title: Using alternative or direct anthropometric measurements to assess risk for malnutrition in nursing homes.
abstract: OBJECTIVE
  The aim of this study was to use the Malnutrition Universal Screening Tool (MUST) to assess the applicability of alternative versus direct anthropometric measurements for evaluating the risk for malnutrition in older individuals living in nursing homes (NHs).
  
  
  METHODS
  We conducted a cross-sectional survey in 67 NHs in Tuscany, Italy. We measured the weight, standing height (SH), knee height (KH), ulna length (UL), and middle-upper-arm circumference of 641 NH residents. Correlations between the different methods for calculating body mass index (BMI; using direct or alternative measurements) were evaluated by the intraclass correlation coefficient and the Bland-Altman method; agreement in the allocation of participants to the same risk category was assessed by squared weighted kappa statistic and indicators of internal relative validity.
  
  
  RESULTS
  The intraclass correlation coefficient for BMI calculated using KH was 0.839 (0.815-0.861), whereas those calculated by UL were 0.890 (0.872-0.905). The limits of agreement were ±6.13 kg/m(2) using KH and ±4.66 kg/m(2) using UL. For BMI calculated using SH, 79.9% of the patients were at low risk, 8.1% at medium risk, and 12.2% at high risk for malnutrition. The agreement between this classification and that obtained using BMI calculated by alternative measurements was "fair-good."
  
  
  CONCLUSIONS
  When it is not possible to determine risk category by using SH, we suggest using the alternative measurements (primarily UL, due to its highest sensitivity) to predict the height and to compare these evaluations with those obtained by using middle-upper-arm-circumference to predict the BMI.
authors.affiliation: Department of Health Science, University of Florence, Florence, Italy. Electronic address: chiara.lorini@unifi.it.
authors.forename: Chiara
authors.initials: C
authors.lastname: Lorini
authors.affiliation: Regional Health Agency of Tuscany, Florence, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Collini
authors.affiliation: Regional Health Agency of Tuscany, Florence, Italy.
authors.forename: Mariangela
authors.initials: M
authors.lastname: Castagnoli
authors.affiliation: Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Geriatric Cardiology and Medicine, Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Di Bari
authors.affiliation: Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Geriatric Cardiology and Medicine, Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Cavallini
authors.affiliation: Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Zaffarana
authors.affiliation: Regional Health Agency of Tuscany, Florence, Italy; Department of Neuroscience, Psychology, Drug Research and Children's Health, University of Florence, Florence, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Pepe
authors.affiliation: Department of Neuroscience, Psychology, Drug Research and Children's Health, University of Florence, Florence, Italy.
authors.forename: Ersilia
authors.initials: E
authors.lastname: Lucenteforte
authors.affiliation: Department of Neuroscience, Psychology, Drug Research and Children's Health, University of Florence, Florence, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Vannacci
authors.affiliation: Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Bonaccorsi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000886:Anthropometry / Q000379:methods*; D001132:Arm; D001827:Body Height; D015992:Body Mass Index; D049628:Body Size; D003430:Cross-Sectional Studies; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006707:Homes for the Aged; D006801:Humans; D007558:Italy; D007866:Leg; D008297:Male; D044342:Malnutrition / Q000175:diagnosis*; D009735:Nursing Homes; D015596:Nutrition Assessment; D012307:Risk Factors; D014457:Ulna
keywords: Agreement; Elderly people; Knee height; Malnutrition Universal Screening Tool; Middle upper arm circumference; Nursing homes; Ulna length