Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Communication
  • Published:

Evaluation of nutritional assessment techniques in elderly people newly admitted to municipal care

Abstract

Objectives: To evaluate the Subjective Global Assessment (SGA) and the Mini Nutritional Assessment (MNA) with regard to validity using a combination of anthropometric and serum-protein measurements as standard criteria to assess protein-energy malnutrition (PEM).

Design: Cross-sectional study with consecutive selection of residents aged ≥65 y.

Setting: A municipality in the south of Sweden.

Subjects: During a year, starting in October 1996, 148 females and 113 males, aged ≥65–104 y of age, newly admitted to special types of housing for the elderly, were included in the study.

Results: According to SGA, 53% were assessed as malnourished or moderately malnourished on admission. The corresponding figure from MNA was 79% malnourished or at risk of malnutrition. Both tools indicated that anthropometric values and serum proteins were significantly lower in residents classified as being malnourished (P<0.05). Sensitivity in detecting PEM was in SGA 0.93 and in MNA 0.96 and specificity was 0.61 and 0.26, respectively. Using regression analysis, weight index and serum albumin were the best objective nutritional parameters in predicting the SGA- and MNA classifications. Item ‘muscle wasting’ in SGA and ‘self-experienced health status’ in MNA showed most predictive power concerning the odds of being assessed as malnourished.

Conclusions: SGA was shown to be the more useful tool in detecting residents with established malnutrition and MNA in detecting residents who need preventive nutritional measures.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  • Beck AM, Ovesen L, Osler M . 1999 The mini nutritional assessment (MNA) and the determine your nutritional health checklist (NSI Checklist) as predictors of morbidity and mortality in an elderly Danish population Br. J. Nutr. 81: 31–36

    Article  CAS  Google Scholar 

  • Bengtsson C, Hultén B, Larsson B, Noppa H, Sreen B, Warnold I . 1981 New weight-height tables in Swedish middle-aged and elderly men and women Läkartidningen 78: 3152–3154

    CAS  PubMed  Google Scholar 

  • Berlinger WG, Potter JF . 1991 Low body mass index in demented outpatients J. Am. Geriat. Soc. 39: 973–978

    Article  CAS  Google Scholar 

  • Boosalis MG, Ott L, Levine AS, Slag MF, Morley JE, Young B, McClain CJ . 1989 Relationship of visceral proteins to nutritional status in chronic and acute stress Crit. Care Med. 17: 741–747

    Article  CAS  Google Scholar 

  • Cederholm T, Hellström K . 1992 Nutritional status in recently hospitalized and free-living elderly Gerontology 38: 105–110

    Article  CAS  Google Scholar 

  • Charney P . 1995 Nutritional assessment in the 1990s: where are we now? Nutr. Clin. Pract. 10: 131–139

    Article  CAS  Google Scholar 

  • Christensson L, Unosson M, Ek A-C . 1999 Malnutrition in elderly people newly admitted to a community resident home J. Nutr. Health Aging 3: 133–139

    CAS  PubMed  Google Scholar 

  • Christensson L, Unosson M, Ek A-C . 2001 Individually adjusted meals for older people with protein-energy malnutrition: a single case study J. Clin. Nurs. 10: 491–502

    Article  CAS  Google Scholar 

  • Comban B, Di Castri A, Plaze JM, Arnaud-Battandier F . 1999 Epidemiological study of malnutrition in elderly patients in acute, sub-acute and long-term care using the MNA® J. Nutr. Health Aging 3: 146–151

    Google Scholar 

  • de Groot, Beck AM, Scholl M, van Staveren WA . 1998 Evaluating the determine your nutritional health checklist and the mini nutritional assessment as tools to identify nutritional problems in elderly Europeans Eur. J. Clin. Nutr. 52: 877–883

    Article  CAS  Google Scholar 

  • Dempsey DT, Mullen JL . 1987 Prognostic value of nutritional indices J. Parent. Enternal Nutr. 1: (5 suppl): 109–114

    Article  Google Scholar 

  • de Onis M, Habicht JP . 1996 Anthropometric reference data for international use: recommendations from a World Health Organization expert committee Am. J. Clin. Nutr. 64: 650–658

    Article  CAS  Google Scholar 

  • Detsky AS, Baker JP, Mendelsson RA, Wolman SL, Wesson DE, Jeejeebhoy KN . 1984 Evaluating the accuracy of nutritional assessment techniques applied to hospitalised patients: methodology and comparisons J. Parent. Enternal Nutr. 8: 153–159

