The journal of nutrition, health & aging

, Volume 15, Issue 3, pp 175–180

Predicting the value of the mini nutritional assessment (MNA) as an indicator of functional ability in older Iranian adults (Kahrizak elderly study)

  • M. Mirarefin
  • Farshad Sharifi
  • H. Fakhrzadeh
  • N. Nazari
  • M. Ghaderpanahi
  • Z. Badamchizade
  • Y. Tajalizadekhoob
JNHA: Nutrition

Abstract

Objective

We aimed to investigate the appropriateness of the Mini Nutritional Assessment (MNA) in predicting functional ability in older adults.

Design

Cross-sectional study.

Setting

Participants were recruited from the Kahrizak Charity Foundation (KCF).

Measurements

Nutritional and ability status were examined using the MNA and the Barthel Index (BI). Participants were divided according to MNA (≤23.5 and > 23.5).

Results

Two hundred and thirty-five ≥ 60-year-old subjects were studied. The MNA and BI were positively correlated (r = 0.199; P = 0.001). The optimal cut-off point for BI with the highest sensitivity and specificity derived from the ROC curve was approximately 91.5 for males and 83.5 for females. The BI was significantly associated with MNA (odds ratio (OR): 1.89; 95% CI: 1.17–3.05, P = 0.009), mobility (OR: 6.39; 95% CI: 3.43–11.89, P < 0.001), consuming ≥ 2 servings of fruit and vegetables (OR: 2.27; 95% CI: 1.09–4.72, P = 0.02) and self-view of nutritional status (OR: 4.15; 95%CI: 1.26–13.63, P = 0.01). The sensitivity (62.9% in males; 68.2% in females) and specificity (51.4% in males and 52.9% in females) of these cut-off points justifies the appropriateness of the MNA for determining functional ability.

Conclusion

The MNA is potentially able to verify functional status among the elderly (as BI ≥ 91.5 with those of < 91.5 in males and ≥ 83.5 with those of < 83.5 in females) of KCF. It is suggested that this relationship should be further studied in a larger prospective population-based study.

