As malnutrition is common in older persons, a number of tools to assess the severity of the condition have been developed. The review summarized here considers the features of the best known of them.
From a practical viewpoint, assessments should be simple, rapid, and validated as to their reliability. Use of a suitable test can assist in rhe overall work-up for diagnosing malnutrition, and allow appropriate treatment to help lower mortality, improve quality of life, and save healthcare costs.
The tests reviewed were the following:
- Mini Nutritional Assessment (MNA)
- Nutritional Risk Index (NRI)
- Nutritional Risk Score (NRS)
- Nutritional Screening Initiative (NSI)
- Nutritional Risk Assessment Scale (NuRAS)
- Payette Nutrition Screening Scale
- Prognostic Nutritional Index (PNI)
- Sadness-Cholesterol-Albumin-Loss of weight-Eating-Shopping (SCALES)
- Subjective Global Assessment (SGA)
While most of these tests can be used to detect and prevent dietary deficits in older persons, the MNA was considered to be more discriminatory (greatest sensitivity, greatest sensitivity), as well as lending itself to use in follow-up of nutritional intervention measures. it is also quick and inexpensive.
The MNA, which was developed jointly in Toulouse (France), New Mexico (USA), and Lausanne (Switzerland), is an 18-item questionnaire designed for the elderly. The items cover the following:
- calf and arm circumference (as measures of fat and muscle mass)
- body mass index (weight in kg/height in meters2)
- number of drugs taken, acute disease in last 3 months, bedsores, mobility, appetite
- eating habits - number of meals, daily intake of protein, vegetables, fruit, liquids
- subjective health
The first 6 questions are a screen, which takes about 3 minutes to administer - if their total score is above a given level, the subject is not at risk of malnutrition, and there is no need to complete the rest of the assessment. Family members or caregivers can provide answers for cognitively impaired subjects.
The MNA can be used for nutritional assessment of frail or institutionalized elderly, where it is highly sensitive (96%). In hospitalized patients, MNA scores correlated with duration and cost of stay - low scores on admission were associated with longer and more expensive hospitalization. MNA scores were also found to correlate well with Mini Mental Status Exam scores, showing that declining cognitive function can be responsible for declining nutritional status. The test can be used by Alzheimer disease caregivers to monitor their charge's nutritional status.
Finally, MNA scores can be a guide to treatment. Thus scores of 24 and above require no specific measures. Scores of 17 to 23.5 demand that the individual items are analyzed to identify the reasons for a low score, which should then be corrected, as far as possible. Scores of below 17 indicate protein-energy malnutrition (macronutrient deficiency), which requires a full work-up of likely causes and prompt treatment.
A recent editorial in Nutrition has reviewed the MNA and raised some minor critical points, but welcomes it as a useful tool for assessing the nutritional status of elderly persons.1
1. Chumlea WC. The state of the Mini Nutritional Assessment? Nutrition 1999;15:159-161
