title: Simplifications of the mini nutritional assessment short-form are predictive of mortality among hospitalized young and middle-aged adults.
abstract: OBJECTIVE
  Measuring malnutrition in hospitalized patients is difficult in all settings. I evaluated associations of items in the mini nutritional assessment short-form (MNA-sf), a nutritional-risk screening tool previously validated in the elderly, with malnutrition among hospitalized patients in Uganda. I used results to construct two simplifications of this tool that may be applicable to young and middle-aged adults.
  
  
  METHODS
  I assessed the association of each MNA-sf item with the mid-upper arm circumference (MUAC), a specific measure of malnutrition at appropriate cut-offs. I incorporated only malnutrition-specific items into the proposed simplifications scoring each item according to its association with malnutrition. I assessed numbers classified to different score-levels by the simplifications and, via proportional hazards regression, how the simplifications predicted in-hospital mortality.
  
  
  RESULTS
  I analyzed 318 patients (median age 37, interquartile range 27 to 56). Variables making it into the simplifications were: reduced food intake, weight loss, mobility, and either BMI in kg/m(2) (categorized as <16, 16 to 16.9, and ≥17) or MUAC in centimeters (categorized as <16 or <17, 16 to 18.9 or 17 to 19.9, and ≥19 or ≥20 for females and males respectively). Compared to the traditional MNA-sf, the simplifications classified fewer patients as malnourished, yet remained strongly predictive of in-hospital mortality. In the MUAC-incorporating simplification, malnourished patients had 3.8-fold (95% CI 1.9 to 7.8) higher risk of in-hospital death than those not malnourished; adjusting for age, sex, and HIV status.
  
  
  CONCLUSIONS
  The MNA-sf simplifications described may provide an improved measure of malnutrition in hospitalized young and middle-aged adults.
authors.affiliation: Department of Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda; Department of Epidemiology and Biostatistics, University of California San Francisco, CA, USA. Electronic address: asiimwesteve@gmail.com.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Asiimwe
mesh_terms: D000328:Adult; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000175:diagnosis*; D008875:Middle Aged; D015596:Nutrition Assessment
keywords: Hospitalized patients; MNA-sf; Malnutrition; Mini nutritional assessment; Young adults