Key words

Nutritional assessment functional ability older adults 

Abbreviations

MNA

Mini Nutritional Assessment

BI

Barthel Index

MUAC

Mid Upper Arm Circumference

BMI

Body Mass Index

KCF

Kahrizak Charity Foundation

GNRI

Geriatric Nutritional Risk Index

ADL

Activities of Daily Living

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Skelton DA, Greig CA, Davies JM, Young A (1994) Strength, power and related functional ability of healthy people aged 65–89 years. Age Ageing 23: 371–377.PubMedCrossRefGoogle Scholar
  2. 2.
    Visvanathan R (2003) Under-nutrition in older people: a serious and growing global problem! J Postgrad Med 49: 352–360.PubMedGoogle Scholar
  3. 3.
    Morley JE, Thomas DR (1999) Anorexia and aging: pathophysiology. Nutrition 5: 499–503.CrossRefGoogle Scholar
  4. 4.
    Tsai AC, HO, Chang MC (2008) Assessing the prevalence of malnutrition with the Mini Nutritional Assessment (MNA) in a nationally representative sample of elderly Taiwanese. J Nutr Health Aging 12(4): 239–243.PubMedCrossRefGoogle Scholar
  5. 5.
    White JV, Dwyer JT, Posner BM, Ham RJ, Lipschitz DA, Wellman NS (1992) Nutrition screening initiative: the Nutrition Screening Initiative. Am J Publ Health 92: 163–167.Google Scholar
  6. 6.
    Guigoz Y, Vellas B, Garry PJ (1996) Assessing the nutritional status of the elderly: the Mini Nutritional Assessment as part of the geriatric evaluation. Nutr Rev 54(1 pt 2): S59–S65.PubMedGoogle Scholar
  7. 7.
    Lei Z, Qingyi D, Feng G, Chen W, Hock RS, Changli W (2009) Clinical study of mini nutritional assessment for older Chinese impatients. J Nutr Health Aging 13(10): 871–875.PubMedCrossRefGoogle Scholar
  8. 8.
    Stuck AE, Walthert JM, Nikolaus T, Büla CJ, Hohmann C, Beck JC (1999) Risk factors for functional status decline in community-living elderly people: a systematic literature review. Soc Sci Med 48(4): 445–469.PubMedCrossRefGoogle Scholar
  9. 9.
    Launer LJ, Harris T, Rumpel C, Madans J (1994) Body mass index, weight change and risk of mobility disability in middle-aged and older women. JAMA 271: 1093–1098.PubMedCrossRefGoogle Scholar
  10. 10.
    Cereda E, Valzolgher L, Pedrolli C (2008) Mini nutritional assessment is a good predictor of functional status in institutionalised elderly at risk of malnutrition. Clin Nutr 27(5): 700–705.PubMedCrossRefGoogle Scholar
  11. 11.
    Cereda E, Vanotti A (2007) The new Geriatric Nutritional Risk Index is a good predictor of muscle dysfunction in institutionalized older patients. Clin Nutr 26(1): 78–83.PubMedCrossRefGoogle Scholar
  12. 12.
    Odlund Olin A, Koochek A, Ljungqvist O, Cederholm T (2005) Nutritional status, well-being and functional ability in frail elderly service flat residents. Eur J Clin Nutr 59(2): 263–270.PubMedCrossRefGoogle Scholar
  13. 13.
    Landi F, Zuccala G, Gambassi G, Incalzi RA, Manigrasso L, Pagano F, Carbonin P, Bernabei R (1999) Body mass index and mortality among older people living in the community. J Am Geriatr Soc 47: 1072–1076.PubMedGoogle Scholar
  14. 14.
    Romagnoni F, Zuliani G, Bollini C, Leoci V, Soattin L, Dotto S, Izzotti P, Valerio G, Lotto D, Fellin R (1999) Disability is associated with malnutrition in institutionalized elderly people. The I.R.A. Study. Aging 11: 194–199.Google Scholar
  15. 15.
    Ödlundi Olin A, Koochek A, Ljungqvist O, and Cederholm T (2005) Nutritional status, well-being and functional ability in frail elderly service flat residents. Euro J Clin Nutr 59: 263–270.CrossRefGoogle Scholar
  16. 16.
    Frughan M, Jafari Z, Peymaneh S et al. (2008) Adapting mini mental state exam of old ages dwelling in Tehran, 2006. J Tazeh-hay-e Oloum Shenaakhti 10(2): 29–37. [In Persian]Google Scholar
  17. 17.
    Mahoney FI, Barthel D (1965) Functional evaluation: the Barthel Index. Md State Med J 14: 56–61.Google Scholar
  18. 18.
    Persson M, Brismar KE, Katzarski K, Nordenström J, Cederholm TE (2002) Nutritional status using Mini Nutritional Assessment and Subjective Global Assessment predict mortality in geriatric patients. J Am Geriatr Soc 50: 1996–2002.PubMedCrossRefGoogle Scholar
