Population-specific Mini Nutritional Assessment can improve mortality-risk-predicting ability in institutionalised older Taiwanese

Authors

  • Alan C Tsai,

    1. Authors:Alan C Tsai, PhD, Professor, Graduate Institute of Long-term Care, Asia University, Wufeng, Taichung, Taiwan and Associate Professor Emeritus, Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Pei-Yu Ku, MS, Registered Nurse, Chang-Hua Nursing Home, MOI, Chang-Hua; Jeng-Dau Tsai, MD, Instructor, Institute of Medical Science, Chung-Shan Medical University, Taichung, Taiwan
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  • Pei-Yu Ku,

    1. Authors:Alan C Tsai, PhD, Professor, Graduate Institute of Long-term Care, Asia University, Wufeng, Taichung, Taiwan and Associate Professor Emeritus, Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Pei-Yu Ku, MS, Registered Nurse, Chang-Hua Nursing Home, MOI, Chang-Hua; Jeng-Dau Tsai, MD, Instructor, Institute of Medical Science, Chung-Shan Medical University, Taichung, Taiwan
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  • Jeng-Dau Tsai

    1. Authors:Alan C Tsai, PhD, Professor, Graduate Institute of Long-term Care, Asia University, Wufeng, Taichung, Taiwan and Associate Professor Emeritus, Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Pei-Yu Ku, MS, Registered Nurse, Chang-Hua Nursing Home, MOI, Chang-Hua; Jeng-Dau Tsai, MD, Instructor, Institute of Medical Science, Chung-Shan Medical University, Taichung, Taiwan
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Alan C Tsai, Associate Professor Emeritus, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA. Telephone: 734 761 2468.
E-mail:atsai@umich.edu

Abstract

Aim and objectives.  The study determined whether a new version of the Mini Nutritional Assessment that adopted population-specific anthropometric cut-points would improve the mortality-predicting ability in institutionalised Taiwanese older people.

Background.  Routine screening is the key for detecting emerging malnutrition, but the tool must be simple, reliable and easy-to-use to be well accepted. The Mini Nutritional Assessment can meet these requirements, but for non-Western populations, modifications based on anthropometric considerations are needed.

Design.  The study purposively sampled 208 residents, aged >65 years, of a long-term care institution in Central Taiwan. Subjects were free of acute infection/disease and able to communicate. A university human-subject-study ethics committee approved the protocol.

Methods.  The study included biochemical measurements and a structured questionnaire for eliciting personal data and answers to questions in the Mini Nutritional Assessment. Follow-up survival/mortality was tracked for two consecutive six-month periods and analysed according to nutritional statuses graded with the original or a modified Mini Nutritional Assessment. The modified version adopted population-specific anthropometric cut-points and was without body mass index.

Results.  The modification improved the mortality-predictive ability. Mortality rates for the first six months were 8·7, 3·9 and 0% according to the original Mini Nutritional Assessment and 10·6, 3·4 and 0% according to the modified version for subjects rated malnourished, at risk of malnutrition and normal, respectively. The mortality-predictive ability of both versions weakened after six months.

Conclusion.  Both versions can predict follow-up mortality, but the modified version has improved ability. For best results, the tool should be applied every six months or less (shorter for more frail older people) to screen for new cases of at-risk individuals.

Relevance to clinical practice.  The Mini Nutritional Assessment that adopts population-specific anthropometric cut-points may have improved nutritional-risk and mortality-risk predictive abilities. The tool can help care-workers detect emerging nutritional problems and enable timely intervention. Routine use of the tool may help improve the quality of care.

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