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A new era in nutritional assessment: More effective mini nutritional assessment-short form with alternative calf
Neslihan Hazel Önür1, Tuğba Erdoğan1, Zeynep Fethullahoğlu Durmuş1
1Department of Geriatrics, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Türkiye.
Objective:
The Mini Nutritional Assessment-Short Form (MNA-SF) is widely used for nutritional screening in older adults. While body mass index (BMI) is the most common anthropometric parameter, calf circumference (CC) is used when BMI is unavailable, with a cutoff of <31 cm. Recently, sex-and population-specific CC cutoffs and BMI-adjusted CC values have been proposed. This study aimed to examine malnutrition prevalence and its association with mortality among older outpatients using seven MNA-SF modifications, including standard and modified approaches incorporating sex, population-specific CC cutoffs, and/or BMI-adjusted CC values.
Methods:
In this retrospective cohort study, older adults evaluated in our geriatric outpatient clinic between November 2012 and June 2024 were included. Seven MNA-SF modifications were applied. Nutritional status was assessed using seven versions of MNA-SF based on BMI, CC(<31cm), population-specific-CC(<33 cm), sex-specific-CC(<33/34 cm), sex-and population-specific-CC(<32/33 cm), and BMI-adjusted-CC values. Malnutrition was defined as MNA-SF score <8. Malnutrition prevalence and its association with mortality were analyzed using ROC and Cox regression analyses.
Results:
A total of 2051 patients (mean age 74.9 ± 6.9 years, 68.4% female) were analyzed. Mortality was assessed in 1822 patients (median follow-up 74 months), with 631 (33.5%) deaths recorded. The highest mortality incidence (53.8%) was observed in the malnutrition group defined by BMI-adjusted modification. All modifications showed similar predictive value for mortality (AUC 62-64%). However, in multivariate survival analysis, modifications -especially the BMI-adjusted versions-demonstrated stronger and more consistent associations with mortality compared to standard BMI and CC approaches.
Conclusions:
MNA-SF modifications incorporating sex, population-specific cutoffs, and/or BMI-adjusted CC values may improve detection of malnutrition and prediction of adverse outcomes, particularly mortality.
