Mini-Nutritional-Assessment (MNA) without Body Mass Index (BMI) predicts functional disability in elderly Taiwanese
Li-Chin Lee
a,b, Alan Chung-hong Tsai
a,c,*
aDepartment of Healthcare Administration, Asia University, Taichung 41354, Taiwan
bCenter of Administration, Tungs’ Taichung MetroHarbor Hospital, Wuchi, Taichung 43503, Taiwan
cDepartment of Health Services Management, School of Public Health, China Medical University, Taichung 40402, Taiwan
1. Introduction
Aging is associated with a gradual decline in physiological and physical functional abilities and older adults are associated with an increased risk of under-nutrition (Stuck et al., 1999; Ahmed and Haboubi, 2010). Studies have shown that approximately 2–8% are undernourished and 24–36% are at risk of malnutrition among community-living elderly (Guigoz, 2006; Han et al., 2009); 9–13%
are malnourished and 31–45% are at risk of malnutrition among outpatients (Guigoz, 2006; Saka et al., 2010); 12–21% are malnourished and 51–61% are at risk of malnutrition among nursing home residents (Guigoz, 2006; Wojszel, 2006.); and 23–
29% are malnourished and 46–50% are at risk of malnutrition among hospitalized elderly (Guigoz, 2006; Chang et al., 2010).
Numerous studies have found that nutritional status was associated with functional impairment or dependency (Chernoff,
2001; Meydani, 2001; Zuliani et al., 2001; Guigoz, 2006; Rivlin, 2007; Chevalier et al., 2008; Spaccavento et al., 2009; Ahmed and Haboubi, 2010; Chang et al., 2010; Saka et al., 2010). Malnourished elderly have increased frequency of hospitalization and hospital length of stay and increased risk of depression and mortality (van Nes et al., 2001; Guigoz, 2006; Wojszel, 2006; Chan et al., 2010;
Chang et al., 2010; Saka et al., 2010; Tsai et al., 2010). They also have impaired cognition and decreased quality of life (Chevalier et al., 2008; Smoliner et al., 2009).
The MNA is a validated and widely used nutritional assessment/
screening tool. It has good sensitivity, specificity and reliability, and is effective for evaluating the nutritional status of older adults living in a variety of settings (Guigoz et al., 2002; Guigoz, 2006;
Vellas et al., 2006). The MNA consists of 18 items covering four dimensions (anthropometry, dietary assessment, global assess- ment, and self-evaluation) (Guigoz et al., 1994). It has better sensitivity and validity than other single-item indicators such as the BMI, weight loss, energy intake or serum albumin in detecting emerging malnutrition (Vellas et al., 1999; Guigoz, 2006). The MNA has two forms, LF (or full-MNA) and SF. The first 6 items of the full MNA constitutes the SF. MNA-SF is designed for indentifying those who are potentially at risk of malnutrition (screening). Those who A R T I C L E I N F O
Article history:
Received 15 October 2011
Received in revised form 7 December 2011 Accepted 8 December 2011
Available online 3 January 2012
Keywords:
MNA
Functional decline Nutritional status Elderly Taiwan
A B S T R A C T
Nutritional status and functional ability are mutually dependent especially in the elderly. This study examined the functional status-predictive ability of the MNA in a cross-sectional study. We analyzed the dataset of the ‘‘Survey of Health and Living Status of the Elderly in Taiwan’’ (SHLSET). Subjects were 2948 65 year-old persons who were rated with the long-form (LF) and short-form (SF) MNA with or without BMI for the risk of malnutrition, and with the Activities of Daily Living (ADL) and the Instrument Activities of Daily Living (IADL) for functional status. The ADL and IADL scores were calculated according to rated nutritional status. Receiver Operating Characteristic (ROC) curves were generated for ADL and IADL status predicted by the MNA. Logistic regression was performed to evaluate the association of rated MNA scores with ADL or IADL status. Results showed that both SF and LF of MNA-T1 and T2 were able to predict ADL and IADL disabilities. Those who were rated malnourished or at risk of malnutrition had drastically higher risk of ADL or IADL dependency compared to those who were rated normal. The SF versions performed well in rating nutritional status and predicting ADL and IADL status. Overall, MNA- T2-SF performed at least equally well as MNA-T1-SF in rating functional decline. These results suggest the MNA is able to predict functional decline of the elderly. MNA-T2, especially the SF, a version without BMI should be particularly useful in clinical, long-term care and community settings.
