA showed a significant and independent impact on mortality, (HR = 1.76, 95%, CI = 1.34–2.32, and HR = 0.56, 95% CI = 0.42–0.73, respectively). Moreover, the clinical decision curve revealed a higher clinical net benefit when the MNA was included, compared to the partial models without MNA. Conclusion: Nutritional status is an independent predictor of long-term mortality among elderly patients with AMI. MNA score in elderly patients with AMI may help prognostic stratification and identification of patients with, or at risk of, malnutrition in order to apply interventions to improve nutritional status, and maybe survival in this population.
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Donini LM, Marrocco W, Marocco C, Lenzi A. Validity of the Self- Mini Nutritional Assessment (Self- MNA) for the Evaluation of Nutritional Risk. A Cross- Sectional Study Conducted in General Practice. J Nutr Health Aging 2018; 22:44-52. [PMID: 29300421 DOI: 10.1007/s12603-017-0919-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Malnutrition is a frequent condition in the elderly especially in hospitals and in nursing homes, and even among the free-living elders the prevalence is not negligible (5-10%). Awareness towards malnutrition is still limited. The lack of time for nutritional assessment by the overcommitted healthcare personnel, including the general practitioners (GPs), may represent one possible explanation for limited recognition of malnutrition. Therefore, a self-administered instrument could be useful in raising alert on the GPs and allow early detection of malnutrition and early care provision. The aim of the present study was to analyze the validity of the Self-MNA that takes cue from the Mini Nutritional Assessment- Short Form (MNA-SF) and has been adapted to be self-administered by free-living elderly subjects. METHODS Participants were recruited from patients referring to the GP offices in Italy. Nutritional evaluation was performed through the administration of Full-MNA, MNA-SF and Self-MNA. The comorbidity level was assessed through the Cumulative Illness Rating Scale (CIRS). The level of difficulty in filling out the test was reported by the participants, and the time spent to complete the Self-MNA was also registered. RESULTS A total of 226 subjects, 125 women and 101 men (75.1 ±8 and 75.3 ± 8 years old, respectively; p=0.89) were enrolled, and 214 (94.7%) of them completed the Self-MNA. According with the Full-MNA test score, 8.4% of women and 3.5% of men were classified as malnourished, whereas 32.7% of women and 31.4% of men were at risk of malnutrition. Agreement between Self-MNA and Full-MNA, and Self-MNA vs. MNA-SF was classified as "moderate" (k = 0.476 and 0.496 respectively; p < 0.001). Self-MNA showed a fair predictive value compared to the Full-MNA and MNA-SF tests (76.6 and 79.9%, respectively) with a barely adequate sensitivity (70.9 and 75.4%, respectively). The analysis of the characteristics of FN (false negative: subjects who were considered at risk of malnutrition or malnourished at Full-MNA but not at Self-MNA) showed that the clinical and functional aspects of these subjects (age, comorbidity and severity, time necessary to complete the Self-MNA, decrease in food intake, severe illness in the past 3 months, dementia and depression, fluid intake, need for feeding assistance, arm and calf circumferences) were very similar to the characteristics of true positive subjects. Patients required 6.7 ± 4.5 minutes to complete the test and 25 subjects (11.7%) needed more than 10 minutes, up to a maximum of 30 minutes. Patients who stated a greater difficulty were older (79.8 ± 7 vs. 73.5 ± 7 years; p<0.001), they were more «malnourished» at Full-MNA (10.7 vs. 1,7%; p= 0.006) and clinical status was characterized by a higher severity index (1.72 ± 0.6 vs. 1.41 ± 0.4; p= 0.008). CONCLUSION In the present study we investigated the validity of the Self-MNA in a sample of free-living elderly subjects. The results obtained confirm the validity of the test that may represent a useful tool for the GPs, although some important limitations need to be considered, limiting its use in clinical practice.