  19. 19.
    Kikafunda JK, Lukwago FB (2005) Nutritional status and functional ability of the elderly aged 60 to 90 years in the Mpigi district of central Uganda. Nutr 21: 59–66.CrossRefGoogle Scholar
  20. 20.
    Yang RC, Mack GW, Wolfe RR, Nadel ER (1998) Albumin synthesis after intense intermittent exercise in human subjects. J Appl Physiol 84: 584–592.PubMedCrossRefGoogle Scholar
  21. 21.
    Bonnefoy M, Conru C, Normand S, Boutitie F, Bugnard F, Rahmani A, Lacour JR, Laville M (2003) The effects of exercise and proteinenergy supplements on body composition and muscle function in frail elderly individuals: a long-term controlled randomised study. Br J Nutr 89: 731–738.PubMedCrossRefGoogle Scholar
  22. 22.
    Unosson M, Ek AC, Nilsson L, Thorslund L, Bjurulf P (1992) Effects of dietary supplement on functional condition and clinical outcome measured with a modified Nortons cale. Clin Nutr 11: 134–139.PubMedCrossRefGoogle Scholar
  23. 23.
    Potter JM, Roberts MA, McColl J, Reilly JJ (2001) Protein energy supplements in unwell elderly patients—a randomized controlledtrial. J Parent Enteral Nutr 25: 323–329.CrossRefGoogle Scholar
  24. 24.
    Birren JE, Schaie KW, Gatz M, Salthouse TA (2006) Handbook of the psychology of aging. 6th edn. Warner Schaie. Academic Press, San Diego, CA.Google Scholar
  25. 25.
    Fiatarone MA, O’Neill EF, Ryan ND, Clements KM, Solares KM, Nelson ME, Roberts SB, Kehayias JJ, Lipsitz LA, Evans WJ (1994) Exercise training and nutritional supplementation for physical frailty in very elderly people. NEJM 330: 1769–1775.PubMedCrossRefGoogle Scholar
  26. 26.
    Payette H, Guigoz Y, Vellas BJ (1999) Study design for nutritional assessments in the elderly. In: Yu BP (ed) Methods in Aging Research. Boca Raton, Fla: CRC Press LLC, pp 301–320.Google Scholar
  27. 27.
    Bourdel-Marchasson I, Joseph PA, Dehail P, Biran M, Faux P, Rainfray M, Emeriau JP, Canioni P, Thiaudière E (2001) Functional and metabolic early changes in calf muscle occurring during nutritional repletion in malnourished elderly patients. Am J Clin Nutr 73: 832–838.PubMedGoogle Scholar
  28. 28.
    Bos C, Benamouzig R, Bruhat A, Roux C, Mahe S, Valensi P, audichon C, Ferrière F, Rautureau J, Tomé D (2000) Short-term protein and energy supplementation activates nitrogen kinetics and accretion in poorly nourished elderly subjects. Am J Clin Nutr 71:1129–1137.PubMedGoogle Scholar
  29. 29.
    Volpi E, Kobayashi H, Sheffield-Moore M, Mittendorfer B, Wolfe RR (2003) Essential amino acids are primarily responsible for the amino acid stimulation of muscle protein anabolism in healthy elderly adults. Am J Clin Nutr 78: 250–258.PubMedGoogle Scholar
  30. 30.
    Paddon-Jones D, Sheffield-Moore M, Zhang XJ, Volpi E, Wolf SE, Aarsland A, Ferrando AA, Wolfe RR (2004) Amino acid ingestion improves muscle protein synthesis in the young and elderly. Am J Physiol Endocrinol Metab 286: E321–328.PubMedCrossRefGoogle Scholar
  31. 31.
    Ferdous T, Cederholm T, Razzaque A, Wahlin A, Nahar Kabir Z (2009) Nutritional status and self-reported and performance-based evaluation of physical function of elderly persons in rural Bangladesh. Scand J Public Health 37(5): 518–524.PubMedCrossRefGoogle Scholar
  32. 32.
    Yarasheski KE, Zachwieja JJ, Bier DM (1993) Acute effects of resistance exercise on muscle protein synthesis rate in young and elderly men and women. Am J Physiol 265: E210–E214.PubMedGoogle Scholar
  33. 33.
    Morais JA, Ross R, Gougeon R, Pencharz PB, Jones PJ, Marliss EB (2000) Distribution of protein turnover changes with age in humans as assessed by wholebody magnetic resonance image analysis to quantify tissue volumes. J Nutr 130: 784–791.PubMedGoogle Scholar
  34. 34.
    Welle S, Thornton C, Statt M, McHenry B (1994) Post-prandial myofibrillar and whole-body protein synthesis in young and old human subjects. Am J Physiol 267: E288–E294.Google Scholar
  35. 35.
    Polito A, Cuzzolaro M, Raguzzini A, Censi L, Ferro-Luzzi A (1998) Body composition changes in anorexia nervosa. Eur J Clin Nutr 52: 655–662PubMedCrossRefGoogle Scholar
  36. 36.
