Adoption of population-specific anthropometric cut-points improves the functionality of the Mini Nutritional Assessment in nursing home residents in Taiwan

[[abstract]]Objective: The study aimed to investigate the functionalities of the original and modified MNA (Mini Nutritional Assessment) in assessing the nutritional status of nursing home residents and to identify the factors associated with the nutritional status. Methods: With a purposive design, the study recruited 103 >65 y residents who were free of acute disease/infection and had a >3 months residence of a nursing home in Central Taiwan as study subjects. An on-site face-to-face interview was carried out on each subject to elicit personal data, health condition and answers to questions in the MNA and CNAQ (Council on Nutrition Appetite Questionnaire). Anthropometrical indicators were also measured. Serum biochemical parameters were obtained from their routine measurements which were maintained by the institution. Subjects' nutritional status was assessed with three versions of the MNA, the original, the MNA-TI which adopted population-specific anthropometric cut-points, and the MNA-TII which further eliminated BMI from the scale and adjusted the scoring. The study protocol was approval by Asia University. Results: The original version graded 27% malnourished, 52% at risk of malnutrition and 20% normal; MNA-TI graded 18.5, 53 and 23%, and MNA-TII graded 23, 47 and 30%, respectively. Analysis with Frieman Test and Wilcoxon Signed-rank post hoc tests showed that the distribution of nutritional status graded with the original MNA was different from that of the two modified versions, but results between the two modified versions were not different from each other. Results also showed that serum albumin, calf circumference, the number of chronic diseases and activities of daily living were significantly correlated with MNA scores. Regression analysis indicates that activities of daily living and calf-circumference are the two major predictors while number of chronic diseases and serum albumin are also significant predictors of the nutritional status. Discussion: Results suggest that MNA modified according to population-specific anthropometric cut-points has improved functionality over the original version. It also shows that MNA-TII which is without BMI can function at least equally well as MNA-TI. Approximately 70% of nursing home residents are at risk of malnutrition. Results of this study suggest that the MNA is useful as a tool for routine monitoring of the nutritional status of nursing home elderly