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Affiliation(s)
- L M Donini
- Lorenzo M Donini, MD, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy, phone: +39 06 4969 0216, fax: +39 06 4991 0699,
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Machado RSP, Coelho MASC, Veras RP. Validity of the portuguese version of the mini nutritional assessment in brazilian elderly. BMC Geriatr 2015; 15:132. [PMID: 26493313 PMCID: PMC4619212 DOI: 10.1186/s12877-015-0129-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 10/12/2015] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Malnutrition is common and affects negatively the health of the older adult. The Mini Nutritional Assessment (MNA), a nutritional assessment tool allows to identify elders malnourished and at risk of malnutrition. The aim of this study is to validate the Portuguese version of the MNA. METHODS Cross-sectional study with 344 Brazilian elderly. The full version of the MNA was performed, also calf circumference (CC), mid arm circumference (MAC) and body fat (BF). Psychometric evaluation was carried out and correlation, diagnostic accuracy and ROC curves were generated. RESULTS Construct validity was supported, all four questionnaire dimensions were evidenced in the Principal Component Analysis and also significant Spearman correlation (P < 0.001) were demonstrated. Criterion validity was also evidenced with relevant sensitivity (MAC = 82.8; CI95% = 64.2-94.2) and specificity (CC = 80.0; CI95% = 74.0-85.1). In the ROC curve AUC was excellent (MAC = 0.832; CI95% =0.785-0.873). CONCLUSIONS The full MNA demonstrated significant results and sufficient exploratory psychometric properties that supported its validity. It seems to be valid tool to access nutritional status of Brazilian elderly.
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Affiliation(s)
- Renata Santos Pereira Machado
- Instituto de Nutrição Josué de Castro - INJC, Universidade Federal do Rio de Janeiro - UFRJ, Av. Carlos Chagas Filho, 373 - Ed. do Centro de Ciências da Saúde, Bloco J / 2° andar. Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, 21941-902, Brasil.
| | - Maria Auxiliadora Santa Cruz Coelho
- Instituto de Nutrição Josué de Castro - INJC, Universidade Federal do Rio de Janeiro - UFRJ, Av. Carlos Chagas Filho, 373 - Ed. do Centro de Ciências da Saúde, Bloco J / 2° andar. Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, 21941-902, Brasil.
| | - Renato Peixoto Veras
- Universidade Aberta da Terceira Idade - UnATI, Universidade Estadual do Rio de Janeiro - UERJ, Rio de Janeiro, Brasil.
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Naidoo I, Charlton KE, Esterhuizen TM, Cassim B. High risk of malnutrition associated with depressive symptoms in older South Africans living in KwaZulu-Natal, South Africa: a cross-sectional survey. J Health Popul Nutr 2015; 33:19. [PMID: 26825267 PMCID: PMC5026002 DOI: 10.1186/s41043-015-0030-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 10/02/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Malnutrition contributes to functional and cognitive decline in older adults, which results in decreased quality of life and loss of independence. This study aimed to identify determinants of nutritional risk among community-dwelling adults in KwaZulu-Natal, South Africa. METHODS A cross-sectional survey was undertaken in 1008 subjects aged 60 years and over who were randomly selected by systematic sampling. Demographics, socioeconomic data and self-reported history of medical conditions were recorded. The Mini Nutritional Assessment-Short Form (MNA-SF) was used to screen for nutritional risk, and the Centre for Epidemiologic Studies Depression scale was administered to all subjects. Descriptive statistics and the Pearson chi-square and Kruskal-Wallis tests were used for statistical analysis. Logistic regression modelling determined predictors of nutritional risk. RESULTS Of the 984 participants (mean age = 68.8 ± 7.4 years; range 60-103 years) who completed the MNA-SF, 51% were classified as having a normal nutritional status, 43.4% at risk for malnutrition and 5.5% classified as malnourished. Men were more likely to be either at risk for malnutrition or be malnourished than women (p = 0.008), as were subjects with a monthly household income of ≤R1600 per month (~133 USD) (p = 0.003). In logistic regression models, depressed people were 2.803 (p < 0.001) times more likely to be at risk or be malnourished than those not depressed. CONCLUSION A high prevalence of risk of malnutrition was identified in older South Africans living in an urban area with poor infrastructure. Further investigations are warranted to determine whether the higher prevalence of depressive symptomatology in nutritionally at risk individuals is a determinant or a consequence of malnutrition, in order to develop targeted nutritional interventions in this age group.