    Article  CAS  Google Scholar 

  • Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelsson RA, Jeejeebhoy KN . 1987a What is subjective global assessment of nutritional status? J. Parent. Enternal. Nutr. 11: 8–13

    Article  CAS  Google Scholar 

  • Detsky AS, Baker JP, O'Rourke K, Johnston N, Whittaker S, Mendelsson RA, Jeejeebhoy KN . 1987b Predicting nutrition-associated complications for patients undergoing gastrointestinal surgery J. Parent. Enternal Nutr. 11: 440–446

    Article  CAS  Google Scholar 

  • Detsky AS, Smally PS, Chang J . 1994 Is this patient malnourished? JAMA 271: 54–58

    Article  CAS  Google Scholar 

  • Ek A-C, Unosson M, Larsson J, von Schenck H, Bjurulf P . 1991 The development of and healing of pressure sores related to the nutritional state Clin. Nutr. 10: 245–250

    Article  CAS  Google Scholar 

  • Ek A-C, Unosson M, Larsson J, Ganowiak W, Bjurulf P . 1996 Interrater variability and validity in subjective nutritional assessment of elderly patients Scand. J. Caring Sci. 10: 163–168

    Article  CAS  Google Scholar 

  • Ferguson RP, O'Connor P, Crabtree B, Batchelor A, Mitchell J, Coppola D . 1993 Serum albumin and prealbumin as predictor of clinical outcomes of hospitilized elderly nursing home residents J. Am. Geriatt. Soc. 41: 545–549

    Article  CAS  Google Scholar 

  • Fleck A . 1988 Acute phase response: implications for nutrition and recovery Nutrition 4: 109–117

    Google Scholar 

  • Gazzoti C, Pepinster A, Petermans J, Albert A . 1997 Interobserver agreement on MNA nutritional scale of hospitilized elderly patients J. Nutr. Health Aging 1: 23–27

    Google Scholar 

  • Gibson RS . Principles of Nutritional Assessment New York: Oxford University Press 1990 pp 187–208

    Google Scholar 

  • Guigoz Y, Vellas B, Garry PJ . 1994 Mini nutritional assessment: a practical assessment tool for grading the nutritional state of elderly patients Facts. Res. Gerotol. 4: (Suppl 2): 15–59

    Google Scholar 

  • Guigoz Y, Vellas B, Garry PJ . 1996 Assessing the nutritional status of the elderly: mini nutritional assessment as a part of geriatric evaluation Nutr. Rev. 54: 59–65

    Article  Google Scholar 

  • Jeejeebhoy KN, Detsky AS, Barker JP . 1990 Assessment of nutritional status J. Parent. Enternal. Nutr. 14: 193–196

    Article  Google Scholar 

  • Joosten E, Vanderelst B, Pelemans W . 1999 The effect of different diagnostic criteria on the prevalence of malnutrition in a hospitalized geriatric population Aging Clin. Exp. Res. 11: 390–394

    Article  CAS  Google Scholar 

  • Lansey S, Waslien C, Mulvihill M, Fillit H . 1993 The role of anthropometry in the assessment of malnutrition in the hospitalized frail elderly Gerontology 39: 346–353

    Article  CAS  Google Scholar 

  • Larsson J, Unosson M, Ek A-C, Nilsson L, Thorslund S, Bjurulf P . 1990 Effect of dietary supplement on nutritional status and clinical outcome in 501 geriatric patients–a randomised study Clin. Nutr. 9: 179–184

    Article  CAS  Google Scholar 

  • Michael JP, Lesourd B, Conne P . 1991 Prevalence of infections and their risk factors in geriatric institutions: a one-day multicentre survey WHO Bull. 69: 35–41

    Google Scholar 

  • Muhlethaler R, Stuck AE, Minder CE, Frey BM . 1995 The prognostic significance of protein-energy malnutrition in geriatric patients Age Aging 24: 193–197

    Article  CAS  Google Scholar 

  • Omran ML, Morley JE . 2000 Assessment of protein energy malnutrition in older persons, Part 1: history, examination, body composition, and screening tools Nutrition 16: 50–63

    Article  CAS  Google Scholar 

  • Ostbye T, Tyas S, McDowell I, Koval J . 1997 Reported activities of daily living: agreement between elderly subjects with and without dementia and their caregivers Age Ageing 26: 99–106

