title: Screening for malnutrition among nursing home residents - a comparative analysis of the mini nutritional assessment, the nutritional risk screening, and the malnutrition universal screening tool.
abstract: BACKGROUND
  The European Society for Clinical Nutrition and Metabolism (ESPEN) has recommended the Mini Nutritional Assessment (MNA®), the Nutritional Risk Screening 2002 (NRS), and the Malnutrition Universal Screening Tool (MUST) for nutritional screening in various settings and age groups. While in recent years all three tools have been applied to nursing home residents, there is still no consensus on the most appropriate screening tool in this specific setting.
  
  
  OBJECTIVE
  The present study aims at comparing the MNA, the NRS, and the MUST with regard to applicability, categorization of nutritional status, and predictive value in the nursing home setting.
  
  
  METHODS
  MNA, NRS, and MUST were performed on 200 residents from two municipal nursing homes in Nuremberg, Germany. Follow-up data on infection, hospitalization, and mortality were collected after six and again after twelve months.
  
  
  RESULTS
  Among 200 residents (mean age 85.5 ± 7.8 years) the MNA could be completed in 188 (94.0%) and the NRS and MUST in 198 (99.0%) residents. The prevalence of 'malnutrition' according to the MNA was 15.4%. The prevalence of 'risk of malnutrition' (NRS) and 'high risk of malnutrition' (MUST), respectively, was 8.6% for both tools. The individual categorization of nutritional status showed poor agreement between NRS and MUST on the one hand and MNA on the other. For all tools a significant association between nutritional status and mortality was demonstrated during follow-up as classification in 'malnourished', respectively 'high risk of malnutrition' or 'nutritional risk', was significantly associated with increased hazard ratios. However, the MNA showed the best predictive value for survival among well-nourished residents.
  
  
  CONCLUSIONS
  The evaluation of nutritional status in nursing home residents by MNA, NRS, and MUST shows significant differences. This observation may be of clinical relevance as nutritional intervention is usually based on screening results. As the items of the MNA reflect particularities of the nursing home population, this tool currently appears to be the most suitable one in this setting.
authors.affiliation: Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Heimerichstr. 58, D-40419 Nürnberg, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Diekmann
authors.forename: K
authors.initials: K
authors.lastname: Winning
authors.forename: W
authors.initials: W
authors.lastname: Uter
authors.forename: M J
authors.initials: MJ
authors.lastname: Kaiser
authors.forename: C C
authors.initials: CC
authors.lastname: Sieber
authors.forename: D
authors.initials: D
authors.lastname: Volkert
authors.forename: J M
authors.initials: JM
authors.lastname: Bauer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D005858:Germany; D006707:Homes for the Aged; D006760:Hospitalization; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000175:diagnosis* / Q000517:prevention & control; D009735:Nursing Homes; D015596:Nutrition Assessment; D009752:Nutritional Status; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires
references.citation: J Psychiatr Res. 1975 Nov;12(3):189-98
references.pmid: 1202204
references.citation: J Am Med Dir Assoc. 2010 Jul;11(6):428-35
references.pmid: 20627184
references.citation: Br J Nutr. 2004 Nov;92(5):799-808
references.pmid: 15533269
references.citation: Z Gerontol Geriatr. 2005 Oct;38(5):322-7
references.pmid: 16244816
references.citation: Am J Clin Nutr. 2005 Oct;82(4):784-91; quiz 913-4
references.pmid: 16210707
references.citation: Nutr Rev. 1996 Jan;54(1 Pt 2):S59-65
references.pmid: 8919685
references.citation: Clin Nutr. 2008 Jun;27(3):340-9
references.pmid: 18504063
references.citation: Clin Nutr. 2002 Dec;21(6):461-8
references.pmid: 12468365
references.citation: J Gerontol A Biol Sci Med Sci. 2001 Oct;56 Spec No 2:54-64
references.pmid: 11730238
references.citation: Z Gerontol Geriatr. 2007 Feb;40(1):3-12
references.pmid: 17318726
references.citation: Nutr Clin Pract. 2008 Aug-Sep;23(4):388-96
references.pmid: 18682590
references.citation: Clin Nutr. 2006 Apr;25(2):330-60
references.pmid: 16735082
references.citation: Md State Med J. 1965 Feb;14:61-5
references.pmid: 14258950
references.citation: Clin Nutr. 2004 Oct;23(5):1009-15
references.pmid: 15380890
references.citation: Arch Intern Med. 2007 Apr 23;167(8):774-80
references.pmid: 17452539
references.citation: J Clin Psychol. 1994 Mar;50(2):256-60
references.pmid: 8014251
references.citation: Nutr Clin Pract. 2008 Aug-Sep;23(4):373-82
references.pmid: 18682588
references.citation: Eur J Clin Nutr. 2001 Jun;55(6):482-92
references.pmid: 11423925
references.citation: Am J Med. 1995 Jan;98(1):67-74
references.pmid: 7825621
references.citation: Br J Nutr. 2006 Feb;95(2):325-30
references.pmid: 16469149
references.citation: Br J Nutr. 2008 Jul;100(1):152-8
references.pmid: 18053309
references.citation: Clin Nutr. 2003 Aug;22(4):415-21
references.pmid: 12880610
references.citation: Clin Nutr. 2003 Jun;22(3):321-36
references.pmid: 12765673
references.citation: J Nutr Health Aging. 2009 Dec;13(10):863-9
references.pmid: 19924345
references.citation: Nutr Rev. 1994 Apr;52(4):113-22
references.pmid: 8028816
references.citation: J Nutr Health Aging. 2008 Feb;12(2):117-22
references.pmid: 18264638
references.citation: Geriatr Nurs. 1996 Mar-Apr;17(2):63-7
references.pmid: 8707152
references.citation: Clin Geriatr Med. 2002 Nov;18(4):699-708, vi
references.pmid: 12608498
references.citation: Clin Nutr. 1992 Jun;11(3):134-9
references.pmid: 16839988
references.citation: Nutrition. 2007 Jul-Aug;23(7-8):564-9
references.pmid: 17616343