ß2011 Elsevier Ireland Ltd. All rights reserved.
* Corresponding author at: Department of Healthcare Administration, Asia University, 500 Liufeng Rd., Wufeng, Taichung 41354, Taiwan.
Tel.: +886 4 2332 3456x1943; fax: +886 4 2332 1206.
E-mail address:[email protected](A.-h. Tsai).
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Archives of Gerontology and Geriatrics
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doi:10.1016/j.archger.2011.12.006
are identified as ‘‘at risk of malnutrition’’ are further assessed with the full MNA. Under most conditions, MNA-SF predicts the full MNA well (Rubenstein et al., 2001; Guigoz, 2006).
The MNA has been found to be multifunctional. In addition to grading the nutritional status, it has been shown to evaluate depression, cognition, functional status and mortality of older adults. Several cross-sectional studies have shown that the MNA score is associated with the functional status or able to predict functional decline of older adults (Wojszel, 2006; Salvi et al., 2008;
Spaccavento et al., 2009; Saka et al., 2010).Chang et al. (2010)have further observed that the MNA is able to predict future functional deterioration in hospitalized patients with geriatric syndrome.
However, most of these studies were conducted with relatively small samples. Hence, the present study was aimed to examine the functional status-predictive ability of the MNA and compared the ability of two adapted versions of the MNA in predicting the functional ability in a large national sample of elderly Taiwanese.
2. Methods
2.1. Data and subjects
Data for this analysis were from the SHLSET, a population-based longitudinal cohort study conducted by the Bureau of Health Promotion of Taiwan for gaining an understanding of the role of socioeconomic, environmental, lifestyle and healthcare factors on health, well-being and quality of life of older Taiwanese (Chang and Hermalin, 1996a,b). The SHLSET was initiated with a multi- stage national probability sample in 1989. The design, sampling and survey procedures have been described in a recent publication (Lee and Tsai, 2011). Subjects in the cohort were interviewed for demographic, socioeconomic, lifestyle and health or healthcare- related data every 3 or 4 years. The completion rates ranged from 79.1% to 91.8%. Methods and procedure of the survey were reviewed and approved by government-appointed representa- tives. All participants signed an informed consent and subjects’
anonymity was preserved at all times.
The present study analyzed datasets of the 1999 survey which had a specific emphasis on diet and nutrition. Our analysis included all (2948) participants who were 65 years of age in 1999.
2.2. Measurements
Nutritional status was rated with both the LF and SF of two Taiwanese-specific versions (Taiwan version-1, and 2, T1 and T2) of the MNA. T1 is a normalized version, the same as the original MNA, except it adopted the population-specific anthropometric cutoff points. T2 is modified from T1 by replacing items Q (mid- arm circumference, MAC) and R (calf circumference, CC) for F (BMI) in the scale. Of the 3 points of item F, 1 point was reassigned to item Q and 2 points to item R. Thus, T2 has the same total score but only 17 items (Tsai et al., 2008). Data for all items but I (pressure sore/
skin ulcers) and M (fluid intake) in MNA-LF were identified in the database. So, MNA-T1-LF was based on 16 items and T2 on 15 items with a total score of 28 points. However, the total score was proportionately adjusted to the full score basis (30 points). A total score of 16.5 suggests malnourishment; 17–23.5, at risk of malnutrition; and 24, normal. All MNA-SF items were available in the dataset. T1-SF included items A-F, whereas T2-SF included items A-E and item R (CC). MNA-SF has a maximum score of 14; a score 7 suggests malnourishment; 8–11, at risk of malnutrition;
and 12, normal (Kaiser et al., 2009).
