SCREENING OF NUTRITIONAL STATUS AMONG ELDERLY PEOPLE AT FAMILY MEDICINE

Prevalencija malnutricije kod osoba starije životne dobi je visoka. Otkrivanje malnutricije ili rizika za nastanak malnutricije se može sprovesti korištenjem instrumenata za probir i procjenu nutritivnog statusa. Cilj ovog preglednog članka je istražiti instrumente kojima je bilo provedeno istraživanje validnosti, pouzdanosti, specifi čnosti i senzitivnosti za probir nutritivnog statusa osoba starijih od 65 godina u obiteljskojj medicini. Sistematski pregled literature učinjen je prema iskazu Preferencijalno izvještavanje o stavkama za sistematske preglede i meta-analiza (Preferred Reporting Items for Systematic Reviews and meta-analysis (PRISMA) statement). Studije su preuzete preko elektronskih baza MEDLINE, Pubmed i Cochrane Library, te manualnim pretraživanjem relevantnih studija citiranih u listi referenci ključnih članaka. Elektronske baze su pretraživane defi niranjem ključnih riječi (nutrition, nutritional status, malnutrition, screening, assessment, evaluation, tool, family medicine, general practice) adaptiranih za svaku bazu i korištenjem termina MESH (Medical Subject Headings). Manualno pretraživanje preglednih članaka i originalnih članaka učinjeno je preko Electronic Journals Library. Uključene studije su obuhvatile ispitivanje validacije instumenata probira nutritivnog statusa na samostalnim osobama starijim od 65 godina života. Analizom studija pronađeni su sljedeći instrumenti: Mini nutritivna procjena (engl. Mini Nutritional Assessment - MNA), Kratka Mini nutritivna procjena (engl. Mini Nutritional Assessment-Short Form - MNA-SF), Inicijativa za nutritivni probir (engl. Nutrition Screening Initiative - NSI), koja uključuje listu DETERMINE, Level I i II Screen, Stari u zajednici: Evaluacija rizika za jedenje i nutriciju (engl. Seniors in the Community: Risk Evaluation for Eating and Nutrition -SCREEN I and SCREEN II), Subjektivna globalna procjena (engl. Subjective Global Assessment - SGA), Indeks nutritivnog rizika (engl. Nutritional Risk Index - NRI), zatim južnoafrički i malezijski instrument bez specifi čnog naziva. MNA i MNA-SF imaju najveću pouzdanost i validnost za probir nutritivnog statusa (NS) u zajednici, a pouzdanost i validnost SCREEN II su zadovoljavajući. Premda je za probir NS kod samostalnih osoba starijih od 65 godina razvijeno nekoliko instrumenata, većina nije prošla sveobuhvatno ispitivanje validnosti. MNA i MNA-SF imaju najveću pouzdanost i validnost za skrining NS kod samostalnih osoba starijih od 65 godina, a pouzdanost i validnost SCREEN II su zadovoljavajuće. Ovi instrumenti također sadrže sva tri indikatora NS i praktični su za korištenje u obiteljskoj medicini. Ipak, zlatni standard za probir se ne može postaviti jer je dalje ispitivanje pouzdanosti i kontinuiranu validaciju studijama više razine dokaza potrebno kontinuirano sprovesti u obiteljskoj medicini.The prevalence of malnutrition in elderly is high. Malnutrition or risk of malnutrition can be detected by use of nutritional screening or assessment tools. This systematic review aimed to identify tools that would be reliable, valid, sensitive and specifi c for nutritional status screening in patients older than 65 at family medicine. The review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies were retrieved using MEDLINE (via Ovid), PubMed and Cochrane Library electronic databases and by manual searching of relevant articles listed in reference list of key publications. The electronic databases were searched using defi ned key words adapted to each database and using MESH terms. Manual revision of reviews and original articles was performed using Electronic Journals Library. Included studies involved development and validation of screening tools in the community-dwelling elderly population. The tools, subjected to validity and reliability testing for use in the community-dwelling elderly population were Mini Nutritional Assessment (MNA), Mini Nutritional Assessment-Short Form (MNA-SF), Nutrition Screening Initiative (NSI), which includes DETERMINE list, Level I and II Screen, Seniors in the Community: Risk Evaluation for Eating, and Nutrition (SCREEN I and SCREEN II), Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), and Malaysian and South African tool. MNA and MNA-SF appear to have highest reliability and validity for screening of community-dwelling elderly, while the reliability and validity of SCREEN II are good. The authors conclude that whilst several tools have been developed, most have not undergone extensive testing to demonstrate their ability to identify nutritional risk. MNA and MNA-SF have the highest reliability and validity for screening of nutritional status in the community-dwelling elderly, and the reliability and validity of SCREEN II are satisfactory. These instruments also contain all three nutritional status indicators and are practical for use in family medicine. However, the gold standard for screening cannot be set because testing of reliability and continuous validation in the study with a higher level of evidence need to be conducted in family medicine