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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 9  |  Issue : 2  |  Page : 132-135

Screening of malnutrition using the mini-nutritional assessment among hospitalized elderly patients in Western Gujarat


Department of Community Medicine, M. P. Shah Government Medical College, Jamnagar, Gujarat, India

Date of Submission17-Jan-2020
Date of Decision03-Jan-2020
Date of Acceptance25-Jan-2020
Date of Web Publication9-Apr-2020

Correspondence Address:
Rohitkumar Vasabhai Ram
Block No. 608, King Palace Apartment, Opposite Mehul Nagar Telephone Exchange, Mehul Nagar, Jamnagar - 361 006, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijhas.IJHAS_102_19

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  Abstract 


BACKGROUND: Increase in life expectancy brings certain health-related conditions with age. Malnutrition is an underlying factor for much morbidity and hence, its identification and appropriate intervention has a great value in averting poor clinical outcomes.
OBJECTIVE: The present study was conducted to find the nutritional status of elderly patients admitted to the hospital.
MATERIALS AND METHODS: Hospital-based cross-sectional study was conducted among 163 indoor elderly patients from the different departments of a government hospital for the duration of 2 months and their nutritional status was assessed using internationally validated tools, Mini-Nutritional Assessment – Short form (MNA-SF). Data were entered and analyzed statistically using Microsoft Excel software.
RESULTS: The overall prevalence of malnutrition among hospitalized elderly patients was found to be 10.43% and half of the patients (50.31%) were at risk of malnutrition, as per the MNA-SF score. The rate of malnutrition was high among male patients than female patients, and the prevalence of malnutrition rises with an increase in age. Hospitalized patients were found to have decreased intake of food, weight loss of >3 kg, restricted in mobility, and body mass index <19. More than half suffered psychological stress in the past 3 months and around 70% of patients suffered from mild-to-severe dementia or depression.
CONCLUSION: Malnutrition among hospitalized elderly patients needs to be identified and intervened at the earliest to postpone or alleviate poor health outcomes.

Keywords: Elderly, malnutrition, mini-nutritional assessment, screening


How to cite this article:
Makwana NR, Ram RV, Khambhati S. Screening of malnutrition using the mini-nutritional assessment among hospitalized elderly patients in Western Gujarat. Int J Health Allied Sci 2020;9:132-5

How to cite this URL:
Makwana NR, Ram RV, Khambhati S. Screening of malnutrition using the mini-nutritional assessment among hospitalized elderly patients in Western Gujarat. Int J Health Allied Sci [serial online] 2020 [cited 2020 Jun 1];9:132-5. Available from: http://www.ijhas.in/text.asp?2020/9/2/132/282125




  Introduction Top


The world faces a continuous increase in the number of older people[1] and are the most nutritionally vulnerable group as per the World Health Organization.[2] Elderly people are at increased risk of nutrient and energy deficiencies.[3] Age-related physiological changes and the presence of other factors such as social and psychological, presence of disease may predispose the older people to protein-energy malnutrition.[4] Poor nutritional status is related to increased demand on health services, lengthier hospital stays and is recognized as an important independent predictor of morbidity and mortality.[2],[3],[5],[6],[7],[8]

Malnutrition is quite prevalent in hospitalized patients[1],[2],[5],[9],[10],[11] and largely unrecognized in older patients.[4],[5],[7],[12] Kaiser et al.[13] have reported in their retrospective pooled analysis of 4407 older adults from 12 countries that the overall prevalence of malnutrition was 22.8% (ranging from 5.8% to 50.5%, with 38.7% in the hospital setting). The incidence of malnutrition was also high among hospitalized older patients.[10]

Malnutrition will lead to the development of frailty[11] and associated with many adverse clinical outcomes.[5],[8] Therefore, the early identification of malnutrition and nutritional intervention has a great value in the prevention of associated poor clinical outcomes.[2],[5],[14],[15] Since the data on malnutrition among elderly are lacking in the study area, this is an initial attempt to identify the burden of malnutrition among hospitalized older patients with the globally recognized and validated tool,[3],[7],[16] i.e., mini-nutritional assessment.


  Materials and Methods Top


The present cross-sectional study was conducted among elderly patients (aged 60 years or more) admitted at the tertiary level government hospital of Jamnagar district of Gujarat State from February to March 2019. As the study center is lacking a dedicated geriatric ward, patients were identified from the major different wards (medicine, surgery, gynecology, orthopedic, etc.) of the hospital. The study included a total of 163 elderly patients admitted in February in selected different wards and data were collected in the first 24–48 h of admission.

