title: Mini-Nutritional Assessment, Malnutrition Universal Screening Tool, and Nutrition Risk Screening Tool for the Nutritional Evaluation of Older Nursing Home Residents.
abstract: Malnutrition plays a major role in clinical and functional impairment in older adults. The use of validated, user-friendly and rapid screening tools for malnutrition in the elderly may improve the diagnosis and, possibly, the prognosis. The aim of this study was to assess the agreement between Mini-Nutritional Assessment (MNA), considered as a reference tool, MNA short form (MNA-SF), Malnutrition Universal Screening Tool (MUST), and Nutrition Risk Screening (NRS-2002) in elderly institutionalized participants.
  
  
  
  Participants were enrolled among nursing home residents and underwent a multidimensional evaluation. Predictive value and survival analysis were performed to compare the nutritional classifications obtained from the different tools.
  
  
  
  A total of 246 participants (164 women, age: 82.3 ± 9 years, and 82 men, age: 76.5 ± 11 years) were enrolled. Based on MNA, 22.6% of females and 17% of males were classified as malnourished; 56.7% of women and 61% of men were at risk of malnutrition. Agreement between MNA and MUST or NRS-2002 was classified as "fair" (k = 0.270 and 0.291, respectively; P < .001), whereas the agreement between MNA and MNA-SF was classified as "moderate" (k = 0.588; P < .001). Because of the high percentage of false negative participants, MUST and NRS-2002 presented a low overall predictive value compared with MNA and MNA-SF. Clinical parameters were significantly different in false negative participants with MUST or NRS-2002 from true negative and true positive individuals using the reference tool. For all screening tools, there was a significant association between malnutrition and mortality. MNA showed the best predictive value for survival among well-nourished participants.
  
  
  
  Functional, psychological, and cognitive parameters, not considered in MUST and NRS-2002 tools, are probably more important risk factors for malnutrition than acute illness in geriatric long-term care inpatient settings and may account for the low predictive value of these tests. MNA-SF seems to combine the predictive capacity of the full version of the MNA with a sufficiently short time of administration.
authors.affiliation: Department of Experimental Medicine-Medical Pathophysiology, Food Science, and Endocrinology Section, Sapienza University of Rome, Rome, Italy.
authors.forename: Lorenzo M
authors.initials: LM
authors.lastname: Donini
authors.affiliation: Department of Experimental Medicine-Medical Pathophysiology, Food Science, and Endocrinology Section, Sapienza University of Rome, Rome, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Poggiogalle
authors.affiliation: Department of Clinical Medicine, Sapienza University, Rome, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Molfino
authors.affiliation: ISFOL (Istituto per lo Sviluppo della Formazione Professionale dei Lavoratori), Department of Employment and Social Policies, Rome, Italy.
authors.forename: Aldo
authors.initials: A
authors.lastname: Rosano
authors.affiliation: Department of Experimental Medicine-Medical Pathophysiology, Food Science, and Endocrinology Section, Sapienza University of Rome, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Lenzi
authors.affiliation: Department of Clinical Medicine, Sapienza University, Rome, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Rossi Fanelli
authors.affiliation: Department of Clinical Medicine, Sapienza University, Rome, Italy. Electronic address: maurizio.muscaritoli@uniroma1.it.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Muscaritoli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000175:diagnosis*; D008403:Mass Screening / Q000295:instrumentation*; D009735:Nursing Homes; D015596:Nutrition Assessment; D018570:Risk Assessment / Q000379:methods
keywords: MNA; MUST; NRS-2002; malnutrition; older adults