da Silva Gabriella D, Batista Afra V De A, Costa Maria C R De A, Dos Santos Ana C O
Institute of Biological Sciences, University of Pernambuco, Recife, Brazil.
Oswaldo Cruz University Hospital, University of Pernambuco, Recife, Brazil.
Front Nutr. 2024 Nov 8;11:1456091. doi: 10.3389/fnut.2024.1456091. eCollection 2024.
Malnutrition remains common in adults over 60 years old. Although there are screening and diagnostic tools for malnutrition, there is no globally used approach to diagnosing malnutrition in older adults admitted to the hospital. In this study, we verified the agreement between the Global Leadership Initiative on Malnutrition (GLIM) and the Mini Nutritional Assessment (MNA) and the ability of the instruments to identify frailty and sarcopenia associated with malnutrition.
For adults over 60 years old, malnutrition diagnosis was performed using the Mini Nutritional Assessment Full Form (MNA-FF) tool and the GLIM criteria, which included calf circumference and fat-free mass index to assess muscle mass, with and without the Mini Nutritional Assessment Short Form (MNA-SF) screening. Health conditions were assessed in older adults, and the association of these conditions with malnutrition was analyzed using both tools.
A total of 432 adults over 60 years old were investigated with a mean age of 71.14 ± 8 years. The GLIM criteria with the nutritional screening tool identified 61-63% of older adults as malnourished. Of these, 63-64% were severely malnourished. The MNA-FF tool classified 20% of those assessed as malnourished. The agreement between the MNA-FF and GLIM was better with the use of screening, with a kappa (K) value of -0.10 and - 0.11. Sarcopenia was associated with malnutrition as identified by the MNA-FF (OR: 3.08, 95% CI: 1.84-5.14) and only by the GLIM ANTHRO (OR: 1.66, 95% CI: 1.05-2.63). Frailty was associated with the MNA-FF (OR: 15.99, 95% CI: 2.16-118.36), GLIM ANTHRO (OR: 2.21, 95% CI: 1.31-3.71), and GLIM BIA (OR: 2.45, 95% CI: 1.45-4.12).
It is possible to verify that divergent conceptual frameworks are used to understand malnutrition by the MNA-FF and GLIM and that the GLIM obtained a greater number of malnutrition diagnoses. Both the GLIM ANTHRO and the MNA-FF associated malnutrition with frailty and sarcopenia, with higher hazard ratios for the MNA-FF.
60岁以上成年人营养不良现象仍然普遍。尽管有营养不良的筛查和诊断工具，但对于入院的老年人，尚无全球通用的营养不良诊断方法。在本研究中，我们验证了营养不良全球领导倡议（GLIM）与微型营养评定法（MNA）之间的一致性，以及这两种工具识别与营养不良相关的衰弱和肌肉减少症的能力。
对于60岁以上成年人，使用微型营养评定法完整版（MNA-FF）工具和GLIM标准进行营养不良诊断，GLIM标准包括小腿围和去脂体重指数以评估肌肉量，同时使用或不使用微型营养评定法简版（MNA-SF）进行筛查。对老年人的健康状况进行评估，并使用这两种工具分析这些状况与营养不良的关联。
共调查了432名60岁以上成年人，平均年龄为71.14±8岁。结合营养筛查工具的GLIM标准将61%-63%的老年人判定为营养不良。其中，63%-64%为重度营养不良。MNA-FF工具将20%的受评估者判定为营养不良。使用筛查时，MNA-FF与GLIM之间的一致性更好，kappa（K）值为-0.10和-0.11。MNA-FF（比值比：3.08，95%置信区间：1.84-5.14）以及仅GLIM人体测量学标准（比值比：1.66，95%置信区间：1.05-2.63）均显示肌肉减少症与营养不良相关。衰弱与MNA-FF（比值比：15.99，95%置信区间：2.16-118.36）、GLIM人体测量学标准（比值比：2.21，95%置信区间：1.31-3.71）和GLIM生物电阻抗分析标准（比值比：2.45，95%置信区间：1.45-4.12）相关。
可以验证，MNA-FF和GLIM在理解营养不良方面使用了不同的概念框架，且GLIM得出的营养不良诊断数量更多。GLIM人体测量学标准和MNA-FF均将营养不良与衰弱和肌肉减少症相关联，MNA-FF的风险比更高。
