Nutritional Status According to the Short-Form Mini Nutritional Assessment (MNA-SF) and Clinical Characteristics as Predictors of Length of Stay, Mortality, and Readmissions Among Older Inpatients in China: A National Study

Abstract

BackgroundStudies are scarce in China that explore the association of nutritional status, measured using the Short-Form Mini Nutritional Assessment (MNA-SF) and biochemical data, on adverse clinical outcomes among older inpatients. In this study, we aimed to determine the prevalence of malnutrition in tertiary hospitals of China and the associations between malnutrition and adverse clinical outcomes.MethodsThis prospective study involved 5,516 older inpatients (mean age 72.47 ± 5.77 years) hospitalized in tertiary hospitals between October 2018 and February 2019. The tertiary hospitals refer to the hospital with more than 500 beds and can provide complex medical care services. The MNA-SF was used to assess nutritional status. Multiple logistic regression and negative binomial regression were used to analyze the relationship between nutritional parameters and risk of hospital length of stay (LoS), mortality, and rehospitalization.ResultsWe found that 46.19% of hospitalized patients had malnutrition or malnutrition risk, according to the MNA-SF. Death occurred in 3.45% of patients. MNA-SF scores 0–7 (odds ratio [OR] 5.738, 95% confidence interval [CI] 3.473 to 9.48) were associated with a six-fold higher likelihood of death, and scores 8–11 (OR 3.283, 95% CI 2.126–5.069) with a three-fold higher likelihood of death, compared with MNA-SF scores 12–14 in the logistic regression model, after adjusting for potential confounders. A low MNA-SF score of 0–7 (regression coefficient 0.2807, 95% CI 0.0294–0.5320; P < 0.05) and a score of 8–11 (0.2574, 95% CI 0.0863–0.4285; P < 0.01) was associated with a significantly higher (28.07 and 25.74%, respectively) likelihood of increased LoS, compared with MNA-SF score 12–14. MNA-SF scores 0–7 (OR 1.393, 95% CI 1.052–1.843) and 8–11 (OR 1.356, 95% CI 1.124–1.636) were associated with a nearly 1.5-fold higher likelihood of 90-day readmission compared with MNA-SF scores 12–14 in the logistic regression model. Moreover, hemoglobin level, female sex, education level, former smoking, BMI 24–27.9 kg/m2, age 75 years and above, and current alcohol consumption were the main factors influencing clinical outcomes in this population.ConclusionsMalnutrition increases the risk of hospital LoS, mortality, and 90-day readmission. The use of nutritional assessment tools in all hospitalized patients in China is needed. The MNA-SF combined with hemoglobin level may be used to identify older inpatients with a high risk of adverse clinical outcomes. These findings may have important implications for the planning of hospital services.

Comparison of the accuracy of Geriatric Nutritional Risk Index with that of the Mini Nutritional Assessment Short Form and GLIM criteria in assessing nutritional status to predict the 1-year prognosis of hospitalized Japanese older adults: A single-institutional cohort study

“…MNA ® -SF is also a nutritional assessment tool speci c for older adults, and its scores have been reported to be associated with prognosis [11,[19][20][21]. The results of this study showed an HR of 2.17 for malnutrition; however, no signi cant association was observed between at risk, malnutrition, and prognosis.…”

Comparison of the adequacy of geriatric nutritional risk index with that of the mini nutritional assessment-short form and global leadership initiative on malnutrition criteria in assessing nutritional status to predict the 1-year prognosis of hospitalized Japanese older adults: a single-institutional cohort study

“…Most patients in this study had bone and joint diseases (42.5%), whereas fewer patients with cardiovascular and kidney diseases were prone to developing edema, suggesting that the GNRI strongly contributed to the prognosis, as reported in previous studies. MNA Ⓡ -SF is also a nutritional screening tool specific for older adults, and its scores have been associated with prognosis [11,[21][22][23]. The results of this study showed an HR of 2.17 for malnutrition; however, no significant association was observed between risk, malnutrition, and prognosis.…”

Musculoskeletal Ultrasound Shows Muscle Mass Changes during Post-Acute Care Hospitalization in Older Men: A Prospective Cohort Study

“…The Mini-Nutritional Assessment Short Form (MNA-SF) [ 32 ] was used to assess baseline malnutrition risk at admission to the post-acute care unit. Scores < 11 indicate risk of malnutrition [ 49 , 50 ].…”