UWL: Screening and Assessment Methods (2009)
- To assess whether concordance between MNA-SF scores and biological nutrition parameters also exists among a cohort of elderly patients suffering from a severe injury such as hip fracture
- To evaluate the ability of MNA-SF scores to detect higher in-hospital mortality, nosocomial infection or new pressure ulcer occurrence
- Patients more than 64 years of age admitted for osteoporotic hip fracture following minor trauma to a 1,000-bed teaching hospital between January 2002 and March 2002
- All fractures had to be radiographically confirmed and considered suitable for surgical repair.
- Patients who received conservative therapy (N=2)
- Those with pathological fractures (N=2) or multiple fractures (N=7)
- Terminally ill patients with a presumed life expectancy of less than six months (N=5)
- Those for whom surgery was delayed for 48 hours or more (N=6)
- Those who were taking lipid-lowering drugs (N=5).
100 consecutive elderly people who were admitted for hip fracture and who underwent surgery complemented by rehabilitation therapy.
Prospective cohort study.
- MNA-SF nutritional scale and laboratory values were assessed within three days after hip fracture surgery
- According to hospital guidelines, all patients received antibiotic and antithrombotic prophylaxis, and protein supplements (20g per day)
- Spinal anesthesia was used
- Patients were mobilized early and rehabilitation was started as soon as possible.
- Chi-square and Student's T-test were applied
- Pearson correlation coefficients were calculated
- All statistical test were two-sided.
Timing of Measurements
MNA-SF nutritional scale and laboratory values were assessed within three days after hip fracture surgery.
- Weight, height and BMI
- Serum albumin, cholesterol and total lymphocyte count
- Functional status assessed by Barthel Index
- Comorbidity measured by Charlson score
- Complications arising from hospital stay (nosocomial infection and pressure ulcers) were recorded.
- Nutritional status measured with MNA-SF nutritional scale, consisting of six items extracted from MNA: BMI, appetite, weight loss, mobility, current illness and neuropsychological problems
- Interviewed about their prior residential status (nursing home or community), social status and ability to perform activities of daily living.
- Initial N: 100 consecutive patients. 73 remained after application of exclusion criteria.
- Attrition (final N): 73 patients [61 female (84%), 12 male]
- Age: Mean age 81.5±7.1 years
- Location: Spain.
|Values||MNA-SF Pearson Correlation Coefficients||
Serum total cholesterol (mmol per L)
Serum albumin (g per L)
|Serum total lymphocytes per mm3||1,278±463||R=0.147||0.2|
|Previous Barthel Index||78.2±19||R=-0.59||0.6|
- Inhospital mortality was 10%. MNA-SF scores of these patients pointed toward a higher risk of malnutrition (8.8 vs. 10.1) but this difference did not reach statistical significance.
- The mean MNA-SF score was 11±0.5 (range, three to 14); according to these values, 39 patients (53%) were at risk of malnutrition
- MNA-SF scores were not significantly correlated to patients' laboratory values
- Seven (9.5%) patients with normal MNA-SF scores had albumin levels less than 30g per L
- MNA-SF values did not correlate either with previous functional status or with comorbidity
- 14 episodes of nosocomial infection were diagnosed in 11 patients, and six patients developed pressure ulcers during hospitalization. The MNA-SF values were not useful in predicting the development of nosocomial infection (P=0.3) or those at risk for pressure ulcers (P=0.2).
MNA-SF test scale values reflect a clinical process in post-operative hip-fractured patients that is different from serum albumin, cholesterol or lymphocyte count. In conclusion, we believe that the MNA-SF and the biochemical nutrition values applied reflect different clinical processes.
|University/Hospital:||Hospital Universitari de Bellvitge|
Authors note that the MNA-SF questionnaire is the first of a two-step process, that if the MNA-SF is negative, there is no need to answer the remaining MNA questions. Authors note the following:
- Lack of predictive value may be attributed to the following: A low MNA-SF score does not represent a risk to those patients in whom hypoalbuminemia is not present, provided that they are correctly managed with good medical care
- Two possible limitations: Short duration of follow-up and small sample size.
