Mini-Nutritional Assessment, Malnutrition Universal Screening Tool, and Nutrition Risk Screening Tool for the Nutritional Evaluation of Older Nursing Home Residents

Lorenzo M Donini; Eleonora Poggiogalle; Alessio Molfino; Aldo Rosano; Andrea Lenzi; Filippo Rossi Fanelli; Maurizio Muscaritoli

doi:10.1016/j.jamda.2016.06.028

Mini-Nutritional Assessment, Malnutrition Universal Screening Tool, and Nutrition Risk Screening Tool for the Nutritional Evaluation of Older Nursing Home Residents

J Am Med Dir Assoc. 2016 Oct 1;17(10):959.e11-8. doi: 10.1016/j.jamda.2016.06.028. Epub 2016 Aug 12.

Authors

Lorenzo M Donini¹, Eleonora Poggiogalle¹, Alessio Molfino², Aldo Rosano³, Andrea Lenzi¹, Filippo Rossi Fanelli², Maurizio Muscaritoli⁴

Affiliations

¹ Department of Experimental Medicine-Medical Pathophysiology, Food Science, and Endocrinology Section, Sapienza University of Rome, Rome, Italy.
² Department of Clinical Medicine, Sapienza University, Rome, Italy.
³ ISFOL (Istituto per lo Sviluppo della Formazione Professionale dei Lavoratori), Department of Employment and Social Policies, Rome, Italy.
⁴ Department of Clinical Medicine, Sapienza University, Rome, Italy. Electronic address: maurizio.muscaritoli@uniroma1.it.

PMID: 27528452
DOI: 10.1016/j.jamda.2016.06.028

Abstract

Introduction: Malnutrition plays a major role in clinical and functional impairment in older adults. The use of validated, user-friendly and rapid screening tools for malnutrition in the elderly may improve the diagnosis and, possibly, the prognosis. The aim of this study was to assess the agreement between Mini-Nutritional Assessment (MNA), considered as a reference tool, MNA short form (MNA-SF), Malnutrition Universal Screening Tool (MUST), and Nutrition Risk Screening (NRS-2002) in elderly institutionalized participants.

Methods: Participants were enrolled among nursing home residents and underwent a multidimensional evaluation. Predictive value and survival analysis were performed to compare the nutritional classifications obtained from the different tools.

Results: A total of 246 participants (164 women, age: 82.3 ± 9 years, and 82 men, age: 76.5 ± 11 years) were enrolled. Based on MNA, 22.6% of females and 17% of males were classified as malnourished; 56.7% of women and 61% of men were at risk of malnutrition. Agreement between MNA and MUST or NRS-2002 was classified as "fair" (k = 0.270 and 0.291, respectively; P < .001), whereas the agreement between MNA and MNA-SF was classified as "moderate" (k = 0.588; P < .001). Because of the high percentage of false negative participants, MUST and NRS-2002 presented a low overall predictive value compared with MNA and MNA-SF. Clinical parameters were significantly different in false negative participants with MUST or NRS-2002 from true negative and true positive individuals using the reference tool. For all screening tools, there was a significant association between malnutrition and mortality. MNA showed the best predictive value for survival among well-nourished participants.

Conclusions: Functional, psychological, and cognitive parameters, not considered in MUST and NRS-2002 tools, are probably more important risk factors for malnutrition than acute illness in geriatric long-term care inpatient settings and may account for the low predictive value of these tests. MNA-SF seems to combine the predictive capacity of the full version of the MNA with a sufficiently short time of administration.

Keywords: MNA; MUST; NRS-2002; malnutrition; older adults.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Female
Humans
Male
Malnutrition / diagnosis*
Mass Screening / instrumentation*
Nursing Homes*
Nutrition Assessment*
Risk Assessment / methods