Abstract
Background
The European Society for Clinical Nutrition and Metabolism (ESPEN) has recommended the Mini Nutritional Assessment (MNA®), the Nutritional Risk Screening 2002 (NRS), and the Malnutrition Universal Screening Tool (MUST) for nutritional screening in various settings and age groups. While in recent years all three tools have been applied to nursing home residents, there is still no consensus on the most appropriate screening tool in this specific setting.
Aim
The present study aims at comparing the MNA, the NRS, and the MUST with regard to applicability, categorization of nutritional status, and predictive value in the nursing home setting.
Method
MNA, NRS, and MUST were performed on 200 residents from two municipal nursing homes in Nuremberg, Germany. Follow-up data on infection, hospitalization, and mortality were collected after six and again after twelve months.
Results
Among 200 residents (mean age 85.5 ±7.8 years) the MNA could be completed in 188 (94.0%) and the NRS and MUST in 198 (99.0%) residents. The prevalence of ‘malnutrition’ according to the MNA was 15.4%. The prevalence of ‘risk of malnutrition’ (NRS) and ‘high risk of malnutrition’ (MUST), respectively, was 8.6% for both tools. The individual categorization of nutritional status showed poor agreement between NRS and MUST on the one hand and MNA on the other. For all tools a significant association between nutritional status and mortality was demonstrated during follow-up as classification in ‘malnourished’, respectively ‘high risk of malnutrition’ or ‘nutritional risk’, was significantly associated with increased hazard ratios. However, the MNA showed the best predictive value for survival among well-nourished residents.
Conclusion
The evaluation of nutritional status in nursing home residents by MNA, NRS, and MUST shows significant differences. This observation may be of clinical relevance as nutritional intervention is usually based on screening results. As the items of the MNA reflect particularities of the nursing home population, this tool currently appears to be the most suitable one in this setting.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
De Groot CPGM, van Staveren WA. Undernutrition in the European SENECA studies. Clin Geriatr Med 2002; 18: 699–708.
Amarantos E, Martinez A, Dwyer J. Nutrition and Quality of Life in older Adults. J Gerontol A Biol Sci Med Sci 2001; 56/2: 54–64.
Cederholm T, Jagren C, Hellstrom K. Outcome of protein-energy malnutrition in elderly medical patients. Am J Med 1995; 98: 67–74.
Dey DK, Rothenberg E, Sundh V, Bosaeus I, Steen B. Body Mass Index, weight change and mortality in the elderly. A 15 year longitudinal population study of 70 y olds. Eur J Clin Nutr 2001; 55:482–492.
Kondrup J, Johansen N, Plum LM, Bak L, Larsen ICH, Martinsen A, Andersen JR, Baemthsen H, Bunch E, Lauesen N. Incidence of nutritional risk and causes of inadequate nutritional care in hospitals. Clin Nutr 2002; 21:461–468.
Kaiser R, Winning K, Uter W, Stehle P, Lesser S, Sieber CC, Bauer JM. Comparison of two different approaches for the application of the Mini Nutritional Assessment in nursing homes: resident interviews versus assessment by nursing staff. J Nutr Health Aging 2009; 13(10): 863–869.
Pauly L, Stehle P, Volkert D. Nutritional situation of elderly nursing home residents. Z Gerontol Geriatr 2007; 40: 3–12.
Bauer JM, Kaiser MJ, Anthony P, Guigoz Y, Sieber CC. The Mini Nutritional Assessment — Its History, Today’s Practice, and Future Perspectives. Nutr Clin Praet 2008; 23(4): 388–396.
Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN Guidelines for Nutrition Screening 2002. Clin Nutr 2003; 22(4): 415–421.
Lesher EL, Berryhill JS. Validation of the Geriatric Depression Scale — short form among inpatients. J Clin Psychol 1994; 50:256–260.
Folstein MF, Folstein S, McHugh PR. Mini Mental State: a practical method for grading cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189–198.
Mahoney FI, Barthel DW. Functional Evaluation: The Barthel Index. Md State Med J 1965; 14:61–65.
Kaiser R, Winning K, Uter W, Volkert D, Lesser S, Stehle P, Kaiser MJ, Sieber CC, Bauer JM. Functionality and mortality in obese nursing home residents — An example of ‘Risk Factor Paradox’? J Am Med Direc Assoc 2010, 11,(6):428–435.
Guigoz Y, Vellas B, Garry PJ. Mini Nutritional Assessment: a practical assessment tool for grading the nutritional state of elderly patients. Facts Res Gerontol 1994; 2: 15–60.
Guigoz Y, Vellas B, Garry PJ. Assessing the Nutritional Status of the elderly. The Mini Nutritional Assessment as Part of the Geriatric Evaluation. Nutr Rev 1996; 54: 59–65
Kondrup J, Rasmussen HH, Hamberg O, Stanga Z, and ad hoc ESPEN working group. Nutritional Risk Screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 2003; 22: 321–336.
Malnutrition Advisory Group (MAG). MAG-guideline s for Detection and Management of Malnutrition. British Association for Parenteral and Enteral Nutrition, Redditeh, UK 2000.
