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Nutritional status using mini nutritional assessment and subjective global assessment predict mortality in geriatric
Margareta D Persson1, Kerstin E Brismar, Krassimir S Katzarski
1Department of Endocrinology, Rosenlunds Hospital, Stockholm, Sweden. margareta.persson@rosger.sspo.sll.se
Objectives:
To evaluate the clinical assessment of nutritional status and mortality in geriatric patients.
Design:
Prospective follow-up study.
Setting:
Acute geriatric inpatient ward.
Participants:
Eighty-three consecutive acute geriatric patients (mean age +/- standard deviation = 83 +/- 7; 68% women).
Measurements:
Patients were classified as (1) having protein-energy malnutrition (PEM), (2) having moderate PEM or being at risk for PEM, or (3) being well nourished according to Subjective Global Assessment (SGA) and Mini Nutritional Assessment (MNA). Body mass index ((BMI) kg/m2), arm anthropometry, and handgrip strength were determined. In a subgroup of patients (n = 39), body composition was analyzed using dual energy x-ray absorption and bioelectrical impedance. Three-year mortality data were obtained from the Swedish population records.
Results:
Twenty percent and 26% of the patients were classified as having PEM based on SGA and MNA, respectively, whereas 43% and 56%, respectively, were classified as having moderate PEM or being at risk for PEM. Objective measures, such as BMI, arm anthropometry, handgrip, and body fat were 20% to 50% lower in the malnourished group than in the well-nourished subjects (P <.05). Moreover, mortality was higher in those classified as being malnourished, ranging from 40% after 1 year to 80% after 3 years, compared with 20% after 1 year (P =.03-0.17) and 50% after 3 years (P <.01) in patients classified as being well nourished.
Conclusion:
Fewer than one-third of newly admitted geriatric patients had a normal nutritional status according to SGA and MNA. BMI, arm anthropometry, body fat mass, and handgrip strength were reduced, and 1-, 2-, and 3-year mortality was higher in patients classified as malnourished. The present data justify the use of SGA and MNA for the assessment of nutritional status in geriatric patients.