Mini Nutritional Assessment (MNA): Research and Practice in the Elderly

Transcription

1 Nestlé Nutrition Workshop Series Clinical & Performance Programme Volume 1 Mini Nutritional Assessment (MNA): Research and Practice in the Elderly Editors Bruno Vellas, University of Toulouse, Toulouse, France Philip J. Garry, University of New Mexico, Albuquerque, USA Yves Guigoz, Nestlé Research Center, Lausanne, Switzerland ABC

2 Nestec Ltd., 55 Avenue Nestlé, CH 1800 Vevey (Switzerland) S. Karger AG, P.O. Box, CH 4009 Basel (Switzerland) 1999 Nestec Ltd., Vevey (Switzerland) and S. Karger AG, Basel (Switzerland). All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, or recording, or otherwise, without the written permission of the publisher. Printed in Switzerland on acid-free paper by Reinhardt Druck, Basel ISBN Library of Congress Cataloging-in-Publication Data Mini nutritional assessment (MNA): research and practice in the elderly / editors, Bruno Vellas, Philip J. Garry, Yves Guigoz. (Nestlé Nutrition workshop series. Clinical & performance programme; v.1) Nestlé Nutrition Services. Includes bibliographical references and index. ISBN Nutrition disorders in old age Diagnosis. 2. Aged Nutrition Evaluation. 3. Aged Diseases Nutritional aspects. I. Vellas, B.J. (Bruno J.) II. Garry, Philip J., III. Guigoz, Yves. IV. Nestlé Nutrition Services. V. Nestlé Clinical & Performance Nutrition Workshop (1st:1997: Lausanne, Switzerland) VI. Series. RC620.6.M )63 dc21 The material contained in this volume was submitted as previously unpublished material, except in the instances in which credit has been given to the source from which some of the illustrative material was derived. Great care has been taken to maintain the accuracy of the information contained in the volume. However, neither Nestec Ltd. nor S. Karger AG can be held responsible for errors or for any consequences arising from the use of the information contained herein.

3 Contents VII Preface IX Foreword XI Contributors 1 Introduction Ferdinand Haschke (Vevey) 3 The Mini Nutritional Assessment (MNA) for Grading the Nutritional State of Elderly Patients: Presentation of the MNA, History and Validation Yves Guigoz (Lausanne) and Bruno Vellas (Toulouse) 13 The Mini Nutritional Assessment and Body Composition in Healthy Adults Wm. Cameron Chumlea, Gwendolyn Hall, Flavius Lilly, R.M. Siervogel and Shumei S. Guo (Dayton, Ohio) 23 MNA and Immunity: Nutritional Status and Immunological Markers in the Elderly E.J. Schiffrin, Yves Guigoz, Geneviève Perruisseau, Stéphanie Blum, Yves Delneste, Robert Mansourian (Lausanne), B. Vellas and A. Blancher (Toulouse) 35 Comparative Nutrition Evaluation with the Mini Nutritional Assessment and the Nutritional Risk Assessment Scale P. Oster, B.M. Rost, U. Velte and G. Schlierf (Heidelberg) 41 MNA and Odor Perception Martijn I. Griep, Tony F. Mets, Kris Collys, Dominique Verté, Gino Verleye, Ingrid Ponjaert-Kristoffersen and Desire L. Massart (Ghent) 61 The MNA Score in People Who Have Aged Successfully K. Scheirlinckx (Yvoir), B. Vellas (Toulouse) and P.J. Garry (Albuquerque, N. Mex.) V

4 Contents 67 Anorexia of Aging, Leptin, and the Mini Nutritional Assessment J.E. Morley, D.K. Miller, H.M. Perry III, P. Patrick (St. Louis, Mo.), Y. Guigoz (Lausanne) and B. Vellas (Toulouse.) 79 Associations among the Mini Nutritional Assessment Instrument, Dehydration, and Functional Status among Older African Americans in St. Louis, Mo., USA Douglas K. Miller, Horace M. Perry III and John E. Morley (St. Louis, Mo.) 87 Mini Nutritional Assessment and Alzheimer Patients F. Nourhashemi, S. Guyonnet, P.J. Ousset (Toulouse), V. Kostek, S. Lauque, W.C. Chumlea (Dayton, Ohio), B. Vellas (Toulouse) and J.L. Albarède (Dayton, Ohio) 93 Mini Nutritional Assessment and Cancer Gilbert B. Zulian, Gabriel Gold, François Herrmann and Jean-Pierre Michel (Thônex) 101 Comprehensive Geriatric Assessment (CGA) and the MNA: An Overview of CGA, Nutritional Assessment, and Development of a Shortened Version of the MNA Laurence Z. Rubenstein, Judith Harker (Los Angeles, Calif.), Yves Guigoz (Lausanne) and Bruno Vellas (Toulouse) 117 The Mini Nutritional Assessment for Preoperative Nutritional Evaluation: A Study on 419 Elderly Surgical Patients Robert Cohendy (Nîmes) 123 The Mini Nutritional Assessment in Clinical Practice Antoni Salvá, M. José Bleda and Ignasi Bolibar (Barcelona) 131 MNA and Nutritional Intervention F. Arnaud-Battandier (Sèvres), S. Lauque (Toulouse), M. Paintin, R. Mansourian (Lausanne), B. Vellas (Toulouse) and Y. Guigoz (Lausanne) 141 MNA and Cost of Care P. Quadri, C. Fragiacomo, W. Pertoldi (Mendrisio), Y. Guigoz (Lausanne), F. Herrmann and Ch.H. Rapin (Geneva) 149 Animal Model: Metabolic and Thermic Responses to Diet and Environment (4 C) in Obesity during Aging in the LA/Ntul//-cp Rat Orien L. Tulp and Susan P. DeBolt (Philadelphia, Pa.) 157 Appendix 159 Posters 177 Discussions of Poster Presentations 187 Conclusion 191 Subject Index VI

