NUTRITIONAL ASSESSMENT IN OLDER ADULTS

<table><caption>**Table 15 (continued)**
MNA® Sensitivity/Specificity against Nutritional assessment parameters & other parameters</caption><thead><tr><th>Reference</th><th>Sensitivity</th><th>Specificity</th><th>References</th></tr></thead><tbody><tr><td>A dietitian assessment was used as the gold standard</td><td>80</td><td>90</td><td>Harris D.G. et al. J Hum Nutr Diet. 2008;21:3-9</td></tr><tr><td>SGA</td><td>95</td><td>61</td><td>Velasco C. Et al. Eur J Clin Nutr. 2011;65:269-274</td></tr><tr><td>To identify the ability for predicting development of complications in hospitalized patients</td><td>73</td><td>57</td><td>Ocón Bretón M.J. et al. Nutr Hosp 2012;27:701-706</td></tr><tr><td>Frailty Fried's Criteria</td><td>56</td><td>91</td><td>Dent E. Et al. J Nutr Health Aging 2012;16:764-767</td></tr><tr><td>SGA</td><td>84</td><td>88</td><td>Sheard J.M. et al. E-SPEN Journal 2013;8:e187-e92</td></tr><tr><td>SGA</td><td>71</td><td>99</td><td>Sheean P.M. et al. Clin Nutr 2013;32:752-757</td></tr><tr><td>NRS-2002</td><td>87</td><td>44</td><td></td></tr><tr><td>NRS-2002 for elderly &gt;70 years</td><td>81</td><td>96</td><td></td></tr><tr><td>In hospital mortality</td><td>74</td><td>42</td><td>Abd-El-Gawad W.M. et al. Clin Nutr 2014;33:1108-1116</td></tr><tr><td>Prolonged hospital length of stay</td><td>72</td><td>37</td><td></td></tr><tr><td>Infectious complications</td><td>72</td><td>31</td><td></td></tr><tr><td>Clinical assessment by two qualified physicians</td><td>90</td><td>96</td><td>Shilpa J. & Kumari K.S. Int J of Adv Res 2014;2:214-221</td></tr><tr><td>BMI &lt;20</td><td>95</td><td>94</td><td></td></tr><tr><td>Mid Upper Arm Circumference &lt;22 cm</td><td>91</td><td>59</td><td></td></tr><tr><td>Calf Circumference &lt;31 cm</td><td>73</td><td>98</td><td></td></tr><tr><td>Combined index: malnourished to any degree or at risk of malnutrition according to at least 4 out of 5 of the screening tools (MNA®, MNA®-SF, GNRI, MUST, NRS-2002)</td><td>100</td><td>61</td><td>Baek M.-A. Et al. Nutr Res Pract 2015;9(6):637-643</td></tr><tr><td>SGA</td><td>93</td><td>72</td><td>Calleja Fernández A. Et al.</td></tr><tr><td>Nutr Hosp 2015;31:2240-2246</td><td></td><td></td><td></td></tr><tr><td>Clinical Status (extensive evaluation(anthropometry, biochemical markers, 3d diet record, CG) by 2 geriatricians)</td><td>92</td><td>86</td><td>Sarikaya D. Et al.</td></tr><tr><td>Arch Gerontol Geriatr 2015;61:56-60</td><td></td><td></td><td></td></tr><tr><td>BMI &lt;18.5 kg/m²</td><td>74</td><td>63</td><td>Machado R.S.P. et al. BMC Geriatr 2015;15:132</td></tr><tr><td>Mid-arm circumference &lt;23 cm</td><td>83</td><td>77</td><td></td></tr><tr><td>Calf circumference &lt;31 cm</td><td>67</td><td>80</td><td></td></tr><tr><td>Body fat (&lt;24% women/&lt;14% men)</td><td>59</td><td>74</td><td></td></tr><tr><td>ICD-10-AM criteria</td><td>58</td><td>97</td><td>Marshall S. Et al. J Acad Nutr Diet 2016;116:785-794</td></tr><tr><td>BMI</td><td>86</td><td>67</td><td>Ghimire S P. Et al plos One 2017;12:e0172052</td></tr><tr><td>BMI &lt;18.5 kg/m²</td><td>80</td><td>73</td><td>Hailemariam H. Et al. BMC Nutrition 2016;2:11</td></tr><tr><td>Chang nutritional assessment</td><td>63</td><td>73</td><td>Muñoz Díaz B. Et al. (2019) Family Practice 2019;36:172-178</td></tr><tr><td>Serum albumin ≥3.5 g/ml</td><td>75</td><td>78</td><td>Doroudi T. Et al. Int J Prev Med 2019;10:168</td></tr><tr><td>BMI &lt;18.5 kg/m²</td><td>88</td><td>90</td><td>Woldekidan M.A. et al. South Afr J Clin Nut Online 27 Mar 2020</td></tr><tr><td>Mean</td><td>80</td><td>68</td><td></td></tr><tr><td>± SD</td><td>13</td><td>22</td><td></td></tr><tr><td>Range</td><td>56 - 100</td><td>31 - 99</td><td></td></tr></tbody></table>
THE JOURNAL OF NUTRITION, HEALTH & AGING

