© Borgis - New Medicine 4/2003, s. 125-129
Ewa Borowiak1, Tomasz Kostka2
Usefulness of short (MNA-SF) and full version of the Mini Nutritional Assessment (MNA) in examining the nutritional state of older persons
1 Institute of Nursing, Medical University of Lodz, Lodz, Poland
Head: dr J. Kobos, MD, PhD
2 Department of Social and Preventive Medicine, Medical University of Lodz, Poland
Head: prof. W. Drygas, MD, PhD
Aim of the study: To assess the usefulness of the short (MNA-SF) and full versions of the Mini Nutritional Assessment (MNA) in examining the nutritional state of older persons.
Material and methods: 311 subjects aged more than 65 years participated in the study: 151 living in an institution (DPS) (111 women and 40 men) and 160 community-dwelling elderly (116 women and 44 men).
Results: In comparison with MNA, the MNA-SF had a sensitivity of 73.6% in the community-dwelling elderly, and 64.4% in those institutionalised. In the community-dwelling elderly, 95% of persons with a good nutritional state and 73.6% of undernourished subjects were correctly classified. In an institution environment 100% persons with good nutritional state and 64.4% undernourished subjects were correctly classified by MNA-SF. In both groups MNA-SF and MNA corresponded with the findings of other measures of geriatric assessment (ADL, IADL, MMSE, GDS).
Conclusions: The study supports the usefulness of MNA-SF as a screening tool for examination of the nutritional state in the community-dwelling elderly. Generally, the full version of MNA confirmed the results of MNA-SF in this group. The relatively low sensitivity of MNA-SF in older and frailer institutionalised elderly persons requires further study.
Malnutrition, which affects a great many subjects above the age of 65 years, is a significant medical problem (1-3). In Sweden, 38% of the elderly have an unsatisfactory nutritional state, and 49% are at high risk of malnutrition (4). Among the Danish population above the age of 65 years, the percentage of persons with an unsatisfactory nutritional state equals 38% (5). Malnutrition can often be both the cause as well as the result of a poor psychophysical state in the elderly. Its frequency correlates with the incidence of acute diseases and increased mortality (5, 6). Therefore, it is necessary to systematically assess the nutritional state of the elderly.
The methods most often used in clinical studies are: Body Mass Index (BMI), serum albumins, protein, transferrine, cholesterol, body fatty tissue%, calf circumference and biochemical transformation markers of osseous tissue (7, 8). One of the most popular screening tools used to assess the nutritional state is the Mini Nutritional Assessment (MNA). In clinical practice two versions of this questionnaire are used: the full version, worked out in 1994 (13), and the short version known as the MNA-SF (9). The short version was introduced in order to shorten the time of study, as a potential tool in geriatric screening (9). The MNA questionnaire turned out to be an effective tool in assessing the nutritional state of older persons with diabetes (10), in the preoperational period (11), in orthopaedics (7) and in institutionalised subjects (12). In the available literature only two studies were found on comparative assessment of MNA and MNA-SF (9, 11). Apart from these, there are no results of comparative studies carried out in Poland. Therefore, the aim of this study was to assess the usefulness of the short (MNA-SF) and full versions of Mini Nutritional Assessment in examining the nutritional state of the community-dwelling and institutionalised elderly.
MATERIAL AND METHODS
The study was carried out in the city of Lodz in 2001-2002 among 311 respondents above the age of 65 years. The respondents were divided into two groups:
1.institutionalised subjects – residents of two nursing homes in Lodz (from nine existing) – 111 women and 40 men.
2.community-dwelling subjects – 116 women and 44 men. These home-dwelling persons were included into the study by random choice based on their statements at the community health centre. The criteria for taking part in the study were: age, verbal communication efficiency and patient´s agreement to the study.
Every respondent was interviewed in order to gain information about their diseases, medications taken and tobacco smoking.
Both the short and full versions of the MNA questionnaire (13) were used to assess the nutritional state. The following were also assessed: psychological state using Mini-Mental State Examination MMSE (14) and Geriatric Depression Scale GDS (15), physical function by means of ADL (16) and Instrumental Activities of Daily Living IADL (17).