Functional status was assessed with a self-reported question- naire about the ADL and the IADL adapted from the 1984 National Health Interview Survey Supplement on Aging (Fitti and Kovar,
1987). Two scores were derived from each scale: one measuring difficulty in carrying out the items and the other measuring the degree of difficulty on performing on each of the tasks. To assess ADL, participants were asked whether they had difficulty bathing, dressing, transferring, eating, walking or toileting independently.
An item that one ‘‘cannot do independently’’ is considered
‘‘dependent’’ for that item. Participants also rated the level of difficulty for performing each of the six items on a scale from 0 to 3 (0, no difficulty; 1, some difficulty; 2, much difficulty; 3, cannot do). Individual scores were summed across each of the six items to yield a total score from 0 to 18, with higher scores reflecting a higher level of ADL difficulty (Johnson et al., 2007). To assess IADL, participants were asked whether they had difficulty shopping, handling finances, transporting, housekeeping, using the tele- phone or doing some heavy housework. As with ADL, two scores were derived from each person. An ADL/IADL dependency was defined as ‘‘inability to do one or more ADL/IADL independently (that is a score of 3 in one or more ADL/IADL item)’’.
2.3. Statistical analysis
The distribution of ADL and IADL status are shown according to nutritional status rated with the MNA (LF and SF). Binary logistic regression analysis was performed to determine the significance of the association of subjects’ nutritional status (malnourished, at risk of nutrition, and normal by both the short form and long form of T1 and T2, respectively) with functional disability (dependent vs.
independent) controlled for sociodemographic (gender, age, years of formal education, whether living alone), health behavioral (smoking, drinking and physical activity), and chronic disease (chronic diseases included hypertension, heart disease, diabetes, stroke, and cancer) variables. ROC curves were generated for MNA- SF using the full MNA as the referent and for ADL and IADL status predicted by the MNA-LF and MNA-SF. All statistical analyses were performed with SPSS/Windows 15.0 (SPSS Inc., Chicago, IL) software package. All values were weighting-adjusted according to study design. Statistical significance for all analyses was accepted at
a
= 0.05.3. Results
There were slightly more men (55%) than women; 24.9% were current smokers; 14.2% drank alcohol 1 time/wk; and 55%
reportedly exercised 3 times/wk; 14.1% of subjects had medical emergency visits and 21.9% had hospitalization during the past 12 months. Most subjects (71%) had one or more chronic diseases (Table 1).
Table 2shows the scoring pattern evaluated with the MNA.
About 11% of subjects had severe or moderate loss of appetite;
15.7% had weight loss; 9% could not get out of bed or go out; 10.4%
suffered psychological stress; 58.8% consumed fewer protein-rich foods than desired; 8.7% had less than desired fruit-vegetable intakes; 20.4% self-viewed malnourished or were uncertain about their nutritional status and 46.1% thought their health status was not as good as peers or were uncertain about their health status.
Nearly 30% had less than desired BMI (<21 kg/m2).
Table 3shows the distribution of nutritional status (computed from data shown inTable 2) and the distribution of ADL and IADL status according to the rated nutritional status. MNA-T1-LF rated 3.4% of the cohort malnourished, 16.8% at risk of malnutrition, and 79.8% normal and the MNA-T1-SF rated 4.7%, 20.1% and 75.2%, respectively, whereas the MNA-T2-LF rated 3.1%, 13.1%, 83.9% and T2-SF rated 3.8%, 19.3%, 76.9%, respectively. Elderly who were rated malnourished or at risk of malnutrition by either the LF or SF of T1 or T2 had drastically higher (worse) ADL and IADL scores or L.-C. Lee, A.-h. Tsai / Archives of Gerontology and Geriatrics 54 (2012) e405–e410
e406
disabilities. MNA-T2 appeared to perform better than T1, especially the SF.