<table><caption>**Table 16**
MNA® -SF Sensitivity/Specificity against Nutritional assessment parameters & other parameters</caption><thead><tr><td>Reference</td><td>Sensitivity</td><td>Specificity</td><td>References</td></tr></thead><tbody><tr><td>Detailed nutritional assessment</td><td>93</td><td>38</td><td>Visvanathan R. Et al. Age Ageing 2004;33:260-265</td></tr><tr><td>Malnutrition by nutritionist</td><td>100</td><td>38</td><td>Ranhoff AH et al. J Nutr Health Aging 2005;9:221-225.</td></tr><tr><td>BMI&lt;23</td><td>86</td><td>71</td><td></td></tr><tr><td>BMI&lt;18.5</td><td>100</td><td>74.1</td><td>Suzana S.J. et al. Malays J Nutr 2007;13:29-44</td></tr><tr><td>MUAC (&lt;22cm for women; &lt;23cm for men)</td><td>81.8</td><td>97.3</td><td></td></tr><tr><td>CC (&lt;27.3cm for women; &lt;30.1cm for men)</td><td>91</td><td>74</td><td></td></tr><tr><td>Dietitian assessment</td><td>80</td><td>90</td><td>Harris D.G. et al. J Hum.Nutr Diet 2008;21:3-9</td></tr><tr><td>Albumin 3.5 g/dl</td><td>44</td><td>61</td><td>Yamada K. Et al. Am J Clin Nutr 2008;87:106-113</td></tr><tr><td>Prealbumin 30 mg/dl</td><td>48</td><td>67</td><td></td></tr><tr><td>BMI &lt; 18.5 kg/m²</td><td>100</td><td>81</td><td></td></tr><tr><td>Thigh muscle area/Thigh bone area &lt;10</td><td>65</td><td>68</td><td></td></tr><tr><td>CONUT (controlling nutritional status): albumin, total cholesterol and total lymphocyte count</td><td>77</td><td>61</td><td>Jürschik Jiménez P. Et al. Arch Latinoam Nutr 2009;59(1):38-46</td></tr><tr><td>Moderate risk of malnutrition (5-10% unintentional weight loss last 6 months, BMI &lt;20.0 kg/m2) and severe risk of malnutrition (BMI &lt;18.5 kg/m2, weight loss &gt;5% last month or &gt;10% last 6 months)</td><td>100</td><td>41</td><td>Neelemmaat F. Et al. J Clin Nurs 2011; 20:2144-2152</td></tr><tr><td>BMI & Weight Loss:</td><td></td><td></td><td>Hertroijs D. Et al. J Rehabil Med 2012;44:696-701</td></tr><tr><td>1. Severely undernourished: BMI &lt; 20 and/or &gt; 5% unintentional weight loss in the past month and/or &gt; 10% unintentional weight loss in the past 6 months</td><td>93</td><td>44</td><td></td></tr><tr><td>2. Moderately undernourished: BMI 20-22 and/or 5-10% unintentional weight loss in the past 6 months</td><td>44</td><td>89</td><td></td></tr><tr><td>Frailty</td><td></td><td></td><td></td></tr><tr><td>Fried's Criteria</td><td>64</td><td>79</td><td>Dent E. Et al.</td></tr><tr><td>J Nutr Health Aging 2012;16:764-767</td><td></td><td></td><td></td></tr><tr><td>SGA as reference</td><td>95</td><td>78</td><td>Sheard J.M. et al. E-SPEN Journal 2013;8:e187-e92</td></tr><tr><td>SGA as reference</td><td>100</td><td>53</td><td>Young A.M. et al. Nutrition 2013;29:101-106</td></tr><tr><td>Prediction of inadequate energy intake</td><td>72</td><td>29</td><td></td></tr><tr><td>In hospital mortality</td><td>73.7</td><td>41.5</td><td>Abd-El-Gawad W.M. et al. Clin Nutr 2014;33:1108-1116</td></tr><tr><td>Prolonged hospital length of stay</td><td>72.3</td><td>36.7</td><td></td></tr><tr><td>Infectious complications</td><td>71.6</td><td>30.6</td><td></td></tr><tr><td>Combined index: malnourished to any degree or at risk of malnutrition according to at least 4 out of 5 of the screening tools (MNA®, MNA®-SF, GNRI, MUST, NRS-2002)</td><td>100</td><td>49.4</td><td>Baek M-H. & Heo Y-R. Nutr Res Pract 2015;9:637-643</td></tr><tr><td>Clinical Status (extensive evaluation(anthropometry, biochemical markers, 3d diet record, CG) by 2 geriatricians)</td><td>94</td><td>81</td><td>Sarikaya D. Et al. Arch Gerontol Geriatr 2015;61:56-60</td></tr><tr><td>Frailty:</td><td></td><td></td><td></td></tr><tr><td>Fried's frailty index</td><td>94</td><td>83.3</td><td>Lilamand M. Et al. J Nutr Health Aging 2015:19:570-574</td></tr><tr><td>Albumin 3.5 g/dl</td><td>68</td><td>61</td><td>Zhou J. Et al. Nutr J 2015;14:68</td></tr><tr><td>ICD-10-AM criteria</td><td>100</td><td>23</td><td>Marshall S. Et al. J Acad Nutr Diet 2016;116:795-801</td></tr><tr><td>Muscle wasting: i. E., appendicular skeletal muscle mass two standard deviations (SD) below the mean of a healthy young reference group aged 18-40 years</td><td>74</td><td>54</td><td>Saitoh M. Et al. Wien Klin Wochenschr 2016;128:497-504</td></tr><tr><td>ESPEN diagnostic criteria</td><td>100</td><td>63</td><td>Van der Sijp M.P.L. et al. Injury 2018;49:2239-2243</td></tr></tbody></table>
NUTRITIONAL ASSESSMENT IN OLDER ADULTS

