Assessment of Nutritional Status in Older Adults Using the Mini Nutritional Assessment: Patterns of Impairments and Targets for Dietary Rehabilitation. Analysis of the Multicenter Prospective Study «POSTSCRIPTUM»

Background

. Frailty and related nutritional disorders are highly prevalent among older adults, especially in inpatient settings [1, 2]. The Mini Nutritional Assessment (MNA) is a validated tool that enables not only screening of nutritional status but also a more detailed evaluation of risk factors for developing malnutrition [3].

Objective

— to conduct a comprehensive evaluation of nutritional parameters in patients aged 60 years and older residing in care homes and geriatric centers in Moscow, to detail responses across MNA domains, to identify correlations with functional, psychoemotional and clinical parameters, and to propose targets for dietary interventions.

Materials And Methods

A multicenter prospective study (within the first phase of the «POSTSCRIPTUM» clinical trial) included 792 patients aged 60 years and older (mean age 76.8 ± 8.2 years, 68% women) with indications for geriatric rehabilitation. Nutritional assessment was performed using the full version of the MNA [3]. Based on the total score, patients were divided into two groups: «normal» (MNA ≥24, n = 636) and «at risk of malnutrition» (MNA < 24, n = 156). A comparative analysis of responses to each of the 18 MNA items was carried out, along with correlation analysis between the MNA score and age, body mass index (BMI), functional independence (Barthel Index, Lawton Index), physical performance (Short Physical Performance Battery, SPPB), muscle strength (handgrip dynamometry), cognitive status (Montreal Cognitive Assessment (MoCA), depression (15-item Geriatric Depression Scale, GDS-15), pain (Visual Analogue Scale, VAS score), insomnia (Insomnia Severity Index, ISI), polypharmacy, and frailty screening (score on the «Age Is Not a Hindrance» scale).

Results

. The proportion of patients at risk of malnutrition was 19.7%. Statistically significant differences between groups were found across most MNA domains (p < 0.001). The following factors were significantly more frequent in the malnutrition-risk group: appetite decline (46.8% moderate and 1.3% severe), weight loss over the preceding 3 months (43.6%), mobility limitations (5.8%), acute stress/disease (69.2%), neuropsychological problems (overt dementia or depression —15.4%), polypharmacy (80.8%), pressure ulcers (2.6%), inadequate meal frequency (30.1%), protein-rich food deficit (3.2% with 0–1 markers), insufficient fluid intake (13.5% < 3 cups), low self-perceived nutrition quality (2.6% «insufficient», 26.3% «do not know»), self-rated health «not good» (41.0%), and reduced mid-upper arm circumference (3.2%) and calf circumference (5.8%). Correlation analysis demonstrated a weak positive association between MNA scores and the Barthel Index (r s = 0.26) and SPPB (r s = 0.27), a weak-to-moderate negative association with GDS-15 (r s = –0.31), and weak negative associations with frailty screening (r s = –0.28) and pain (r s = –0.24).

Conclusion

. Malnutrition risk was identified in every fifth patient. Moderate appetite decline, weight loss, neuropsychological problems, polypharmacy and poor self-rated health were widespread among patients at risk of malnutrition. Insufficient protein and fluid intake was also statistically significant. Rank correlation analysis showed a strong relationship between poor nutritional status and depressive symptoms, while other statistically significant associations were less strong, emphasizing the multifactorial nature of nutritional status among older adults. This should be taken into account when diagnosing and treating malnutrition, especially focusing on depression, physical activity and pain. Dietary targets for correction are proposed based on the study's limitations, and the results may be useful for developing nutritional support protocols for geriatric care facilities in Russia.