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Published on October 17, 2007

Author: Belly

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Slide1:  Update on the Mini Nutritional Assessment (MNA) VELLAS B. & GUIGOZ Y. Department of Internal Medicine and Geriatrics, Toulouse University Hospital, France Nestlé Product Technology Centre Konolfingen, Switzerland Slide2:  Undernutrition in the elderly Guigoz et al., Nutr Rev 1996;54:S59-65 & Constans T. Rev Prat 2003;53:275-279 Slide3:  Geriatric Assessment Instruments cognitive functions Mini Mental State Examination (MMS) affective functions Geriatric Depression Scale (GDS) gait Tinetti gait & balances evaluation autonomy Activities of Daily Living (ADL & IADL) nutritional impact Mini nutritional Assessment MNA Guigoz et al., Nutr. Rev. Nutr. Rev. 1996;54:S59-65 Update on the MNA:  - Screening & - Assessment a reliable scale clearly define thresholds usable by a generalist assessor minimal opportunity for bias introduced by the data collector acceptable to patient inexpensive Update on the MNA Guigoz et al., Nutr. Rev. 1996;54:S59-65 Vellas B et al., J Am Geriatr Soc 2000;48:1300-1309c Rubenstein LZ et al., J Gerontol 2001;56:M366-M372 Slide5:  The MNA scores have been found to be significandy correlated to nutritional intake (p<0.01 for energy, carbohydrates, fiber, calcium, vitamin D, iron, vitamin B6, and vitamin C), and An MNA score between 17 and 23.5 can identify those persons with mild malnutrition Vellas B et al., J Am Geriatr Soc 2000;48:1300-1309c Slide6:  The MNA scores have been found to be significandy correlated to anthropometric and biological nutritional parameters (p<0.001 for hemoglobin, albumin, transthyretin, transferrin, cholesterol, retinol, -tocopherol, 25-OHcholecalciferol, zinc). An MNA score between 17 and 23.5 can identify those persons with mild malnutrition Vellas B et al., J Am Geriatr Soc 2000;48:1300-1309c Slide7:  The MNA Screening Form (MNA-SF) By a gradual process of simplification using correlation between each item and the MNA total score, internal consistency (coefficient alpha) and sensitivity, specificity, the most significant questions were selected. Rubenstein LZ et al., J Gerontol 2001;56:M366-M372 Scatterplot for MNA-SF versus full MNA scores (n=881) Slide8:  The MNA Screening Form (MNA-SF) 1. Body mass index (BMI) (kg/m2) 2. Weight loss in past 3 months? 3. Acute illness or major stress in past 3 months? 4. Mobility 5. Dementia or depression 6. Has appetite & food intake declined in past 3 months? Rubenstein LZ et al., J Gerontol 2001;56:M366-M372 Slide9:  The 6-item MNA-SF seems as effective as the full 18-item MNA for nutrition screening. this 2-step screening process could save substantial screening effort: Especially in low-risk populations. The MNA-SF was further validated in preoperative nutritional assessment of ambulatory elderly patients Cohendy et al. Aging 2001;13:293-297 Rubenstein LZ et al., J Gerontol 2001;56:M366-M372 The MNA Screening Form (MNA-SF) Slide10:  MNA score categorizes the elderly patients with following thresholds maximum score 30 points (identical to the maximal MMS score) 24 points : normal/well-nourished 17 to 23,5 points: border line/at risk of malnutrition 17 points : undernutrition Guigoz et al., Facts & Res. Gerontol. 1994 (suppl.2):15-70 Slide11:  MNA Status BMI Albumin Energy Intake [kg/m²] [g/L] [kcal/day] normal 26 ± 3 41 ± 3 1833 ± 508 (n = 265) at risk 25 ± 4 41 ± 3 1639 ± 527 (n = 51) Guigoz et al., Facts & Res. Gerontol. 