The use of the Mini-Nutritional Assessment (MNA) tool in elderly orthopaedic patients

Abstract

Objective: To assess the use of the Mini-Nutritional Assessment (MNA) in elderly orthopaedic patients. Design: An observation study assessing the nutritional status of female orthopaedic patients. Setting: The orthopaedic wards of the Royal Surrey County Hospital. Subjects: Forty-nine female patients aged 60 ± 103 y; dietary records were obtained for 41 subjects and 36 subjects gave a blood sample for biochemical analysis. Major outcome methods: MNA questionnaire, anthropometry, plasma albumin, transferrin, C-reactive protein (CRP) levels and dietary analyses. Results: The group as a whole had low mean values for body weight, albumin and transferrin and high CRP levels. In addition, the group had mean energy intakes well below the estimated average requirement (EAR) and mean intakes of vitamin D, magnesium, potassium, selenium and non-starch polysaccharides (NSP) were below the lower reference nutrient intakes (LRNI). The MNA screening section categorized 69% of the patients as requiring a full assessment (scored 11 or below), but for the purposes of the study the MNA was completed on all patients. The MNA assessment categorized 16% of the group as`malnourished' (scored`17 points), 47% as at risk' (scored 17.5 ± 23.5) and 37% as`well nourished' (scored b23.5). Signi®cant differences were found between the malnourished and well nourished groups for body weight (P`0.001), body mass index (BMI) (P`0.001), demiquet (P`0.001) and mindex (P`0.001). Mean values for energy and nutrient intakes showed a clear stepwise increase across the three groups for all nutrients except sodium, with signi®cant differences for protein (P`0.05), carbohydrate (P`0.05), ribo¯avin (P`0.05) niacin (P`0.05), pyridoxine (P`0.05), folate (P`0.05), calcium (P`0.05), selenium (P`0.05), iron (P`0.05) and NSP (P`0.05) intakes. Stepwise multiple regression analysis indicated that anthropometric assessments were the most predictive factors in the total MNA score. The sensitivity and speci®city of the MNA was assessed in comparison with albumin levels, energy intake and mindex. The sensitivity of the MNA classi®cation of those scoring less than 17 points in comparison with albumin levels, energy intake and mindex varied from 27 to 57% and the speci®city was 66 ± 100%. This was compared with the sensitivity and speci®city of using a score of less than 23.5 on the MNA to predict malnourished individuals. Using this cut-off the sensitivity ranged from 75 to 100%, but the speci®city declined to between 37 and 50%. Conclusions: The results suggest that the MNA is a useful diagnostic tool in the identi®cation of elderly patients at risk from malnutrition and those who are malnourished in this hospital setting.

Lower limb fracture, cognitive impairment and risk of subsequent malnutrition: a prospective evaluation of dietary energy and protein intake on an orthopaedic ward

“…CI ¼ confidence interval; eBMI ¼ body mass index (kg/m 2 ) using stature estimated from knee height (Chumlea et al, 1985). (Murphy et al, 2000) and 5800 kJ/day (Bastow et al, 1983). The varied criteria used to define undernutrition are a likely factor for this large variation in findings.…”

“…Dietary energy intake of the undernourished participants in this study was approximately 4000 kJ/day. In the three studies that have reported selecting participants to be undernourished and have documented dietary energy intake while patients were in the acute care setting (Bastow et al, 1983;Volkert et al, 1996;Murphy et al, 2000), findings have been inconsistent with values ranging between 2950 Nutritional status was assessed upon receiving consent to participate in the study (range: day 2 to day 6 postfracture). Energy and protein intake averaged over 3-5 consecutive days (n ¼ 10, n ¼ 10, n ¼ 48 with 3, 4 and 5 days intake data, respectively).…”

“…In many intake studies cognitive impairment is an exclusion criteria (Bastow et al, 1983;Jallut et al, 1990;Brown and Seabrook, 1992;Patterson et al, 1992;Sullivan et al, 1998;Murphy et al, 2000;Lawson et al, 2003;Eneroth et al, 2005) or has not been reported (Hessov, 1977;Older et al, 1980;Dickerson et al, 1984;Stableforth, 1986;MollerMadsen et al, 1988;Delmi et al, 1990;Hartgrink et al, 1998). Those studies that have included patients with cognitive impairment have not reported intake data according to cognitive status (Volkert et al, 1996;Duncan et al, 2001;Lumbers et al, 2001), despite evidence that eating behaviours associated with decreased dietary intake (e.g.…”

“…The prevalence of poor nutritional status among older adults admitted to hospital with hip fracture ranges from 18 (Koval et al, 1999) to 63% (Murphy et al, 2000). It has been reported that the nutritional status of these patients deteriorates further during admission (Jallut et al, 1990;Brown and Seabrook, 1992;Unosson et al, 1995;Paillaud et al, 2000;Bachrach-Lindstrom et al, 2001) and that being undernourished has an adverse impact on recovery (Bastow et al, 1983;Koval et al, 1999).…”

“…food frequency questionnaire) (Schurch et al, 1998) or for patients post anaesthesia (e.g. 24 h recall) (Murphy et al, 2000;Lumbers et al, 2001) and few have looked specifically at those who were undernourished or nutritionally at risk on admission to the acute care setting (Bastow et al, 1983;Brown and Seabrook, 1992;Volkert et al, 1996;Murphy et al, 2000).…”