Yamakawa Hiroko, Ohnuma Takeshi, Satoh Tomohiko, Sugiyama Keiko, Harikae Maki, Iwamoto Toshihiko
Department of Geriatric Medicine, Tokyo Medical University Hospital.
Nihon Ronen Igakkai Zasshi. 2013;50(2):233-42. doi: 10.3143/geriatrics.50.233.
Assessment of the nutritional state is important in comprehensive geriatric assessment (CGA). Several standardized screening tests for malnutrition are available such as the Mini-Nutritional Assessment (MNA) and MNA-Short Form (MNA-SF). However, it takes more than 10 minutes to perform the MNA-SF alone. We have developed a CGA initiative named 'Dr. SUPERMAN', which is designed to accomplish CGA within 10 minutes. In this study, we evaluated a short-form screening test for malnutrition preceding the MNA.
The MNA-SF, which consists of 6 items (A-F), was administered to 163 elderly outpatients (mean age: 83.4 years, 80 men) with various diseases. Using the results of the MNA-SF score (normal ≥ 12 and abnormal ≤ 11) as a gold standard, the sensitivity, specificity, and positive predictive values (PPVs) of each item were calculated and the best combination of 2 items for identifying malnutrition among the elderly outpatients was selected. According to the combination of 2 items (item B: weight loss during the last 3 months; item F: body mass index (BMI)/calf circumference (CC) in cm), they were divided into 2 groups: the normal control (NC) group (neither items B nor F) and the malnutrition/at risk (MN) group (either items B or D, or both). Findings of the clinical feature, anthropometric measurement, and nutritional biomarker between the 2 groups were examined to clarify the characteristics of each.
The MNA-SF score was distributed as follows: 3-7 in 12 cases, 8-11 in 68 cases, and 12-14 in 83 cases. Based on the MNA-SF score, the combination of items B and F revealed the highest sensitivity (91.3%), specificity (63.9%), and PPV (70.9%), resulting in 103 cases in the MN group and 60 cases in the NC group. A high frequency of anorexia, living alone, hypoprealbuminemia, lymphocytopenia, and dehydration was observed in the MN group, whereas a high frequency of leg edema was observed in the NC group. Cases showing a positive wall-occiput test, which compelled the alternation of CC with BMI, accounted for 24% of all cases.
The combination of 'weight loss during the last 3 months' and initial BMI ≥ 23/CC <31 cm along with a positive wall-occiput test was a useful and valuable SF screening test for malnutrition in elderly outpatients.
在综合老年评估（CGA）中，营养状况评估至关重要。有多种用于营养不良的标准化筛查测试，如微型营养评定法（MNA）和MNA简表（MNA-SF）。然而，仅进行MNA-SF就需要10多分钟。我们开发了一项名为“超级医生”的CGA计划，旨在10分钟内完成CGA。在本研究中，我们评估了在MNA之前进行的一种简短的营养不良筛查测试。
对163名患有各种疾病的老年门诊患者（平均年龄：83.4岁，80名男性）进行了由6个项目（A - F）组成的MNA-SF测试。以MNA-SF评分结果（正常≥12分且异常≤11分）作为金标准，计算每个项目的敏感性、特异性和阳性预测值（PPV），并选择用于识别老年门诊患者营养不良的最佳两项组合。根据两项组合（项目B：过去3个月体重减轻；项目F：体重指数（BMI）/小腿围（CC），单位为厘米），将他们分为两组：正常对照组（NC组）（项目B和F均不符合）和营养不良/风险组（MN组）（项目B或D，或两者均符合）。检查两组之间的临床特征、人体测量和营养生物标志物的结果，以阐明每组的特征。
MNA-SF评分分布如下：12例为3 - 7分，68例为8 - 11分，83例为12 - 14分。基于MNA-SF评分，项目B和F的组合显示出最高的敏感性（91.3%）、特异性（63.9%）和PPV（70.9%），MN组有103例，NC组有60例。MN组中厌食、独居、低前白蛋白血症、淋巴细胞减少和脱水的发生率较高，而NC组中腿部水肿的发生率较高。壁枕试验呈阳性（即需要用BMI替代CC）的病例占所有病例的24%。
“过去3个月体重减轻”与初始BMI≥23/CC<31厘米以及壁枕试验呈阳性的组合，是一种用于老年门诊患者营养不良的有用且有价值的简短筛查测试。
