title: Long-form but not short-form Mini-Nutritional Assessment is appropriate for grading nutritional risk of patients on hemodialysis--a cross-sectional study.
abstract: BACKGROUND
  Routine screening/assessment of protein-energy status is essential for preventing uremic malnutrition in patients on hemodialysis (HD). A simple, low cost, reliable and non-invasive tool is greatly desired.
  
  
  OBJECTIVE
  This study aimed to evaluate the appropriateness of using the long-form (LF) and the short-form (SF) Mini Nutritional Assessment (MNA) for grading the risk of protein-energy malnutrition in patients on HD. DESIGN AND SAMPLING: A cross-sectional study with purposive sampling.
  
  
  METHODS
  A hospital-managed hemodialysis center.
  
  
  METHODS
  152 adult ambulatory patients on hemodialysis.
  
  
  METHODS
  The nutritional status of each patient was graded with MNA-LF and MNA-SF, each in two versions--a normalized-original (content-equivalent) version (by adopting population-specific anthropometric cut-off points) and an alternative version that replaced calf circumference for BMI in the scale. The SGA, serum albumin and serum creatinine served as references. Cross-tabulation test was used to evaluate the consistency of the versions.
  
  
  RESULTS
  MNA-SF versions rated fewer HD subjects malnourished or at risk of malnutrition (32.2% and 24.3% for T1 and T2, respectively) compared to MNA-LF versions (40.8% and 36.2%) or the SGA (47.4%). MNA-SF versions (kappa=0.450 and 0.446) also did not perform as well as MNA-LF versions (kappa=0.734 and 0.666) in predicting the risk of malnutrition in HD patients using the SGA as the reference. MNA-SF also did not perform as well as the MNA-LF using serum albumin or serum creatinine as the reference.
  
  
  CONCLUSIONS
  The MNA-LF is appropriate for predicting protein-energy malnutrition in HD patients but MNA-SF may under-rate these patients. Effort should be made to improve the MNA-SF for HD patients since the short-form is more time-efficient and thus, greatly desired in clinical practice.
authors.affiliation: Department of Healthcare Administration, Asia University, Wufeng, Taichung 41354, Taiwan. atsai@umich.edu
authors.forename: Alan C
authors.initials: AC
authors.lastname: Tsai
authors.forename: Mei-Zu
authors.initials: MZ
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D006435:Renal Dialysis; D018570:Risk Assessment; D055815:Young Adult