5 Preface The Mini Nutritional Assessment (MNA) 1 as Part of the Geriatric Assessment The prevalence of malnutrition is high in elderly people in hospital, living in nursing homes, or involved in home care programs. Development of malnutrition in the elderly is usually a continuum, starting with inadequate food intakes, followed by changes in body composition and biochemical variables. Consequences of malnutrition often go unrecognized owing to lack of specific validated instruments to assess nutritional status in frail elderly persons. The Mini Nutritional Assessment (MNA) has recently been designed and validated [1 4] to provide a single, rapid assessment of nutritional status in the elderly. The MNA provides primary care physicians with a tool for rapid screening of patients who may subsequently need a more extensive nutritional assessment. For validation of the MNA we chose to evaluate the tool against the results of nutritional assessment performed by two physicians trained in nutrition, using comprehensive nutritional evaluation (including dietary intakes, anthropometry, and biochemical indices) [1 5]. The MNA was found to be highly correlated with each of these nutritional variables. The sum of the MNA score distinguishes elderly patients with adequate nutritional status (MNA ), protein-energy malnutrition (MNA! 17), and at risk of malnutrition (MNA between 17 and 23.5). With this scoring, sensitivity was found to be 96%, specificity 98%, and predictive value 97% [6]. The interobserver MNA score agreement was defined by Cohen s kappa, with a Î value = 0.51 (95% confidence interval ) [7]. The MNA has been translated into several languages and is used in many clinics around the world. This book reports recent studies on nutrition in the elderly using the MNA and presented at the international meeting on the MNA in the Nestlé Research Center in Lausanne. B. Vellas, P.J. Garry, Y. Guigoz 1 The Mini Nutrition Assessment (MNA) form is given in the Appendix. VII

6 Preface References 1. Guigoz Y, Vellas BJ, Garry PJ. Assessing the nutritional status of the elderly: the Mini Nutritional Assessment as part of the geriatric evaluation. Nutr Rev 1996; 54: S Vellas B, Guigoz Y. The Mini Nutritional Assessment. Facts, research and intervention in geriatrics, 4th ed. Paris: Springer & Serdi Publishing Co, Vellas B, Guigoz Y. Nutritional assessment as part of the geriatric evaluation. In: Rubenstein LZ, Bernabei R, Wieland D, eds. Geriatric assessment technology: state of the arts. Milan: Kutiz Publishing Co, 1995: Guigoz Y, Vellas B. Malnutrition im Alter: Das Mini Nutritional Assessment (MNA). Ther Umschau 1997; 54: Salva A, Bolivar I, Munoz M, Sacristan V. Un nuevo instrumento para la valoración nutricional en geriatría: el Mini Nutritional Assessment (MNA). Rev Gerontol 1996; 6: Guigoz Y, Vellas B. Test d évaluation du statut nutritionnel de la personne âgée: le Mini Nutritional Assessment (MNA). Med Hyg 1995; 53: Gazzoti C, Pepinster A, Petermans J, Albert A. Interobserver agreement on MNA nutritional scale of hospitalized elderly patients. J Nutr Health Aging 1997; 1: 23. VIII

7 Foreword It has been known for many decades that even in the most affluent countries elderly people admitted to hospital for acute medical or surgical diseases or accidents usually undergo progressive impairment in their nutritional status [1, 2], which remains unnoticed for variable periods. When the medical staff diagnose protein-energy malnutrition, it is often late and may be difficult to correct. Until 1994, only specialized units in the most advanced geriatric centers were using sophisticated measurements to assess malnutrition and to follow progress during realimentation [3, 4]. The criteria used in different centers were not always the same, making comparison between centers difficult. Moreover the techniques used were specialized and not applicable on a large scale in most geriatric centers, which do not have research personnel among their staff. Since the beginning of the 1990s, Vellas, Garry, Guigoz and Albarède have developed and validated the Mini Nutritional Assessment (MNA) [5], which is easy, quick, and economical to perform and enables staff to check the nutritional status of elderly people when they enter hospitals or institutions, and to monitor changes occurring during their stay. This allows the necessary nutritional measures to be applied sooner, to prevent a further decline in nutritional status or to restore it to normality. MNA also allows one to compare the prevalence of protein-energy malnutrition in various centers, and more importantly to compare nutritional measures and protocols used in these centers. Nestlé Clinical Nutrition is very proud to have supported the development and evaluation of MNA for many years and to have been instrumental in promoting this new and indispensable tool for the better care of the elderly. The MNA Symposium will mark an important step in broadening the use of the MNA tool in its various applications. Pierre Guesry Vice-President of Research Nestlé Research Center, Lausanne, Switzerland Franck Arnaud-Battandier Medical Director Nestlé Clinical Nutrition, Sèvres, France IX