<table><caption>**Table 16 (continued)**
MNA® -SF Sensitivity/Specificity against Nutritional assessment parameters & other parameters</caption><thead><tr><th>Reference</th><th>Sensitivity</th><th>Specificity</th><th>References</th></tr></thead><tbody><tr><td>ESPEN diagnostic criteria</td><td>58</td><td>65</td><td>Sánchez-Rodríguez D, et al. Arch Gerontol Geriatr 2018;76:210-214</td></tr><tr><td>SENPE-SEDOM coding criteria</td><td>96</td><td>52</td><td>Castro-Vega I. Et al. Nutr Hosp 2018;35(2):351-358</td></tr><tr><td>Clinical dietitian's assessment of malnutrition</td><td>53</td><td>68</td><td>Thomas J. Et al. Br J Nutr 2019;122:689-697</td></tr><tr><td>SGA as reference</td><td>79</td><td>88</td><td>Joaquín C. Et al. Clin Nutr. 2019;38:2740-2746</td></tr><tr><td>Serum albumin ≥3.5 g/ml</td><td>63</td><td>65</td><td>Doroudi T. Et al. Int J Prev Med 2019;10:168</td></tr><tr><td>BMI <18.5 kg/m²</td><td>86</td><td>90</td><td>Woldekidan M.A. et al. South Afr J Clin Nut Online 27 Mar 2020</td></tr><tr><td>Research nutritionist risk rating score</td><td>95</td><td>89</td><td>Pavlović J.R. et al. (2020) Public Health Nutr on line September 01, 2020</td></tr><tr><td>Mean</td><td>81</td><td>63</td><td></td></tr><tr><td>± SD</td><td>18</td><td>20</td><td></td></tr><tr><td>Range</td><td>44-100</td><td>23-90</td><td></td></tr></tbody></table>
THE JOURNAL OF NUTRITION, HEALTH & AGING

