NUTRITIONAL ASSESSMENT OF GERIATRIC OUTPATIENTS USING MNA AND MUST SCREENING TOOLS
I.M. Heemels, A. Janse, J.H.M. de Vries, C.P.G.M. de Groot
J Aging Res Clin Practice 2013;2(1):46-50
Rationale: For optimal treatment of malnutrition, hospital outpatients need to be screened early. MUST is a recommended screening tool, but MNA or MNA-SF might be more effective in predicting outcome for geriatric outpatients. Objective: To compare MNA and MNA-SF with MUST in screening for malnutrition in geriatric outpatients. Design: A cross-sectional, comparative study was performed during 8 consecutive weeks. Setting: During their visit to the outpatient clinic of Hospital ‘Gelderse Vallei’ (ZGV) patients were screened. Participants: Exclusion criteria (age <65 y, truth disclosure) reduced sample size from 224 to 152. Measurements: After performing CGA, based on MNA-SF, MNA and MUST questions, risk of malnutrition was assessed. Results: MNA-SF indicated 53.9% (n=82) of patients as ‘possibly malnourished’, of whom MNA classified 57.3% as ‘at risk’ and 4.9% as ‘malnourished’. MUST classified 12.5% (n=19) and 2% (n=3) of patients respectively as ‘medium risk’ and ‘high risk’. MNA-SF and MUST classified 40.8% (n=62) and MNA and MUST 46.3% (n=38) patients differently (McNemar test, p<0.0001). There was fair agreement between both MNA-SF and MUST and between MNA and MUST (kappa=0.23 and k=0.22, respectively). Significant differences (p<0.0001) in classification were determined by the items ‘mobility’, ‘declined food intake >3days’, ‘psychological stress’, ‘weight loss’, in the MNA and ‘weight loss’ in the MUST. Conclusion: MNA classified more geriatric outpatients as malnourished than MUST, and may therefore prevent missing patients at risk. MNA may be more suitable in this population because it includes more geriatric oriented risk factors that point out the issues needing attention for treatment of malnutrition.