In order to describe the usefulness of MNA-SF, its sensitivity and specificity were assessed using the full version of the MNA as the reference test (18). The MNA full version results were split: a score> 23.5 meant a satisfactory nutritional state and the score > 23.5 meant malnutrition.
The one-way analysis of variance (ANOVA), the chi–square test and the Pearson product moment correlation coefficient were used to analyse the variables. Quantity variables were presented as mean ± standard deviation. The limit of significance was set at p = 0.05.
The average age for the community-dwelling subjects was lower than the average age for the institutionalised elderly (Table 1). The percentage of men was comparable in both groups. There were 146 persons with ischaemic heart disease, 39 with chronic lung disease, 115 with musculoskeletal disorders (rheumatoid diseases and/or degenerative changes in the locomotor system), 29 with digestive tract ulceration, 60 with diabetes, 165 with hypertension, 122 with circulatory failure, 38 with post-stroke status, 44 with post-myocardial infarction status and 33 with eye disease. The number of medications most often taken was 6 (42 persons), 5 or 4 (41 persons) and 3 (32 persons). It is also important to note that 32 respondents took no medications regularly. Tobacco was smoked by 56 subjects. In comparison with the community-dwelling elderly, there were more institutionalised subjects with stomach and/or duodendal ulcer and eye diseases. Home-dwelling persons were characterized by a higher functional efficiency, higher MMSE score and a larger calf circumference (Table 1). Institutionalised subjects were characterized by a worse nutritional state in comparison with community-dwelling persons both in MNA-SF (10.6 ± 2.5 vs 11.3 ± 2.8; F = 6.6, p = 0.01) and in MNA (21.8 ± 4.0 vs 23.6 ± 4.1; F = 14.2, p <0.001). The short version of the MNA questionnaire in comparison with the full version had a sensitivity of 73.6% in community-dwelling elderly and 64.4% in institutionalised subjects. In the community-dwelling elderly 95% of persons with a good nutritional state and 73.6% of those with malnutrition were correctly classified by MNA-SF. In the institution environment 100% of elderly with a good nutritional state and 64.4% of undernourished subjects were correctly classified. The negative predictive value in MNA-SF was 0.82 for community-dwelling persons and 0.58 for institutional residents. The positive predictive values in MNA-SF were 0.93 and 1.0, respectively.
Table 1. The characteristics of community-dwelling and institutionalised subjects.
NS – non-significant
| ||Community-dwelling elderly
(n = 160)||Institutionalised
(n = 151)||P - value|
|Age||74.1 ? 6.2||78.7 ? 8.0||p < 0.001|
|Ischaemic heart disease (%)||42.5||51.7||NS|
|Lung diseases (%)||11.2||13.9||NS|
|Musculoskeletal disorders (%)||23.1||31.8||NS|
|Stomach and/or duodenal ulceration (%)||5.0||13.9||p = 0.01|
|Chronic heart failure (%) ||38.1||40.4||NS|
|Post-myocardial infarction (%)||11.2||17.2||NS|
|Eye diseases (glaucoma, cataract) (%)||4.4||17.2||p < 0.001|
|Number of medications taken regularly||4.5 ? 3.5||4.6 ? 2.7||NS|
|ADL-score||5.5 ? 1||4.9 ? 1.5||p < 0.001|
|IADL-score||6.4 ? 2.4||3.8 ? 2.8||p < 0.001|
|GDS-score||5.8 ? 3.5||7.1 ? 3.9||NS|
|MMSE-score||25.6 ? 4.9||21.0 ? 6.4||p < 0.001|
|BMI (kg?m-2)||26.7 ? 4.7||25.0 ? 4.1||NS|
|Calf circumference (cm)||36.0 ? 5.4||33.4 ? 3.8||P = 0.03|
|Education (years)||9.0 ? 3.1||7.7 ? 3.4||NS|
|Satisfactory nutritional state - MNA-SF (%)||66.9||56.9||NS|
|Satisfactory nutritional state - MNA (%)||55.0||33.0||p < 0.001|
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