Table 4shows the results of binary logistic regression models controlled for age, sex, years of formal education, living status, health behaviors, health care services, and chronic diseases. The nutritional scores (by both long and short forms of T1 and T2 versions) strongly predicted ADL and IADL status (all p < 0.001).
The LFs appeared to be better than the SFs in predicting functional decline. Of the two SFs, the T2 appeared to be better than T1 in predicting ADL status.
Fig. 1shows the ROC curves generated for MNA-SF using the full MNA as the reference (Panel A1 and B1) and for ADL (Panel A2 and B2) and IADL (Panel A3 and B3) status predicted with the LF and SF of MNA-T1 and -T2, respectively. Both SF versions predicted the respective LF well (Panels A1 and B1). MNA-T1 and T2 were better in predicting ADL than in predicting IADL status. MNA-T2 was better than MNA-T1 in predicting ADL and IADL disabilities.
4. Discussion
4.1. Functional status-predictive ability of the MNA
Results show that both MNA-T1 and T2 are able to predict functional status, in addition to rating the nutritional status of older adults. Elderly who are rated malnourished or at risk of malnutrition by the MNA have drastically higher risk of functional decline compared to those who are rated normal. Malnourishment Table 2
Scoring pattern of MNA items by elderly Taiwanese (N = 2948).
Item and conditions (item score) Scoring N (%)
A. Declined food intake over past 3 months (2)
Severe loss of appetite 0 308 (10.4)
Moderate loss of appetite 1 11 (0.4)
No loss of appetite 2 2629 (89.2)
B. Weight loss during last months (3)
Lost 3 kg body weight 0 462 (15.7)
Does not know 1 22 (0.7)
No 3 2464 (83.6)
C. Mobility (2)
Bed or chair-bound 0 105 (3.6)
Able to get out of bed but does not go out 1 160 (5.4)
Can get out of bed and goes out 2 2683 (91.0)
D. Suffered psychological stress past 3 months (2)
Yes 0 308 (10.4)
No 2 2640 (89.6)
E. Neuropsychological problems (2)
Severe dementia or depression 0 30 (1.0)
Mild dementia 1 180 (6.1)
No psychological problems 2 2738 (92.9)
F. Body mass index (kg/m2) (3) MNA-T1b
<17 0 98 (3.3)
17–19 1 248 (8.4)
19–21 2 524 (17.7)
>21 3 2078 (70.5)
MNA-T2b (Omitted)
G. Lives independently (1)
No 0 58 (2.0)
Yes 1 2890 (98.0)
H. Taking >3 prescribed drugs per day (1)
Yes 0 124 (4.2)
No 1 2824 (95.8)
I. Pressure sore (NA)a
J. Eat full meals per day (2)
1 0 4 (0.1)
2 1 115 (3.9)
>3 2 2829 (96.0)
Table 1
Characteristics of subjects at baseline in 1999 (N = 2948).
Parameter N (%)
Gender
Men 1621 (55.0)
Women 1327 (45.0)
Age (year)
65–74 1663 (56.4)
75–84 1087 (36.9)
85 198 (6.7)
Formal education (year)
6 2324 (78.8)
7–12 464 (15.7)
13 160 (5.5)
Living arrangement
Alone 330 (11.2)
With others 2618 (88.8)
Smoking
Yes 731 (24.9)
Drinking (times/week)
<1 2526 (85.8)
1 418 (14.2)
Physical activity (times/week)
2 1326 (45.0)
3 1622 (55.0)
Emergency visits during past 12 months
Yes 414 (14.1)
Hospitalization during past 12 months
Yes 645 (21.9)
No. of chronic diseasea
0 854 (29.0)
1–2 1568 (53.2)
3 526 (17.8)
aIncluding hypertension, heart disease, pulmonary disease, liver disease, renal disease, diabetes, stroke, arthritis and cancer.
