Mini Nutritional Assessment (short form) and functional decline in older patients admitted to an acute medical ward.
OBJECTIVE
Protein and/or energy malnutrition is common in hospitalized older patients and is associated with poor outcomes. Among recommended nutritional screening tools, contrasting data exist about the usefulness of the Mini Nutritional Assessment Short-Form (MNA-SF). We evaluated whether the MNA-SF, alone or integrated with serum albumin levels, is a reliable predictor of functional decline in older patients.


METHODS
We studied 275 elderly patients (mean age 76.5, 60.7% males) admitted to an acute medical ward of a tertiary-care teaching hospital over a 12-month period. In this observational study, we evaluated nutritional status, with the MNA-SF alone or integrated with albumin. Data were collected at admission and related to laboratory and geriatric assessment features, and length of stay (LOS). Functional decline (defined as a loss >or=10% in terms of Barthel Index score at discharge compared with 2 weeks before admission) was considered as outcome.


RESULTS
The MNA-SF estimated 46% patients at risk of malnutrition. These subjects had worse clinical features (lower total cholesterol and albumin levels), longer LOS (13.3 vs 11.2 days, p=0.014) and considerable functional decline (OR 4.25, 95% CI 1.83-9.9, p=0.001). Integrating the MNA-SF with albumin values, we obtained an effective instrument to detect older inpatients with protein-energy malnutrition, at higher risk of undergoing functional decline (OR 16.19, 95% CI 4.68-56.03, p<0.0001).


CONCLUSIONS
The MNA-SF is a useful screening tool for hospitalized elders at risk of malnutrition. It is associated with poor clinical outcomes and is able to predict functional decline. Together with hypoalbuminemia, it better identifies patients with true protein-energy malnutrition.
Department of Internal Medicine, University Politecnica delle Marche, Ancona, Italy. f.salvi@univpm.it
Fabio
F
Salvi
Raffaella
R
Giorgi
Annalisa
A
Grilli
Valeria
V
Morichi
Emma
E
Espinosa
Liana
L
Spazzafumo
Maria Laura
ML
Marinozzi
Paolo
P
Dessì-Fulgheri
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D015596:Nutrition Assessment; D013997:Time Factors