8 Foreword References 1. Mowe M, Bohmer T. The prevalence of undiagnosed protein-calorie undernutrition in a population of 157 hospitalized elderly patients. J Am Geriatr Soc 1991; 39: Constans T, Bacq Y, Brechot J-F, Guilmot J-L, Choutet P, Lamisse F. Protein-energy malnutrition in elderly medical patients. J Am Geriatr Soc 1992; 40: Starker PM. Nutritional assessment of the hospitalized patient. Adv Nutr Res 1990; 8: Jeejeebhoy KN, Detsky AS, Baker JP. Assessment of nutritional status. J Parenter Enter Nutr 1990; 14: 193 6S. 5. Vellas BJ, Guigoz Y, Garry PJ, Albarède JL. The Mini Nutritional Assessment: MNA. In: Nutrition in the elderly. Facts and research in gerontology 1994 (Supplement). Paris: Serdi, X

9 Contributors Speakers Franck Arnaud-Battandier Nestlé Clinical Nutrition France 2, Rue Troyon F Sèvres Cedex, France Wm.C. Chumlea Fels Professor Wrigth State University Department of Community Health and Pediatrics, School of Medicine 1005 Xenia Avenue Yellow Springs, OH , USA Robert Cohendy Département d Anesthésie-Réanimation Hôpital Gaston-Doumengue F 3000 Nîmes Cedex, France Philip J. Garry Department of Pathology School of Medicine University of New Mexico 2701 Frontier Place N.E. Room 236 Albuquerque, NM 87131, USA Martijn Griep Academic Hospital Vrije Universiteit Brussel (VUB) Department of Geriatrics Laarbeeklaan 101 B 1090 Brussels, Belgium Pierre Guesry Nestlé Research Center Vers-chez-les-Blanc PO Box 44 CH 1000 Lausanne 26, Switzerland Yves Guigoz Nestlé Research Center Vers-chez-les-Blanc PO Box 44 CH 1000 Lausanne 26, Switzerland Douglas K. Miller School of Medicine Department of Internal Medicine Division of Geriatric Medicine St. Louis University Health Sciences Center 1402 S. Grand Blvd., Rm M238 St. Louis, MO 63104, USA John E. Morley School of Medicine Department of Internal Medicine Division of Geriatric Medicine St. Louis University Health Sciences Center 1402 S. Grand Blvd., Rm M238 St. Louis, MO 63104, USA XI

10 Contributors Peter Oster Bethanien Krankenhaus Geriatrisches Zentrum GmbH Rohrbachstrasse 149 D Heidelberg, Germany Pierluigi Quadri Ospedale Regionale della Beata Vergine Via Turconi 23 CH 6850 Mendrisio, Switzerland Laurence Z. Rubenstein Director, Geriatric Research Education and Clinical Center (GRECC) UCLA School of Medicine VAMC Sepulveda (11E) Plummer Street Sepulveda, CA 91343, USA Antonio Salva I Casanovas PASS Centre Geriatric Cabanelles UFISS de Geriatria i Unitat de Convalescencia RDA Alfonso X, E Mataro (Barcelona), Spain Kristel Scheirlinckx Service de gériatrie Clinique Universitaire de Mont-Godinne B 5530 Yvoir, Belgium Eduardo Schiffrin Nestlé Research Center Vers-chez-les-Blanc PO Box 44 CH 1000 Lausanne 26, Switzerland Bruno Vellas Service de Médecine Interne et Gérontologique Clinique Hôpitaux de Toulouse 170, Av. de Casselardit F Toulouse, France Gilbert Zulian C E S C O Centre de Soins continus Chemin de la Savonnière 11 CH 1245 Collonge-Bellerive, Switzerland Invited Attendees Giorgetta Cappa / Italy Tommy Cederholm / Sweden Jadwiga Charzewska / Poland Lisette De Groot / Holland Dolf De Ridder / Belgium Hedi Decrey / Switzerland Laura Del Corso / Italy Lorenzo D. Donini / Italy Tamas Fülop Jr. / Canada C. Gazzotti / Belgium R. Gonthier / France Robledo L. Gutierrez / Mexico E. Joosten / Belgium Vladimir Kh. Khavinson / Russia Stefan Krajcik / Slovakia Roman Lutynski / Poland Yoram Maaravi / Israel Irena M. Rea / N. Ireland Michel Roulet / Switzerland Taisa Semesko / Ukraine Lumila Sineok / Ukraine Slavica Suzic / Yugoslavia Orien L. Tulp / USA Raivo Vokk / Estonia Paul Wiesel / Switzerland Ulla Wissing / Sweden XII