<table><caption>**Table 17**
MNA® -SF Sensitivity/Specificity against MNA®</caption><thead><tr><th>Reference</th><th></th><th>Sensitivity</th><th>Specificity</th><th>References</th></tr></thead><tbody><tr><td>MNA®</td><td></td><td>96</td><td>98</td><td>Rubenstein LZ et al. 2001</td></tr><tr><td>MNA®</td><td></td><td>86</td><td>89</td><td>Cohendy R et al. 2001</td></tr><tr><td>MNA®</td><td>Community</td><td>74</td><td>95</td><td>Borowiak E. & Kostka T. 2003</td></tr><tr><td>MNA®</td><td>Insitution</td><td>64</td><td>100</td><td></td></tr><tr><td>MNA®</td><td></td><td>86</td><td>94</td><td>Kuzuya M et al. 2005</td></tr><tr><td>MNA®</td><td></td><td>100</td><td>95</td><td>Charlton K.E: et al. 2007</td></tr><tr><td>MNA®</td><td></td><td>89</td><td>82</td><td>Wikby et al. 2008</td></tr><tr><td>MNA®</td><td></td><td>85</td><td>89</td><td>Cuervo M. Et al Public Health Nutr 2009;12:82-90</td></tr><tr><td>MNA®</td><td></td><td>89</td><td>44</td><td>Charlton K.E. et al. J Nutr Health Aging 2010;4:622-628</td></tr><tr><td>MNA®</td><td></td><td>95</td><td>64</td><td>Calvo I. Et al. Nutr Hosp 2012;27:1619-1625</td></tr><tr><td>MNA®</td><td></td><td>72</td><td>98</td><td>Sheean P.M. et al. Clin Nutr 2013;32:752-757</td></tr><tr><td>MNA®</td><td></td><td>81</td><td>97</td><td>MNA® -SF CC Donini L.M. et al. J Nutr Health Aging 2013;17:332-328</td></tr><tr><td>MNA®</td><td></td><td>96</td><td>79</td><td>Young A.M. et al. Nutrition 2013;29:101-106</td></tr><tr><td>MNA®</td><td>Urban Community</td><td>100</td><td>97</td><td>MNA® -SF BMI Kostka J. Et al. J Nutr Health Aging 2014;18:366-371</td></tr><tr><td>MNA®</td><td>Rural Community</td><td>92</td><td>94</td><td>MNA® -SF CC</td></tr><tr><td>MNA®</td><td>Insitution</td><td>83</td><td>96</td><td></td></tr><tr><td>MNA®</td><td>Urban Community</td><td>88</td><td>97</td><td></td></tr><tr><td>MNA®</td><td>Rural Community</td><td>81</td><td>90</td><td></td></tr><tr><td>MNA®</td><td>Insitution</td><td>74,1</td><td>94</td><td></td></tr><tr><td>MNA®</td><td></td><td>94</td><td>83</td><td>Lilamand M. Et al. J Nutr Health Aging 2015:19:570-574</td></tr><tr><td>MNA®</td><td></td><td>96</td><td>56</td><td>Donini L.M. et al. J Am Med Dir Assoc 2016;17(10):959.e11-959.e18</td></tr><tr><td>MNA®</td><td></td><td>73</td><td>87</td><td>Montejano Lozoya R. Et al. Peerj 2017;5:e3345</td></tr><tr><td>MNA®</td><td></td><td>90</td><td>78</td><td>MNA® -SF BMI Dent E. Et al. Australas J Ageing 2017;36:E8-E31</td></tr><tr><td>MNA®</td><td></td><td>95</td><td>65</td><td>MNA® -SF CC</td></tr><tr><td>MNA®</td><td></td><td>71</td><td>94</td><td>Joaquín C. Et al. Clin Nutr. 2019;38:2740-2746</td></tr><tr><td>MNA®</td><td></td><td>95</td><td>63</td><td>Holvoet E. Et al. Plos ONE 2020;15(3):e0229722</td></tr><tr><td>Mean</td><td></td><td>87</td><td>85</td><td></td></tr><tr><td>± SD</td><td></td><td>10</td><td>15</td><td></td></tr><tr><td>Range</td><td></td><td>64-100</td><td>44-90</td><td></td></tr></tbody></table>
# NUTRITIONAL ASSESSMENT IN OLDER ADULTS

