title: Which are the most efficient items of mini nutritional assessment in multimorbid patients?
abstract: OBJECTIVE
  The aim of the study was to identify the most significant MNA-items to accelerate the determination of nutritional risk of elderly patients in routine clinical practice in a geriatric hospital. Since MNA requires 10-15 min it is hardly applicable to clinical routine.
  
  
  METHODS
  The study was a cross-sectional study.
  
  
  METHODS
  The study centre was an acute geriatric hospital.
  
  
  METHODS
  In total 808 multimorbid elderly patients were recruited.
  
  
  METHODS
  We applied the MNA in 808 (528 f/280 m) geriatric multimorbid patients (78.5+/-8.7f / 74.6+/-9 m yrs) without cognitive impairment 48 h after hospital admission. Admission diagnoses covered orthopaedical (40%), internal (34%) and cerebrovascular (24%) diseases. According to analysis of reliability the consistency of the MNA scale for multimorbid patients has been verified. In preparation for scale reduction a factor analysis was applied. A reduced scale with selected cutoffs was configured and compared with MNA.
  
  
  RESULTS
  According to MNA, 15% of patients were well-nourished, 65% at risk of malnutrition and 20% were malnourished. The reliability analyses showed a Cronbach's Alpha of 0.60 that represented a satisfactory result. By means of factor analysis the MNA-items were reduced from 18 to 7 items (weight loss, mobility, BMI, number of full meals, fluid consumption, mode of feeding, health status). with new cutoffs (12.5-15 well-nourished, 9-12 at risk of malnutrition, <9 malnourished). According to the modified MNA (m-MNA) 21.7% of the patients were well-nourished, 54.5% at risk of malnutrition and 21.7% were malnourished. The score of the MNA and m-MNA correlated with r=0.910. Furthermore, there was a strong correlation between MNA and m- MNA group classification of 83%.
  
  
  CONCLUSIONS
  The m-MNA enables a rapid (3 min) and efficient screening of malnutrition in multimorbid geriatric patients. The m-MNA is easy to apply and may also be suitable in multimorbid patients with cognitive dysfunction. Due to the variety of items the m-MNA seems to be superior to other screening tools.
authors.affiliation: Charite-Universitatsmedizin Berlin, Campus Virchow-Klinikum, Research Group on Geriatrics at Ev. Geriatriezentrum Berlin, Reinickendorfer Strasse 61, 13347 Berlin, Germany. susanne.hengstermann@charite.de
authors.forename: S
authors.initials: S
authors.lastname: Hengstermann
authors.forename: R
authors.initials: R
authors.lastname: Nieczaj
authors.forename: E
authors.initials: E
authors.lastname: Steinhagen-Thiessen
authors.forename: R-J
authors.initials: RJ
authors.lastname: Schulz
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D005163:Factor Analysis, Statistical; D005260:Female; D015577:Geriatric Assessment; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000175:diagnosis*; D015596:Nutrition Assessment; D009752:Nutritional Status; D018570:Risk Assessment; D013997:Time Factors; D015431:Weight Loss