    Article  CAS  Google Scholar 

  • Pertoldi W, Fragiacomo C, Rapin CH, Guigoz Y, Quadri P . 1996 The mini nutritional assessment a predictor of hospital costs in geriatric patients (Abstract) J. Am. Geriat. Soc. 44: 230

    Google Scholar 

  • Rosenthal AJ, Sanders KM, McMurtry CT, Jacobs MA, Thompson DD, Gheorghiu D, Little KL, Adler RA . 1998 Is malnutrition overdiagnosed in older hospitalized patients? Association between the soluble interleukin-2 receptor and serum markers of malnutrition J. Gerontol. 2: 81–86

    Article  Google Scholar 

  • Rubenstein LZ, Harker J, Guigoz Y, Vellas B . 1999 Comprehensive geriatric assessment (CGA) and the MNA: an overview of CGA, nutritional assessment, and development of a shortened version of the MNA In: Mini Nutritional Assessment (MNA): Research and Practice in the Elderly ed. B Vellas, PJ Garry & Y Guigoz, Nestlé Workshop Series Clinical & Performance Programme. Basel Nestlé. vol. 1, pp 101–116

  • Saletti A, Johansson L, Cederholm T . 1999 Mini nutritional assessment in elderly subjects receiving home nursing care J. Hum. Nutr. Dietet. 12: 381–387

    Article  Google Scholar 

  • Symreng T . 1982 Arm anthropometry in a large reference population and in surgical patients Clin. Nutr. 1: 211–219

    Article  CAS  Google Scholar 

  • Symreng T, Anderberg B, Kågedal B, Norr A, Schildt B, Sjödahl R . 1983 Nutritional assessment and clinical course in 112 elective surgical patients Acta Chir. Scand. 149: 657–662

    CAS  PubMed  Google Scholar 

  • Steiner DL, Norman GR . 1995 Health Measurement Scales. A Practical Guide to Their Development and Use 2nd edn. New York: Oxford University Press

    Google Scholar 

  • Thomas DR, Verdery RB, Gardner L, Kant A, Lindsay J . 1991 A propsective study of outcome from protein-energy malnutrition in nursing home residents J. Parent. Enternal. Nutr. 4: 400–404

    Article  Google Scholar 

  • Thuluvath PJ, Triger DR . 1995 How valid are or reference standards of nutrition? Nutrition 6: 731–733

    Google Scholar 

  • Ulander K, Grahn G, Jeppson B . 1993 Subjective assessment of nutritional status-validity and reliability of a modified Detsky index in a Swedish setting Clin. Nutr. 12: 15–19

    Article  CAS  Google Scholar 

  • Unosson M, Ek A-C, Bjurulf P, Larsson J . 1991 Demographical, sociomedical and physical characteristics in relation to malnutrition in geriatric patients J. Adv. Nurs. 16: 1406–1412

    Article  CAS  Google Scholar 

  • Unosson M, Ek A-C, Bjurulf P, von Schenk H, Larsson J . 1995 Influence of macro-nutrient status on recovery after hip fracture J. Nutr. Environ. Med. 5: 23–34

    Article  Google Scholar 

  • Vellas B, Guigoz Y, Garry PJ, Nourhashemi F, Bennahum D, Lauque S, Albarede J-L . 1999 The mini nutritional assessment (MNA) and its use in grading the nutritional state of elderly patients Nutrition 15: 116–122

    Article  CAS  Google Scholar 

  • Warnold I, Lundholm K . 1984 Clinical significance of preoperative nutritional status in 215 noncancer patients Ann. Surg. 199: 299–305

    Article  CAS  Google Scholar 

  • Wissing U, Unosson M . 1999 The relationship between nutritional status and physical activity, ulcer history and ulcer-related problems in patients with leg and foot ulcers Scand. J. Caring Sci. 13: 123–128

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The study was supported by grants from Vårdalsstiftelsen no. 96/41, 98/359 and the Faculty of Health Sciences, Linköping University, Linköping, Sweden. We thank Birgit Ljungquist, PhD, for her statistical supervision.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to L Christensson.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Christensson, L., Unosson, M. & Ek, AC. Evaluation of nutritional assessment techniques in elderly people newly admitted to municipal care. Eur J Clin Nutr 56, 810–818 (2002). https://doi.org/10.1038/sj.ejcn.1601394

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ejcn.1601394

Keywords

This article is cited by

Search

Quick links