title: High proportions of older people with normal nutritional status have poor protein intake and low diet quality.
abstract: The Mini Nutritional Assessment (MNA) is a well-validated instrument examining the nutritional status of older people. The aim of this study was to examine how older people's energy and nutrient intakes are associated with the MNA and to determine how sensitive and specific MNA is in identifying those having low energy and protein intakes.
  
  
  
  This cross-sectional study combined data from five nutritional studies (N=900): both home-dwelling and institutionalized older people without and with disabilities. Their nutritional status was assessed with MNA, and nutrient intakes were retrieved from 1 to 3day food diaries. Nutrient intakes were divided according to MNA status (normal nutritional status, at-risk of malnutrition, malnourished). Sensitivity, specificity, and likelihood ratios of MNA of various cut-off points were tested with recommended protein and energy intakes. ROC curves was constructed.
  
  
  
  Energy, protein and most nutrient intakes showed logical linear trends according to MNA classes. However, more than three-fourths of the participants with MNA>23.5 had lower than recommended protein intakes. Sensitivity of MNA ranged from 0.32 to 0.82 for recommended energy (F:1570kcal/d/M:2070kcal/d) and protein intakes (1.0g/kg BW or 1.2g/kgBW) cut-off points, and specificity from 0.75 to 0.25, respectively. AUC values were low (0.52-0.53).
  
  
  
  MNA status was consistently associated with nutrient intakes and diet quality. However, a high proportion of older people even with normal nutritional status had poor energy and protein intakes. Thus, MNA does not identify all those with poor nutrient intakes who may be at risk of developing malnutrition.
authors.affiliation: University of Helsinki, Department of General Practice and Primary Health Care, and Helsinki University Central Hospital, Unit of Primary Health Care, Finland. Electronic address: satu.jyvakorpi@gery.fi.
authors.forename: S K
authors.initials: SK
authors.lastname: Jyväkorpi
authors.affiliation: University of Helsinki, Department of General Practice and Primary Health Care, and Helsinki University Central Hospital, Unit of Primary Health Care, Finland.
authors.forename: K H
authors.initials: KH
authors.lastname: Pitkälä
authors.affiliation: University of Helsinki, Department of General Practice and Primary Health Care, and Helsinki University Central Hospital, Unit of Primary Health Care, Finland.
authors.forename: T M
authors.initials: TM
authors.lastname: Puranen
authors.affiliation: University of Helsinki, Department of General Practice and Primary Health Care, and Helsinki University Central Hospital, Unit of Primary Health Care, Finland.
authors.forename: M P
authors.initials: MP
authors.lastname: Björkman
authors.affiliation: University of Helsinki, Department of General Practice and Primary Health Care, and Helsinki University Central Hospital, Unit of Primary Health Care, Finland.
authors.forename: H
authors.initials: H
authors.lastname: Kautiainen
authors.affiliation: University of Helsinki, Department of Medicine, Geriatric Clinic, Helsinki University Central Hospital, and University of Oulu, Institute of Health Sciences/Geriatrics, and Oulu University Hospital, Oulu, Finland.
authors.forename: T E
authors.initials: TE
authors.lastname: Strandberg
authors.affiliation: University of Helsinki, Department of General Practice and Primary Health Care, and Helsinki University Central Hospital, Unit of Primary Health Care, Finland; Helsinki City, Department of Social Services and Health Care, Developmental and Operational Support, Finland.
authors.forename: H H
authors.initials: HH
authors.lastname: Soini
authors.affiliation: University of Helsinki, Department of General Practice and Primary Health Care, and Helsinki University Central Hospital, Unit of Primary Health Care, Finland.
authors.forename: M H
authors.initials: MH
authors.lastname: Suominen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D040561:Assisted Living Facilities; D003430:Cross-Sectional Studies; D004032:Diet; D004044:Dietary Proteins; D002149:Energy Intake; D005260:Female; D006801:Humans; D057187:Independent Living; D008297:Male; D044342:Malnutrition / Q000175:diagnosis*; D015596:Nutrition Assessment; D009752:Nutritional Status; D012372:ROC Curve; D012680:Sensitivity and Specificity
chemical_list: D004044:Dietary Proteins
keywords: MNA; Malnutrition; Micronutrient intake; Older people; Protein intake