Establishment of a short-form screening test for malnutrition in a newly developed comprehensive geriatric assessment initiative named 'Dr. SUPERMAN'

• Published in: Nihon Rōnen Igakkai zasshi Vol. 50; no. 2; pp. 233 - 242
• Main Authors: Yamakawa, Hiroko, Ohnuma, Takeshi, Satoh, Tomohiko, Sugiyama, Keiko, Harikae, Maki, Iwamoto, Toshihiko
• Format: Journal Article
• Language: English; Japanese
• Published: Japan The Japan Geriatrics Society 2013
• Subjects: Aged, 80 and over; Comprehensive geriatric assessment; Female; Geriatric Assessment - methods; Humans; Male; Malnutrition; Malnutrition - diagnosis; Mini-Nutritional Assessment-Short Form; Nutrition Assessment; Nutritional biomarker; Screening test
• ISSN: 0300-9173
• DOI: 10.3143/geriatrics.50.233

Aim: Assessment of the nutritional state is important in comprehensive geriatric assessment (CGA). Several standardized screening tests for malnutrition are available such as the Mini-Nutritional Assessment (MNA) and MNA-Short Form (MNA-SF). However, it takes more than 10 minutes to perform the MNA-SF alone. We have developed a CGA initiative named 'Dr. SUPERMAN', which is designed to accomplish CGA within 10 minutes. In this study, we evaluated a short-form screening test for malnutrition preceding the MNA. Methods: The MNA-SF, which consists of 6 items (A-F), was administered to 163 elderly outpatients (mean age: 83.4 years, 80 men) with various diseases. Using the results of the MNA-SF score (normal ≥12 and abnormal ≤11) as a gold standard, the sensitivity, specificity, and positive predictive values (PPVs) of each item were calculated and the best combination of 2 items for identifying malnutrition among the elderly outpatients was selected. According to the combination of 2 items (item B: weight loss during the last 3 months; item F: body mass index (BMI)/calf circumference (CC) in cm), they were divided into 2 groups: the normal control (NC) group (neither items B nor F) and the malnutrition/at risk (MN) group (either items B or D, or both). Findings of the clinical feature, anthropometric measurement, and nutritional biomarker between the 2 groups were examined to clarify the characteristics of each. Results: The MNA-SF score was distributed as follows: 3-7 in 12 cases, 8-11 in 68 cases, and 12-14 in 83 cases. Based on the MNA-SF score, the combination of items B and F revealed the highest sensitivity (91.3%), specificity (63.9%), and PPV (70.9%), resulting in 103 cases in the MN group and 60 cases in the NC group. A high frequency of anorexia, living alone, hypoprealbuminemia, lymphocytopenia, and dehydration was observed in the MN group, whereas a high frequency of leg edema was observed in the NC group. Cases showing a positive wall-occiput test, which compelled the alternation of CC with BMI, accounted for 24% of all cases. Conclusions: The combination of 'weight loss during the last 3 months' and initial BMI ≥23/CC <31 cm along with a positive wall-occiput test was a useful and valuable SF screening test for malnutrition in elderly outpatients.