Elia M (Chairman and Editor). Screening for Malnutrition: A Multidisciplinary Responsibility. Development and Use of the “Malnutrition Universal Screening Tool” (“MUST”) for Adults. Malnutrition Advisory Group (MAG) 2003, a Standing Commitee of BAPEN.
Stratton RJ, Hackston A, Longmore D, Dixon R, Price S, Stroud M, King C, Elia M. Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the malnutrition universal screening tool (MUST) for adults. Br J Nutr 2004; 92:799–808.
Anthony P. Nutrition Screening Tools for Hospitalized Patients. Nutr Clin Praet 2008; 23(4): 373–382.
Cohen A. Coefficient of agreement for nominal scales. Educ Osychol Meas 1960; 19: 3–11.
Hengstermann S, Nieczaj R, Steinhagen-Thiessen E, Schulz RJ. Which are the most efficient items of the Mini Nutritional Assessment in multimorbid patients? J Nutr Health Aging 2008; 12(2): 117–122.
Kagansky N, Berner Y, Koren-Morag N, Perelman L, Knobler H, Levy S. Poor nutritional habits are predictors of poor outcome in very old hospitalized patients. Am J Clin Nutr 2005; 82: 784–791.
Norman K, Smoliner C, Valentini L, Lochs H, Pirlich M. Is bioelectrical impedance vector analysis of value in the elderly with malnutrition and impaired functionality? Nutrition 2007; 23(7–8): 564–569.
Abbasi AA, Rudman D. Undernutrition in nursing home: prevalence, consequences, causes and prevention. Nutr Rev 1994; 52(4): 113–122.
Dumbaugh T, Haley B, Roberts S. Assessing problem feeding behaviours in mid-stage Alzheimer’s disease. Geriatr Nurs 1996; 17(2): 63–67.
Bauer JM, Vogl T, Wicklein S, Trögner J, Mühlberg W, Sieber CC. Comparison of the Mini Nutritional Assessment, Subjective Global Assessment, and Nutritional Risk Screening (NRS 2002) for nutritional screening and assessment in geriatric hospital patients. Z Gerontol Geriatr 2005; 38: 322–327.
Rasmussen HH, Kondrup J, Staun M, Kadefoged K, Kristensen H, Wengler A. Prevalence of patients at nutritional risk in Danish hospitals. Clinical Nutr 2004; 23: 1009–1015.
Internet reference: World Health Organisation (WHO) (2004): BMI-Classification: http://apps.who.int/bmi/index.jsp?introPage=intro_3.html. 23.07.2012.
Al Snih S, Ottenbacher KJ, Markides KS, Kuo YF, Eschbach K, Goodwin JS. The effect of obesity on disability vs. mortality in older Americans. Arch Intern Med 2007; 167:774–780.
National Research Council. Diet and Health. Implications for Reducing Chronic Disease Risk. National Academy Press, Washington DC 1989: 563–592.
Volkert D, Berner YN, Berry E, Cederholm T, Bertrand PC, Milne A, Palmblad J, Schneider S, Sobotka L, Stanga Z, Lenzen-Grossimlinghaus R, Krys U, Pirlich M, Herbst B, Schuetz T, Schroeer W, Weinrebe W, Ockenga J, Lochs H. ESPEN Guidelines on Enteral Nutrition: Geriatrics. Clin Nutr 2006; 25: 330–360.
Unosson M, Larsson J, Ek A-C, Bjurulf P. Effects of dietary supplement on functional condition and clinical outcome measured with a modified Norton scale. Clin Nutr 1992; 11:134–139.
Guigoz Y, Vellas B. Test d’evaluation de l’etat nutritionnel de la personne agée: le Mini Nutritionel Assessment (MNA). Med Hyg 1995; 53:1965–1969.
Tsai A, Ku PY. Population-specific Mini Nutritional Assessment effectively predicts the nutritional state and follow-up mortality of institutionalized elderly Taiwanese regardless of cognitive status. Br J Nutr 2008; 100:152–158.
Stratton RJ, King CL, Stroud MA, Jackson AA, Elia M. Malnutrition Universal Screening Tool predicts mortality and length of hospital stay in acute ill elderly. Br J Nutr 2006; 95: 325–330.
Sorensen J, Kondrup J, Prokopowicz J, Schiesser M, Krähenbühl L, Meier R, Liberda M, EuroOOPS study group, Clin Nutr 2008; 27:340–349.
Todorovic V, Russell C, Elia M. The ‚MUST’ explanatory booklet. A guide to the, Malnutrition Universal Screening Tool’ (‚MUST) for adults. 2003. www.bapen.org.uk/pdfs/must/must_explan.pdf (Juli 2012).
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Diekmann, R., Winning, K., Uter, W. et al. Screening for malnutrition among nursing home residents — a comparative analysis of the Mini Nutritional Assessment, the Nutritional Risk Screening, and the Malnutrition Universal Screening Tool. J Nutr Health Aging 17, 326–331 (2013). https://doi.org/10.1007/s12603-012-0396-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12603-012-0396-2