Table 2 (Continued )
Item and conditions (item score) Scoring N (%)
K. Consumption of protein-rich foods (1)
0 or 1 ‘‘yes’’ 0 406 (13.8)
2 ‘‘yes’’ 0.5 1328 (45.0)
3 ‘‘yes’’ 1 1214 (41.2)
L. Fruit & vegetable intake (2 servings/d) (1)
No 0 258 (8.7)
Yes 1 2690 (91.3)
M. Fluid intake (NA)a
N. Mode of feeding (2)
Unable to eat without assistance 0 74 (2.5)
Self-fed with some difficulty 1 90 (3.1)
Self-fed without difficulty 2 2784 (94.5)
O. Self view of nutritional status (2)
Malnourished 0 257 (8.7)
Uncertain of status 1 346 (11.7)
No nutritional problem 2 2345 (79.5)
P. Self-rated health status compared to peers (2)
Not as good 0 1360 (46.1)
Uncertain or Unknown 0.5 0 (0)
As good 1 1440 (48.9)
Better 2 148 (5.0)
Q. Mid-arm circumference (cm) (male/female) (1) MNA-T1b
<22.5/<21 0 109 (3.7)
22.5–23.5/21–22 0.5 89 (3.0)
23.5/22 1 2750 (93.3)
MNA-T2b
<22.5/<21 0 109 (3.7)
22.5–23.5/21–22 1 89 (3.0)
23.5/22 2 2750 (93.3)
R. Calf circumference (cm) (male/female) (1) MNA-T1b
<28/<25 0 97 (3.3)
28/25 1 2851(96.7)
MNA-T2b
<28/<25 0 97 (3.3)
28–29/25–26 1 70 (2.4)
29–30/26–27 2 87 (3.0)
30/27 3 2694 (91.4)
a Data are not available in the data base.
b MNA-T1 LF included all 18 items and MNA-T1 SF included items A-F; MNA-T2 LF included all items but item F and MNA-T2-SF included items A-E and item R.
identified by the MNA has been shown to be associated with poor ADL status in community-living and institutionalized elderly (Ruiz-Lo´pez et al., 2003; Suominen et al., 2005; Wojszel, 2006;
Ferdous et al., 2009), in hospitalized patients (Oliveira et al., 2009) and in patients undergoing ambulatory rehabilitation (Chevalier et al., 2008).
The MNA has also been observed to predict functional status of elderly living in a variety of settings. In a cross-sectional study, Cereda et al. (2008)showed that the MNA was suitable for grading functional status (Barthel Index) of institutionalized elderly;Salvi et al. (2008) observed that patients who were rated possible malnutrition by SF MNA had a higher risk of developing functional decline (a loss of 10% Barthel Index score) during the hospitali- zation; andZeyfang et al. (2005)found that the MNA was able to distinguish healthy and independently living older adults with normal functional status from those with mildly impaired functions. In a prospective study of hospitalized patients with geriatric syndrome,Chang et al. (2010)found that the MNA was able to predict future functional deterioration. The current study has further observed that the MNA is able to predict future
functional (ADL and IADL) decline in addition to rating malnutri- tion in a national sample of elderly Taiwanese.
That the MNA can predict IADL status is a relatively new and more interesting finding than its association with ADL status.
Because the IADL represents the higher daily skills, and the decline in IADL usually precedes the decline in ADL (the ADL represents more basic living activities such as the ability of self-feeding). The finding suggests that the MNA is able to predict those who are at the early stage of functional (IADL) decline. A clear advantage of being able to predict those who are at the early stage of IADL decline is to enable timely intervention.
4.2. MNA-SF can function as a stand-alone unit
It is reasonable to expect that the MNA has a functional status- predictive ability because the MNA scale contains items that rate mobility, cognitive status, ability to live independently, ability to self-feed and ability to move around and use instrument (items C, E, G, N, and Q & R, respectively), which are among the risk factors for functional decline (Stuck et al., 1999). The present study Table 3
The distribution of nutritional status and ADL and IADL statuses of a national sample of 2948 Taiwanese men and women 65 years old rated with the MNA-LF and -SF.
