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Clinical nutrition

Predictive value of the mini-nutritional assessment short form (MNA-SF) and nutritional risk screening (NRS2002) in hip fracture

European Journal of Clinical Nutrition volume 73, pages 112–120 (2019)Cite this article

Subjects

Abstract

Background/Objectives

To examine Mini-Nutritional Assessment short form (MNA-SF) and Nutritional Risk Screening 2002 (NRS2002) as prognostic indicators of postoperative complications, length of hospital stay (LOS), readmissions, mobility, living arrangements and mortality after hip fracture.

Subjects/Methods

Population-based prospective data were collected on 265 consecutive hip fracture patients aged 65 and over. Nutritional status according to MNA-SF and NRS2002 was assessed on admission. Outcomes were postoperative complications, LOS, readmissions and mortality 1 and 4 months post fracture and changes in mobility level and living arrangements 4 months post fracture.

Results

At baseline, 18 (7%) patients were malnourished and 108 (41%) at risk of malnutrition according to MNA-SF. According to NRS2002, 11 (4%) patients were at severe risk and 56 (21%) patients at moderate risk of malnutrition. Only MNA-SF predicted mortality, LOS and readmissions. Both instruments proved ineffective in predicting changes in mobility level and living arrangements.

Conclusions

MNA-SF is superior to NRS2002 in predicting short-term hip fracture outcomes.

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References

  1. Cheng S, Levy A, Lefaivre K, Guy P, Kuramoto L, Sobolev B. Geographic trends in incidence of hip fractures: a comprehensive literature review. Osteoporos Int. 2011;22:2575–86.

    Article  CAS  Google Scholar 

  2. Kanis J, Oden A, McCloskey E, Johansson H, Wahl D, Cooper C. A systemic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int. 2012;23:2239–56.

    Article  CAS  Google Scholar 

  3. Stolee P, Poss J, Cook R, Byrne K, Hirdes J. Risk factors for hip fracture in older home care clients. J Gerontol A Biol Sci Med Sci. 2009;64:403–10.

    Article  Google Scholar 

  4. Kaiser M, Bauer J, Rämsch C, Uter W, Guigoz Y, Cederholm T, et al. Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment. J Am Geriatr Soc. 2010;58:1734–8.

    Article  Google Scholar 

  5. Drevet s, Bioteau C, Maziere S, Couturier P, Merloz P, Tonetti J, Gavazzi G. Prevalence of protein-energy malnutrition in hospital patients over 75 years of age admitted for hip fracture. Orthop Trauma Surg Res. 2014;100:669–74.

    Article  CAS  Google Scholar 

  6. Correia M, Hegazi R, Higashiguchi T, Michel J, Reddy B, Tappenden K, et al. Evidence-based recommendations for addressing malnutrition in health care: an updated strategy from the feed M.E. Global Study Group. Jamda. 2014;15:544–50.

    PubMed  Google Scholar 

  7. Nicholson J, Dowrick A, Liew S. Nutritional status and short-term outcome of hip arthroplasty. J Orthop Surg. 2012;20:331–5.

    Article  Google Scholar 

  8. Lim S, Ong K, Chan Y, Loke W, Ferguson M, Daniels L. Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Clin Nutr. 2012;31:345–50.

    Article  Google Scholar 

  9. Carpintero P, Caeiro J, Carpintero R, Morales A, Silva S, Mesa M. Complications of hip fractures: a review. World J Orthop. 2014;18:402–11.

    Article  Google Scholar 

  10. Nuotio M, Tuominen P, Luukkaala T. Association of nutritional status as measured by the Mini-Nutritional Assessment Short Form with changes in mobility, institutionalization and death after hip fracture. Eur J Clin Nutr. 2016;70:393–8.

    Article  CAS  Google Scholar 

  11. Helminen H, Luukkaala T, Saarnio J, Nuotio M. Comparison of the Mini-Nutritional Assessment short and long form and serum albumin as prognostic indicators of hip fracture outcomes. Injury. 2017;48:903–8.

    Article  Google Scholar 

  12. Kondrup J, Allison S, Elia M, Vellas B, Plauth M. ESPEN Guidelines for Nutrition Screening 2002. Clin Nutr. 2003;22:415–21.

    Article  CAS  Google Scholar 

  13. Rasmussen H, Holst M, Kondrup J. Measuring risk in hospitals. Clin Epidemiol. 2010;2:209–16.

    Article  Google Scholar 

  14. van Bokhorst-de van der Schueren M, Guaitoli P, Jansma E, de Vet H. Nutrition screening tools: does one size fit all? A systemic review of screening tools for the hospital setting. Clin Nutr. 2014;33:39–58.

    Article  Google Scholar 

  15. Vellas B, Villars H, Abellan G, Soto M, Rolland Y, Guigoz Y. Overview of the MNA—Its history and challenges. J Nutr Health Aging. 2006;10:456–63.

    CAS  PubMed  Google Scholar 

  16. Rubenstein L, Harker j, Salva A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). J Gerontol a Biol Med Sci. 2001;56:366–72.

    Article  Google Scholar 

  17. Kondrup J, Rasmussen H, Hamberg O, Stanga Z, Ad Hoc ESPEN Working Group. Nutritional risk screening (NRS2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003;22:321–36.