1994;suppl.2:15-70 Healthy elderly should be assessed for risk of malnutrition Slide12:  Source: MNA website: http//www.mna-elderly.com Slide13:  Source: MNA website: http//www.mna-elderly.com Slide14:  In community-dwelling elderly overt undernutrition is low, but the prevalence of inadequate nutrient intakes is high (20- 40% in the Seneca study) In elderly from 7 studies a prevalence of 1% (range 0-3%) for undernutrition, but 29% (range 15-44%) of risk for malnutrition were detected using the MNA Community-dwelling Elderly African Americans Guigoz Y et al., Clin Geriatr Med 2002;18:737-757 MNA 17 to 23.5 MNA<17 Slide15:  Home care & Outpatients % undernutrition n = 1355 elderly MNA <17 Guigoz Y et al., Clin Geriatr Med 2002;18:737-757 Use of the MNA by general practitioner to guide outpatient home care In elderly from 8 studies (general practitioner, outpatient clinic & home care) a prevalence of 4% (range 0-13%) for undernutrition, and 33% (range 8-63%) of risk for malnutrition were detected U.K. Switzerland Belgium Sweden Sweden Sweden Denmark Israel Slide16:  Malnutrition in Hospital Settings A high prevalence of undernutrition has been reported in hospitalized elderly patients In elderly from 10 studies a prevalence of 20% (range 7-32%) of malnutrition was detected using the MNA and 49% (range 25-60%) were at risk of undernutrition ==> A low MNA score is common MNA <17 % undernutrition n = 3298 elderly Guigoz Y et al., Clin Geriatr Med 2002;18:737-757 Switzerland Switzerland Belgium Belgium Belgium Sweden Canada France France U.K. Malnutrition in Institutions:  Malnutrition in Institutions MNA <17 In elderly from 12 studies a prevalence of 37% (range 5-71%) of malnutrition was detected using the MNA and 44% (range 26-67%) at risk of undernutrition were detected The large variability results mainly from the differences in level of dependence and health status among the elderly living in retirement homes, nursing homes, or long-term care facilities Guigoz Y et al., Clin Geriatr Med 2002;18:737-757 Undernutrition correlates with cost of care and length of stay in hospital:  The MNA score can predict hospital stay outcomes in older patients A low MNA score is associated with a striking increase in mortality, prolonged length of stay and greater likelihood of discharge to nursing home. Undernutrition correlates with cost of care and length of stay in hospital MNA Cost Length score of care of stay < 17 11’173 $ 26 days 17-23.5 9’112 $ 20 days  24 7’299 $ 15 days Van Naes et al. Age & Ageing 2001 ;30 :221-226. & Quadri P. MNA Research and Practice in the Elderly: 1999; pp. 141-148 Selecting older patients for Intervention studies :  Selecting older patients for Intervention studies Nutritional intervention prevents weight loss 2 months supplementation with oral supplements : 2 - 3 servings per day corresponding to 300 - 500 kcal In 7 nursing homes in Toulouse area, France: 78 elderly over 65 year old completed the study Oral supplementation was associated with increase in body weight and MNA scores The MNA can also be used as a follow up assessment tool Lauque S et al., Age & Ageing 2000;29:51-56 Supplement Prevention of Malnutrition during and after Hospitalisation:  Prevention of Malnutrition during and after Hospitalisation Nutritional intervention prevents weight loss 2 months supplementation with oral supplements : 2 servings per day providing 500 kcal & 21g protein In 80 patients,75+ year old, at risk of denutrition (MNA< 23.5). Use of daily oral supplementation during and after hospitalisation maintains body weight and increases MNA score in patients at risk of undernutrition Gazzotti C et al., Age & Ageing 2003;32:321-325 Effects of oral nutritional supplementation in patients with Alzheimer disease:  Effects of oral nutritional supplementation in patients with Alzheimer disease Objective: Study the effects of a 3 month nutritional intervention on body weight, nutritional status, body composition, cognition, eating behavior and biochemical markers Design and Methods: Controlled, randomised study on AD elderly persons at risk of denutrition (MNA< 23.5) Conclusion: A 3 month oral supplementation significantly improves body weight (specially fat free mass) and nutritional status Lauque S et al., 2003 (Manuscript in preparation) Change in MNA score [points] supplement control IAG Minimum Data Set :  IAG Minimum Data Set “The Nutrition and Aging Task Force IAG European Region (NAFTER) included the MNA in its proposal for a Minimum Data Set to use in nutritional intervention studies NAFTER (IAG Task Force on Nutrition and Aging) , July 2003

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