Objective: The study was to determine whether a modified MNA (Mini Nutritional Assessment) which adopted population-specific anthropometric cut-points could maintain its functionality in community-living elderly in Taiwan. The study also examined the factors that impact the nutritional status of the elderly.
Methods: One hundred thirty eight male and 163 female >65-year-old outpatients having free annual health examination at a regional hospital in central Taiwan were recruited to participate in a nutritional assessment study. A questionnaire survey elicited participants' sociodemographic status, anthropometric measurement, healthcare-related biochemical indicators and answers to the MNA. Each subject's nutritional status was assessed with the MNA in three versions: the original, MNA-TI which adopts population-specific cut-points and the MNA-TII which further eliminated the BMI question and redistributed its score to the MAC (mid-arm circumference) and CC (calf circumference) questions. Results were analyzed by correlation analysis and logistic regression analysis to determine the association of the nutritional status with the major functional indicators.
Results: All three versions identified the same 0.7% elderly malnourished. The original MNA predicted 16.6%, the MNA-TI predicted 12% and the MNA-TII predicted 10% elderly at risk of malnutrition. Friedman Test and post hoc analysis indicated that the pattern predicted by the original MNA was different from that predicted by the two modified versions whereas the patterns predicted by the two modified versions were not different from each other. Length of hospital stay during the past 6 months, number of prescribed medicine and number of emergency visit during past 3 months showed the strongest significant correlations with MNA scores of the modified MNAs but not the original MNA. Logistic regression analysis showed that female gender, old age, low serum albumin, increased prescription drug usage, duration of hospitalization, and low MAC or CC are variables significantly associated with increased risk of malnutrition.
Conclusion: Adoption of population-specific anthropometric cut-points improves the functionality of the MNA in Taiwanese elderly, a non-Caucasian population, and the improved functionality is maintained in a version without BMI (with adjusted MAC and CC scores). A MNA without BMI has greater applicability and can enhance professional efficiency of healthcare workers. Easier and wider application of the tool will enable early detection of emerging nutritional problems and timely intervention to prevent the development of severe malnutrition and thus helps to save on healthcare cost. Results of this study indicate that female gender, old age, low serum albumin, length of hospital stay and low MAC or CC are the major impacting factors of nutritional status of the free-living elderly.