CHANCES model bilateral pitting oedema (Beattie grade 3 or worse) unable to stand apparent dehydration Also admit if famine oedema (Beattie grade 3 or worse) alone, by clinician assessment Moderate undernutrition Admit into adult SFC if: MUAC 161 - 185 and no relevant signs or few social criteria via screening for: access to food (quantity, quality) distance from centre presence/absence of carers dependents cooking utensils shelter BMI 13 kg/m2, when applied to data from Ferro-Luzzi and James* It is considered as severe undernutrition and is associated with risk of mortality These are suggested starting points and will require consideration of additional factors. Recommends development of specific cut-off points to account for changing redistribution of fat during ageing. Questions whether there is also a need for ethnic differences to be investigated. Borrel, 2001 > 60 Entry into selective feeding programmes: No admission: > 185 Normal (unless famine oedema present, refer to clinician) SFC: 160 - 185 MAM TFC: < 160 SAM Entry into Community Support Programme CSP: > 185 High nutritional risk If one or more social criteria but no anthropometric or clinical criteria, enter into CSP with the purpose of preventing further deterioration in nutritional status Based on data from Nilotic populations Formed the basis for UNHCR/WFP 2011 recommendations, see Table 11 below. Applies to emergency situations and famines. Use in Burundi/Congo failed to confirm its usefulness as a diagnostic tool Not yet been validated in other populations Grellety (ACF), 2001 SAM < 200 MAM 200 - 210 Figures are between WHO 1995/ Ismail and Manandhar 1999/Collins et al 2000 Personal communication based on experience in Rwanda, not research-based 2006 20 – 50 50+ < 210 thin, select for further evaluation (weight loss, physical strength and clinical signs) < 180 select for evaluation(weight loss, physical strength and clinical signs) These are not meant as admission criteria or criteria for malnutrition * based on James, Mascie-Taylor, Norgan, Bistriaw, Shetty & Ferro-Luzzi, 1994; Collins, 1996
Screening with MNA-SF A score of 11 or less in the screening indicates a problem and the need for a completion of the assessment portion. A MNA-SF score of 12 and above indicates a good nutritional status without the need to continue the whole assessment. The assessment score is then added to the screening score. Screening plus assessment with full MNA If the total score on both parts totals 17-23.5, there is a risk of malnutrition A score of < 17 indicates existing malnutrition The MNA includes several risk factors for “frailty”, such as low BMI, decrease of mobility, low muscle mass and low calorie intake. A statistically significant U-shaped association has been found between frailty and BMI. It has been shown to accurately identify older people at risk of increased mortality and morbidity. In 2008-2009, Nestle Nutrition embarked on the MNA International Initiative, conducting research in geriatric settings across the globe to validate a new MNA-SF. The new features of this are: It is now validated as a standalone nutrition screening tool, which can be completed in less than 10 minutes Calf circumference may be used instead of BMI It can identify an older person as well nourished, at risk of malnutrition or malnourished. The MNA requires at least 15 minutes with each patient so is hardly applicable in most humanitarian settings. The MNA-SF takes only 3 minutes but has not been validated or used in community-living settings in developing country contexts, or emergencies. For both the MNA and MNA-SF, cultural issues may apply that have not been considered. Annex 6: Guiding principles for nutrition interventions for older people in emergencies 1. Older people should have physical access to an adequate general ration that is suitable in terms of quantity and quality, that is easily digestible and culturally acceptable Older people should have access to milled cereal and legumes that they are familiar with or alternatively to milling facilities in situations where whole grain cereal is produced Measures should be taken to ensure that older people are: (i) Informed of their eligibility, and (ii) Have physical access to the general ration 2. The physiological changes associated with ageing and its consequences for nutritional requirements and special needs should be reflected in programme