All the included older patients underwent nutritional screening through the most recent short form of the mini-nutritional assessment – Short form (MNA-SF) questionnaire developed by the Nestle nutrition initiative. This tool is widely used worldwide to identify the elderly who are malnourished or those who are at risk of malnutrition.[3],[7] The tool is well-validated with high sensitivity, specificity, and reliability.[3],[12] It has an advantage of fast screening,[5] simple, low-cost, and noninvasive bed-side method.[16] The maximum score on the MNA is 14 points. Individuals with the score >12 considered as well-nourished, those having scores between 8 and 11 were at risk of malnutrition and patients having scored <8 were considered malnourished.

Data collected were entered into the Microsoft Excel software and analyzed. Suitable statistical tests were applied. All statistical tests were two-sided, and P < 0.05 used to indicate statistical significance.

The study was approved by the institutional ethical committee of the host institute and verbal informed consent was taken from the participants before enrolling them in the study.


  Results Top


A total of 163 hospitalized elderly patients were included in the present study, of which, 78 (48%) were female and 85 (52%) were male. More than half of elderly patients were <70 years of age.

According to the MNA-SF score, the overall prevalence of malnutrition among hospitalized elderly patients was found to be 10.43%. Half of the patients (50.31%) were at risk of malnutrition, whereas 39.26% of sample patients had normal nutritional status as per the MNA-SF score [Figure 1]. Malnutrition was highly prevalent among male patients than female elderly patients and the Chi-square test showed a significant association between two variables. While looking at age-wise distribution, it showed an increasing trend with a rise in the age, with the highest prevalence seen in 80 years and above age group, and again data showed a highly significant association on statistical analysis [Table 1].
Figure 1: Nutritional status of participants based on mini-nutritional assessment

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Table 1: Age- and sex-wise distribution of nutritional status

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It was seen from [Table 2] that as the food intake decreases, the rate of malnutrition increases and the data were statistically highly significant (P = 0.0001). Weight loss of >3 kg was reported among 11.8% of malnourished hospitalized elderly patients as against only 1.2% of at risk of malnutrition patients and of the patients having normal nutritional status, 82.8% reported no weight loss in the past 3 months. About 64.7% of malnourished and more than one-third of patients at risk of malnutrition (36.6%) were found to be restricted in mobility and limited to bed or chair bound.
Table 2: Screening variables of the mini-nutritional assessment - short form among hospitalized participants

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More than half of the elderly malnourished patients (53%) suffered from psychological stress in the past 3 months. Similarly, neuropsychological problems (dementia/depression) were seen higher among at-risk and malnourished patients. Body mass index of individuals also represents the same data as other parameters of detecting malnutrition as per the MNA-SF score.


  Discussion Top


A total of 163 hospitalized elderly patients were included in the present study, of which, 78 (48%) were female and 85 (52%) were male. According to the MNA-SF score, the overall prevalence of malnutrition among hospitalized elderly patients was found to be 10.43%, whereas half of the patients (50.31%) were at risk of malnutrition. Although few studies evaluated the nutritional status of hospitalized elderly patients, many of these have shown similar results.[17],[18],[19]

The prevalence of malnutrition was significantly higher among male patients as compared to female patients and this finding is also well correlated with the findings of Amorim Sena Pereira et al.[17] While looking at age-wise distribution, it shows increasing trends with a rise in the age and this is also statistically significant. The aging process is believed to be one of the causes of malnutrition, which affects the nutritional status of the elderly.[20]

In this study, statistically significant association was observed between decrease food intake over the past 3 months, weight loss during the last 3 months and malnutrition.

In this study, we also observed a statistically significant association between restricted mobility conditions like bed or chair bound or able to get out of bed or chair but did not go out and malnutrition.

In this study, we found that persons who suffered from psychological stress in the past 3 months were more prone to malnutrition as compared to persons who do not suffer from psychological stress in the past 3 months and this difference is also statistically significant.

In our study, we also found that persons who suffer from neuropsychological problems such as severe dementia or depression, mild dementia were more prone to malnutrition as compared to persons who do not have any neuropsychological problems and this difference is also statistically significant.


  Conclusion Top


From the results, it is possible to conclude that malnutrition and malnutrition risk among hospitalized elderly patients were conditions of remarkable importance. Finally, according to the association between nutritional status and variables of different dimensions an interdisciplinary approach will be needed to identify the malnutrition among hospitalized elderly patients and intervened at earliest to postpone or alleviate the poor health outcome among hospitalized elderly patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Abd Aziz NA, Teng NI, Abdul Hamid MR, Ismail NH. Assessing the nutritional status of hospitalized elderly. Clin Interv Aging 2017;12:1615-25.  Back to cited text no. 1
    
2.
Calvo I, Olivar J, Martínez E, Rico A, Díaz J, Gimena M. MNA® Mini Nutritional Assessment as a nutritional screening tool for hospitalized older adults; rationales and feasibility. Nutr Hosp 2012;27:1619-25.  Back to cited text no. 2
    