<caption>**Table 18**
MNA®: Practicalities</caption>

At least 22 Expert groups included the MNA® in new Clinical Practice Guidelines, National or International registries, such as:

* World Health Organization Integrated Care for Older People (ICOPE) guidelines.

* Swedish National Board of Health and Welfare document about Malnutrition

* Statement on Nutrition Assessment and Management of Heart Failure Patients in Japan

* Use in protocol of patients with Steinert's dystrophy (Spain)

* Oral Management by Dental Treatment and Nutritional Management for the Support of Oral Feeding in Elderly People with Dementia (Japan)

* iCertus Health, best practice guidelines for wound care

* American Dietetic Association's Evidence Analysis Library toolkit for Unintended Weight Loss for Older Adults

* Associazione Italiana di Dietetica e Nutrizione Clinica (ADI), Associazione Medici Diabetologi (AMD), and Società Italiana de Diabetologia (SID). Use in Recommendations 2013-2014 -Medical Nutrition Therapy in Diabetes Mellitus. (Italy)

* Austrian Society of Geriatrics and Gerontology (OGGG) Geriatric Assessment Guide Quebec Health Ministry's nutrition card

* Canadian Patient Safety Institute program, Safer Healthcare Now (www.patientsafetyinstitute.ca) (CA)

* Central Coast Local Health District care pathway «older adult weight and nutrition»

* National Meal Guidelines resource for Australian Meals on Wheels Association

* Nutrition UP 65 Project for older Portuguese population

<caption>**Table 19**
MNA®: Incorporation of the MNA® into electronic and applications software</caption>

42 Electronic Health Record Software Companies have incorporated MNA® into the software, and 22 Apps for smartphones and tablets have incorporated it as well, such as:

* Evolve Health Cloud (USA) electronic platform that includes medicare annual wellness visit

* 360medical software medical library for physicians (France)

* Android app of screening scales available on SSPEN website

* California Association of Healthcare Facilities (CAHF) online toolkit for care transitions

* Care partners assessment tool package at bedside wound care (Canada)

* CHECKWARE software instruments page (Norway)

* Endo Education Co. smartphone app - is swallow 2 app (iS2 platform) (US)

* Euromedice Ediciones Medicas, S.L. (geriatric assessment tools app for geriatricians)

* GAVON, commercial web-based functional performance assessment solution (Finland)

* GCS D-SISIF software (France)

* GrandCARE electronic caregiving tool

* Health Communication Online tool (Dutch)

* Health Pathways, online health information portal for local GPs (Australia)

* iCertus Health - a distillation of best practice guidelines for wound care

* Linkcare, open platform used in observational trials (Spain)

* MaNeEL consortium (Europe) 22 research groups in 7 countries (Europe)

* Nutritional Medicine Pocket app by Brett and Mechanick (Germany)

* Optum website includes interactive Self-MNA® (US)

* Regional Geriatric Program of Toronto - Use in toolkit on nutrition for healthcare professionals and older adults

* Scorso by DIM3 malnutrition app for hospitals and nursing homes (Belgium)

* Smartphone app for French SPEN (France)

* vSim for Nursing / Gerontology on-line tool (US)

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