MNA-LF MNA-SF
Item Malnourished At risk Normal Malnourished At risk Normal
MNA-T1
Rated results (N, %) 101 (3.4) 494 (16.8) 2353 (79.8) 139 (4.7) 592 (20.1) 2217 (75.2)
MNA Score (Mean SD) 14.24 1.88 21.44 1.85 27.14 1.48 6.06 1.14 10.15 1.05 13.48 0.76
ADL scorea(Mean SD) 9.50 7.95 3.07 5.39 0.28 1.53 6.55 7.62 2.39 4.93 0.36 1.90
ADL disabilities (Mean SD) 2.71 2.84 0.62 1.62 0.04 0.36 1.79 2.58 0.48 1.45 0.06 0.51
IADL scorea(Mean SD) 12.61 6.67 6.80 6.57 1.93 3.63 9.86 7.18 5.58 6.37 2.03 3.81
IADL disabilities (Mean SD) 3.82 2.48 1.77 2.21 0.38 1.05 2.84 2.55 1.43 2.09 0.41 1.12
MNA-T2
Rated results (N, %) 91 (3.1) 385 (13.1) 2472 (83.9) 113 (3.8) 569 (19.3) 2266 (76.9)
MNA Score (Mean SD) 14.43 1.96 21.02 1.65 27.17 1.59 6.36 1.11 10.20 1.04 13.65 0.71
ADL scorea(Mean SD) 10.05 7.97 3.47 5.65 0.36 1.78 8.25 7.96 2.51 4.94 0.34 1.33
ADL disabilities (Mean SD) 2.90 2.86 0.73 1.76 0.05 0.42 2.34 2.74 0.50 1.45 0.06 0.48
IADL scorea(Mean SD) 13.30 6.20 7.32 6.67 2.08 3.83 11.21 7.24 5.72 6.37 2.05 3.32
I ADL disabilities (Mean SD) 4.02 2.39 1.92 2.27 0.42 1.12 3.35 2.61 1.45 2.08 0.42 1.12
aADL included bathing, dressing, feeding, get in and out of bed, toileting, and getting around indoors. IADL included shopping, handling finances, transporting, housekeeping, using telephone, and doing some heavy housework. Both scales had a score range of 0–18. A functional disability is defined as one cannot do the items of ADL or IADL independently.
Table 4
Binary logistic regression analysis of the association that nutritional status graded with the MNA-LF and SF with ADL and IADL dependency in elderly Taiwanese (N = 2948).
Nutritional status % of total ADL IADL
% Depa OR (95% CI) p % Depa OR (95% CI) p
MNA-T1 LF
Normal 79.8 2.8 1 27.5 1
At risk 16.8 24.3 7.40 (5.32–10.3) <0.001 63.5 3.66 (2.88–4.64) <0.001
Malnourished 3.4 59.4 32.2 (18.3–56.7) <0.001 84.5 17.3 (8.90–33.4) <0.001
SF
Normal 75.2 3.1 1 28.0 1
At risk 20.1 19.9 4.73 (3.43–6.52) <0.001 54.1 2.59 (2.08–3.22) <0.001
Malnourished 4.7 42.4 13.3 (8.32–21.2) <0.001 75.4 6.15 (3.93–9.63) <0.001
MNA-T2 LF
Normal 83.9 2.1 1 19.0 1
At risk 13.1 18.3 5.37 (3.55–8.13) <0.001 55.7 3.80 (2.94–4.92) <0.001
Malnourished 3.1 54.5 24.4 (13.7–43.3) <0.001 85.1 16.1 (8.48–30.4) <0.001
SF
Normal 75.4 1.9 1 18.7 1
At risk 19.3 13.3 4.27 (2.82–6.48) <0.001 45.2 2.76 (2.20–3.45) <0.001
Malnourished 3.8 46.6 21.7 (12.6–37.5) <0.001 71.5 7.07 (4.40–11.4) <0.001
Controlled for gender, age, education, chronic diseases (hypertension, diabetes, heart disease, stroke, and cancer), alcohol drinking, smoking and physical activity.
a% of subjects having ADL or IADL dependency.