3.
Cuervo M, García A, Ansorena D, Sánchez-Villegas A, Martínez-González M, Astiasarán I, et al. Nutritional assessment interpretation on 22,007 Spanish community-dwelling elders through the Mini Nutritional Assessment test. Public Health Nutr 2009;12:82-90.  Back to cited text no. 3
    
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Forster S, Gariballa S. Age as a determinant of nutritional status: A cross sectional study. Nutr J 2005;4:28.  Back to cited text no. 4
    
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Alzahrani SH, Alamri SH. Prevalence of malnutrition and associated factors among hospitalized elderly patients in King Abdulaziz University Hospital, Jeddah, Saudi Arabia. BMC Geriatr 2017;17:136.  Back to cited text no. 5
    
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Nambooze J, Fujimura M, Inaoka T. Nutritional status and functional capacity of community-dwelling elderly in Southern Laos. Environ Health Prev Med 2014;19:143-50.  Back to cited text no. 6
    
7.
Machado RS, Coelho MA, Veras RP. Validity of the Portuguese version of the mini nutritional assessment in Brazilian elderly. BMC Geriatr 2015;15:132.  Back to cited text no. 7
    
8.
Kang MC, Kim JH, Ryu SW, Moon JY, Park JH, Park JK, et al. Prevalence of malnutrition in hospitalized patients: A multicenter cross-sectional study. J Korean Med Sci 2018;33:e10.  Back to cited text no. 8
    
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Roller RE, Eglseer D, Eisenberger A, Wirnsberger GH. The Graz Malnutrition Screening (GMS): A new hospital screening tool for malnutrition. Br J Nutr 2016;115:650-7.  Back to cited text no. 9
    
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Dent E, Chapman IM, Piantadosi C, Visvanathan R. Performance of nutritional screening tools in predicting poor six-month outcome in hospitalised older patients. Asia Pac J Clin Nutr 2014;23:394-9.  Back to cited text no. 10
    
11.
Valentini A, Federici M, Cianfarani MA, Tarantino U, Bertoli A. Frailty and nutritional status in older people: The Mini Nutritional Assessment as a screening tool for the identification of frail subjects. Clin Interv Aging 2018;13:1237-44.  Back to cited text no. 11
    
12.
Alzahrani SH, El Sayed IA, Alshamrani SM. Prevalence and factors associated with geriatric malnutrition in an outpatient clinic of a teaching hospital in Jeddah, Saudi Arabia. Ann Saudi Med 2016;36:346-51.  Back to cited text no. 12
    
13.
Kaiser MJ, Bauer JM, Rämsch C, Uter W, Guigoz Y, Cederholm T, et al. Frequency of malnutrition in older adults: A multinational perspective using the mini nutritional assessment. J Am Geriatr Soc 2010;58:1734-8.  Back to cited text no. 13
    
14.
Damião R, Santos ÁD, Matijasevich A, Menezes PR. Factors associated with risk of malnutrition in the elderly in south-eastern Brazil. Rev Bras Epidemiol 2017;20:598-610.  Back to cited text no. 14
    
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Zhou J, Wang M, Wang H, Chi Q. Comparison of two nutrition assessment tools in surgical elderly inpatients in Northern China. Nutr J 2015;14:68.  Back to cited text no. 15
    
16.
Oliveira MR, Fogaça KC, Leandro-Merhi VA. Nutritional status and functional capacity of hospitalized elderly. Nutr J 2009;8:54.  Back to cited text no. 16
    
17.
Amorim Sena Pereira ML, de Almeida Moreira P, Cunha de Oliveira C, Carneiro Roriz AK, Teresópolis Reis Amaral M, Lima Mello A, et al. Nutritional status of institutionalized elderly Brazilians: A study with the Mini Nutritional Assessment. Nutr Hosp 2014;31:1198-204.  Back to cited text no. 17
    
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Kulnik D, Elmadfa I. Assessment of the nutritional situation of elderly nursing home residents in Vienna. Ann Nutr Metab 2008;52 Suppl 1:51-3.  Back to cited text no. 18
    
19.
Donini LM, Scardella P, Piombo L, Neri B, Asprino R, Proietti AR, et al. Malnutrition in elderly: Social and economic determinants. J Nutr Health Aging 2013;17:9-15.  Back to cited text no. 19
    
20.
Cederholm T, Bosaeus I, Barazzoni R, Bauer J, van Gossum A, Klek S, et al. Diagnostic criteria for malnutrition – An ESPEN consensus statement. Clin Nutr 2015;34:335-40.  Back to cited text no. 20
    


    Figures

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    Tables

  [Table 1], [Table 2]



 

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