    Melchior JC (1998) From malnutrition to refeeding during anorexia nervosa. Curr Opin Clin Nutr Metab Care 1: 481–485PubMedCrossRefGoogle Scholar
  37. 37.
    Forbes GB, Reina JC (1970) Adult lean Body Mass declines with age: some longitudinal observations. Metabolism 19: 653–663PubMedCrossRefGoogle Scholar
  38. 38.
    Kyle UG, Genton L, Hans D, Karsegard L, Slosman DO, Pichard C (2001) Agerelated differences in fat-free mass, skeletal muscle, body cell mass and fat mass between 18 and 94 years. Eur J Clin Nutr 55: 663–672.PubMedCrossRefGoogle Scholar
  39. 39.
    Ferdous T, Cederholm T, Kabir ZN, Hamadani JD, Wahlin A (2010) Nutritional Status and Cognitive Function in Community-Living Rural Bangladeshi Older Adults: Data from the Poverty and Health in Ageing Project. J Am Geriatr Soc [Epub ahead of print]Google Scholar
  40. 40.
    Jorissen, BL, Riedel WJ (2002) Nutrients, age and cognition. Clin Nutr 21: 89–95.PubMedCrossRefGoogle Scholar
  41. 41.
    Semba RD, Varadhan R, Bartali B, Ferrucci L, Ricks MO, Blaum C, Fried LP (2007) Low serum carotenoids and development of severe walking disability among older women living in the community: the women’s health and aging study I. Age Ageing 36(1):62–67.PubMedCrossRefGoogle Scholar
  42. 42.
    Semba RD, Blaum C, Guralnik JM, Totin D, Ricks MO, Fried LP (2003) Low carotenoid and vitamin E status are associated with indicators of sarcopenia among older women living in the community. Aging Clin Exp Res 15: 482–487.PubMedGoogle Scholar
  43. 43.
    Cesari M, Pahor M, Bartali B, Cherubini A, Penninx BW, Williams GR, Atkinson H, Martin A, Guralnik JM, Ferrucci L (2004) Antioxidants and physical performance in elderly persons: the Invecchiare in Chianti (InCHIANTI) study. Am J Clin Nutr 79(2): 289–294.PubMedGoogle Scholar
  44. 44.
    Houston DK, Stevens J, Cai J, Haines PS (2005) Dairy, fruit and vegetables intakes and functional limitations and disability in a biracial cohort: the Atherosclerosis Risk in Communities Study. Am J Clin Nutr 81: 515–522.PubMedGoogle Scholar
  45. 45.
    Cook NC, Samman S (1996) Flavonoids — Chemistry, metabolism, cardioprotective effects, and dietary sources. J Nutr Biochem 7: 66–76.CrossRefGoogle Scholar
  46. 46.
    Cohen JH, Kristal AR, Stanford JL (2000) Fruit and vegetable intakes and prostate cancer risk. J of the Natl Cancer Inst 92: 61–68.CrossRefGoogle Scholar
  47. 47.
    Pansarasa O, Castagna L, Colombi B, Vecchiet J, Felzani G, Marzatico F (2000) Age and sex differences in human skeletal muscle: role of reactive oxygen species. Free Radic Res 33:287–293.PubMedCrossRefGoogle Scholar
  48. 48.
    Fano G, Mecocci P, Vecchiet J, Belia S, Fulle S, Polidori MC, Felzani G, Senin U, Vecchiet L, Beal MF (2001) Age and sex influence on oxidative damage and functional status in human skeletal muscle. J Muscle Res Cell Motil 22:345–351.PubMedCrossRefGoogle Scholar
  49. 49.
    Ranhoff AH (1997) Reliability of nursing assistants’ observations of functioning and clinical symptoms and signs. Aging (Milano) 9: 378–380.Google Scholar

Copyright information

© Serdi and Springer Verlag France 2011

Authors and Affiliations

  • M. Mirarefin
    • 1
    • 2
  • Farshad Sharifi
    • 2
    • 3
    • 7
  • H. Fakhrzadeh
    • 4
  • N. Nazari
    • 5
  • M. Ghaderpanahi
    • 1
    • 2
  • Z. Badamchizade
    • 2
    • 6
  • Y. Tajalizadekhoob
    • 2
  1. 1.Master of Nutrition, Endocrinology and Metabolism Research CenterTehran University of Medical SciencesTehranIran
  2. 2.Endocrinology and Metabolism Research CenterTehran University of Medical SciencesTehranIran
  3. 3.MPH of Gerontology, Director of Research and Educational AffairsKahrizak Charity FoundationTehranIran
  4. 4.Dr Shareeati HospitalTehran University of Medical SciencesTehranIran
  5. 5.Bachelor of Nutrition, ResearcherKahrizak Charity FoundationTehranIran
  6. 6.Bachelor of Nursing, Endocrinology and Metabolism Research CenterTehran University of Medical SciencesTehranIran
  7. 7.Endocrinology & Metabolism Research CenterTehran University of Medical SciencesTehranIran

Personalised recommendations