L.-C. Lee, A.-h. Tsai / Archives of Gerontology and Geriatrics 54 (2012) e405–e410 e408
showed that both the LF and SF of MNA-T1 and T2 can predict functional status well, and the SFs performed remarkably well compared to the LFs. These results suggest that the SFs can function satisfactorily as stand-alone units. An independently functioning SF can greatly increase the utility of the MNA in routine practice in clinical and community settings. The time-saving feature of the SF (about 5–10 min vs. 20–25 min) will make periodic screening a much easier routine to achieve.
4.3. Calf circumference can replace BMI in the SF
The present study also found that CC can substitute BMI in the MNA without compromising the ability of the tool in rating nutritional status or predicting functional decline. This is a very viable and useful alternative to the original SF because measuring height and weight in the elderly, especially in those who are frail or with disability, is neither easy nor accurate. Additionally, because CC reflects the lean body mass of the lower extremity and is a major indicator of mobility whereas BMI reflects more of body fatness (Bonnefoy et al., 2002), CC would be a better indicator of lean body mass than the BMI, especially in elderly who have sarcopenia.
4.4. Strengths and limitations
The major strength of this study is that the dataset is from a relatively large population-based study. Thus, results derived from this study should have good generalizability, applicable to Chinese populations who share similar lifestyle and anthropometric characteristics as the study population. However, there are also limitations: (a) data were self-reports which generally have
acceptable quality but error or inaccuracy are inevitable; (b) the number of elderly in the cohort who have dementia, cognitive impairment or mental disability increases with aging which may adversely affect the completion rate and quality of data; (c) data on two MNA items (pressure sore and fluid intake) were not available in the dataset which might have a slight impact on rating the risk of malnutrition; and (d) results could have been further supported with biomarkers or medical reports which were not available in the dataset.
4.5. Implication of the findings
A tool that can rate both nutritional risk and functional status (especially if it is simple, easy to use and non-invasive) should be greatly appreciated not only in clinical and long-term care but also in community settings. Routine screening of nutritional risk of the elderly with appropriate tools such as the MNA enables early detection and timely intervention of elderly who have emerging malnutrition and/or functional impairment.
5. Conclusions
The MNA-T1 and T2 can predict functional status of the elderly, in addition to rating their nutritional status. The MNA-SF predicts the full-MNA well suggesting that the MNA-SF can function independently to rate nutritional risk and predict functional decline. The MNA-T2-SF is a viable alternative to the original SF, especially for elderly with frailty or disability. The MNA, both the LF and SF appear to be a simple but useful tool for routine prescreening of nutritional risk or functional decline of the elderly.
[(Fig._1)TD$FIG]
Fig. 1. Receiver operating characteristic curves generated for MNA-SF using MNA-LF as reference (AUC = 0.971, 95% CI = 0.966–0.976) (Panel A1) and for ADL score (0.826, 0.802–0.850 predicted by MNA-T1-LF and 0.801, 0.777–0.825 by MNA-T1-SF) (Panel A2) and IADL (0.700, 0.681–0.719 predicted by MNA-T1-LF and 0.657, 0.637–0.677 by MNA-T1-SF) (Panel A3). Panel Bs are for MNA-T2, the respective AUCs were 0.970, 0.965–0.975 (B1); 0.868(0.840–0.897) and 0.855 (0.828–0.883) (B2); 0.755 (0.735–0.776) and 0.721 (0.699–0.743) (B3). AUC = area under the curve.
L.-C. Lee, A.-h. Tsai / Archives of Gerontology and Geriatrics 54 (2012) e405–e410 e409
Conflict of interest statement None.
Acknowledgments
This study is based on the data from the ‘‘Survey of Health and Living Status of the Elderly in Taiwan’’ (SHLSET), provided by the Bureau of Health Promotion, Department of Health, R.O.C (Taiwan).
Descriptions or conclusions herein do not represent the viewpoint of the Bureau.
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