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Affiliation(s)
- I Naidoo
- Department of Geriatrics, University of KwaZulu-Natal, Durban, South Africa
| | - Karen E Charlton
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia.
| | - T M Esterhuizen
- Centre for Evidence Based Health Care, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - B Cassim
- Department of Geriatrics, University of KwaZulu-Natal, Durban, South Africa
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Hsu MF, Ho SC, Kuo HP, Wang JY, Tsai AC. Mini-nutritional assessment (MNA) is useful for assessing the nutritional status of patients with chronic obstructive pulmonary disease: a cross-sectional study. COPD 2014; 11:325-32. [PMID: 24475999 DOI: 10.3109/15412555.2013.863274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Malnutrition is prevalent in patients with chronic obstructive pulmonary disease (COPD) but is often neglected in clinical practice. This study examined the usefulness of the Mini Nutritional Assessment (MNA) for assessing the nutritional status of patients with COPD. We recruited 83 patients with COPD in stable condition from the pulmonary rehabilitation unit of a medical center in northern Taiwan. Each patient was interviewed with a structured questionnaire to elicit personal and health-related data, and measured for anthropometric and blood biochemical indicators. Nutritional status was rated with two Taiwanese-specific versions of the MNA, MNA-T1 and MNA-T2. Fat-free mass was measured with bioelectrical impedance analysis (BIA), and exercise capacity indicators with the 6-Minute Walk Test. The two MNA versions showed high agreement (kappa = 0.949) in predicting the nutritional risk, and both versions predicted the FFMI well (area under the curve of the Receiver Operating Characteristics = 0.804, p < 0.001 for MNA-T1; and 0.813, p < 0.001 for MNA-T2). MNA scores decreased with increasing disease severity and were highly correlated with FFMI, BMI, mid-arm circumference, calf circumference, and oxygen saturation at rest and during exercise (all p < 0.01). The MNA score was positively correlated with FEV1, FVC and 6-minute walking distance, and negatively correlated with GOLD stages (all p < 0.05). However, the MNA score was not significantly correlated with blood biochemical indicators, perhaps due to inflammatory status associated with COPD. The MNA appears appropriate for rating the nutritional risk of patients with COPD. Routine use of the MNA may help reduce the risk of malnutrition in patients with COPD.
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Affiliation(s)
- Min-Fang Hsu
- 1Department of Healthcare Administration, Asia University , Wufeng, Taichung , Taiwan
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Vafaei Z, Mokhtari H, Sadooghi Z, Meamar R, Chitsaz A, Moeini M. Malnutrition is associated with depression in rural elderly population. J Res Med Sci 2013; 18:S15-9. [PMID: 23961277 PMCID: PMC3743311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 01/20/2013] [Accepted: 02/04/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Aging induces physiological changes and affects all of organs. Nutritional status and mental health deteriorate with aging. As malnutrition and depression are main problem in elderly this study was performed to assess the association between malnutrition and depression among rural elderly. MATERIALS AND METHODS Three hundred and seventy rural elderly aged over 60 years were examined in a cross-sectional study by systematic sampling method and using mini nutritional assessment (MNA), which is a standard questionnaire for evaluating nutrition status. Depression was evaluated by a validated questionnaire in the elderly. Correlation between Socio-demographic characteristic, diseases, and nutrition status was obtained by t-test, Chi-square test and logistic regression in elderly population. RESULTS Mean ± SD age was 70.6 ± 7.3 years. Frequency of malnutrition was similar in both genders. According to MNA, 3.8% of subjects suffered from malnutrition, 32.7% were at risk of malnutrition and 63.5% were well-nourished. Nutrition status correlated with body mass index (P = 0.028) and depression (P = 0.001). The risk of severe depression in patients with malnutrition was 15.5 times higher than non-depressed persons (odd ratio: 15.5; 95% CI: 2.9-82.5). CONCLUSION Depression could act as a powerful risk for malnutrition in elderly population that it should be controlled by physicians.
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Affiliation(s)
- Zamane Vafaei
- Department of Epidemiology, Isfahan university of Medical Science, Isfahan, Iran
| | - Habibollah Mokhtari
- Cardiovascular research institute, Isfahan university of Medical Science, Isfahan, Iran
| | - Zahra Sadooghi
- Department of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rokhsareh Meamar
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Medical Science, Islamic Azad University, Najafabad Branch, Isfahan, Iran
| | - Ahmad Chitsaz
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Neurology, Isfahan University of Medical Sciences Isfahan, Iran
| | - Mina Moeini
- Cardiovascular research institute, Isfahan university of Medical Science, Isfahan, Iran
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