    Article  Google Scholar 

  18. Koren-Hakim T, Weiss A, Hershkovitz A, Otzrateni I, Anbar R, Gross Nevo R, et al. Comparing the adequacy of the MNA-SF, NRS-2002 and MUST nutritional tools in assessing malnutrition in hip fracture operated elderly patients. Clin Nutr. 2016;35:1053–8.

    Article  Google Scholar 

  19. Sankar A, Johnson S, Beattle W, Tait G, Wijeysundera D. Reliability of the American Society of Anesthesiologists physical status scale in clinical practice. Br J Anaesth. 2014;113:424–32.

    Article  CAS  Google Scholar 

  20. Suhonen J, Rahkonen T, Juva K, Pitkälä K, Voutilainen P, Erkinjuntti T. The treatment pathway of a memory disorder patient. Duodecim. 2011;127:1107–16.

    PubMed  Google Scholar 

  21. Zhou J, Wang M, Wang H, Chi Q. Comparison of two nutrition assessment tools in surgical elderly inpatients in Northern China. Nutr J. 2015;14:68.

    Article  Google Scholar 

  22. Holst M, Yifter-Lindgren E, Surowiak M, Nielsen K, Mowe M, Carlsson M, et al. nutritional screening and risk factors in elderly hospitalized patients: association to clinical outcome? Scand J Caring Sci. 2013;27:953–61.

    Article  Google Scholar 

  23. Baek M, Heo Y. Evaluation of the efficacy of nutritional screening tools to predict malnutrition in the elderly at a geriatric care hospital. Nutr Res Pract. 2015;9:637–43.

    Article  Google Scholar 

  24. Bjorgul K, Novicoff W, Saleh K. American Society of Anesthesiologist Physical Status score may be used as a comorbidity index in hip fracture surgery. J Arthoplasty. 2010;25:134–7.

    Article  Google Scholar 

  25. Olofsson B, Stenvall M, Lundström M, Svensson O, Gustafson Y. Malnutrition in hip fracture patients: an intervention study. J Clin Nurs. 2007;16:2027–38.

    Article  Google Scholar 

  26. Bell J, Bauer J, Capra S, Pulle R. Concurrent and predictive evaluation of malnutrition diagnostic measures in hip fracture inpatients: a diagnostic accuracy study. Eur J Clin Nutr. 2014;68:358–62.

    Article  CAS  Google Scholar 

  27. Botella-Carretero J, Iglesias B, Balsa J, Arrieta F, Zamarron I, Vazquez C. Perioperative oral nutritional supplements in normally or mildly undernourished geriatric patients submitted to surgery for hip fracture: a randomized clinical trial. Clin Nutr. 2010;29:574–9.

    Article  CAS  Google Scholar 

  28. Jie B, Jiang Z, Nolan M, Efron D, Zhu S, Yo K, Kondrup J. Impact of nutritional support on clinical outcome in patients at nutritional risk: a multicenter, prospective cohort study in Baltimore and Beijing teaching hospitals. Nutrition. 2010;26:1088–93.

    Article  Google Scholar 

  29. Cawood A, Elia M, Stratton R. Systemic review and meta-analysis of the effects of high protein oral nutritional supplements. Ageing Res Rev. 2012;11:278–96.

    Article  CAS  Google Scholar 

  30. Avenell A, Smith T, Curtain J, Mak J, Myint P. Nutritional supplementation for hip fracture aftercare in older people. Cochrane Database Syst Rev. 2016;30:11:CD001880.

    Google Scholar 

  31. Helminen H, Luukkaala T, Saarnio J, Nuotio M. Changes in nutritional status and associated factors in a geriatric post-hip fracture assessment. Eur Ger Med. 2017;8:134–9.

    Article  Google Scholar 

  32. Jyväkorpi S, Pitkälä K, Puranen T, Björkman M, Kautiainen H, Strandberg T, et al. High proportions of older people with normal nutritional status have poor protein intake and low diet quality. Arch Gerontol Geriatr. 2016;67:40–5.

    Article  Google Scholar 

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Acknowledgements

Ms Kaisu Haanpää, RN, is gratefully acknowledged for her expert collection of data and performing the MNAs on patients. This study was financially supported by the State Research Financing of Seinäjoki Central Hospital.

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Authors and Affiliations

  1. Senior physician, Department of Surgical, Seinäjoki Central Hospital, Seinäjoki, Finland

    Heli Helminen

  2. Biostatistician Science Center Pirkanmaa Hospital District, Tampere Finland and School of Health Sciences, University of Tampere, Tampere, Finland

    Tiina Luukkaala

  3. Cheaf, Department of Surgical, Oulu University Hospital, Oulu, Finland

    Juha Saarnio

  4. Cheaf, Department of Geriatric Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland

    Maria S. Nuotio

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  1. Heli Helminen
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Correspondence to Heli Helminen.

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Helminen, H., Luukkaala, T., Saarnio, J. et al. Predictive value of the mini-nutritional assessment short form (MNA-SF) and nutritional risk screening (NRS2002) in hip fracture. Eur J Clin Nutr 73, 112–120 (2019). https://doi.org/10.1038/s41430-018-0267-y

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