Quality Criteria Checklist: Primary Research
|1.||Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies)||Yes|
|2.||Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about?||Yes|
|3.||Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice?||Yes|
|4.||Is the intervention or procedure feasible? (NA for some epidemiological studies)||Yes|
|1.||Was the research question clearly stated?||Yes|
|1.1.||Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified?||Yes|
|1.2.||Was (were) the outcome(s) [dependent variable(s)] clearly indicated?||Yes|
|1.3.||Were the target population and setting specified?||Yes|
|2.||Was the selection of study subjects/patients free from bias?||Yes|
|2.1.||Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study?||Yes|
|2.2.||Were criteria applied equally to all study groups?||Yes|
|2.3.||Were health, demographics, and other characteristics of subjects described?||Yes|
|2.4.||Were the subjects/patients a representative sample of the relevant population?||Yes|
|3.||Were study groups comparable?||N/A|
|3.1.||Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT)||N/A|
|3.2.||Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline?||N/A|
|3.3.||Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.)||N/A|
|3.4.||If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis?||N/A|
|3.5.||If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.)||N/A|
|3.6.||If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")?||N/A|
|4.||Was method of handling withdrawals described?||Yes|
|4.1.||Were follow-up methods described and the same for all groups?||Yes|
|4.2.||Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.)||Yes|
|4.3.||Were all enrolled subjects/patients (in the original sample) accounted for?||Yes|
|4.4.||Were reasons for withdrawals similar across groups?||N/A|
|4.5.||If diagnostic test, was decision to perform reference test not dependent on results of test under study?||N/A|
|5.||Was blinding used to prevent introduction of bias?||Yes|
|5.1.||In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate?||N/A|
|5.2.||Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.)||Yes|
|5.3.||In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded?||Yes|
|5.4.||In case control study, was case definition explicit and case ascertainment not influenced by exposure status?||N/A|
|5.5.||In diagnostic study, were test results blinded to patient history and other test results?||N/A|
|6.||Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described?||Yes|
|6.1.||In RCT or other intervention trial, were protocols described for all regimens studied?||N/A|
|6.2.||In observational study, were interventions, study settings, and clinicians/provider described?||Yes|
|6.3.||Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect?||Yes|
|6.4.||Was the amount of exposure and, if relevant, subject/patient compliance measured?||N/A|
|6.5.||Were co-interventions (e.g., ancillary treatments, other therapies) described?||Yes|
|6.6.||Were extra or unplanned treatments described?||Yes|
|6.7.||Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups?||N/A|
|6.8.||In diagnostic study, were details of test administration and replication sufficient?||N/A|
|7.||Were outcomes clearly defined and the measurements valid and reliable?||Yes|
|7.1.||Were primary and secondary endpoints described and relevant to the question?||Yes|
|7.2.||Were nutrition measures appropriate to question and outcomes of concern?||Yes|
|7.3.||Was the period of follow-up long enough for important outcome(s) to occur?||Yes|
|7.4.||Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures?||Yes|
|7.5.||Was the measurement of effect at an appropriate level of precision?||Yes|
|7.6.||Were other factors accounted for (measured) that could affect outcomes?||Yes|
|7.7.||Were the measurements conducted consistently across groups?||N/A|
|8.||Was the statistical analysis appropriate for the study design and type of outcome indicators?||Yes|
|8.1.||Were statistical analyses adequately described and the results reported appropriately?||Yes|
|8.2.||Were correct statistical tests used and assumptions of test not violated?||Yes|
|8.3.||Were statistics reported with levels of significance and/or confidence intervals?||Yes|
|8.4.||Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)?||N/A|
|8.5.||Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)?||N/A|
|8.6.||Was clinical significance as well as statistical significance reported?||Yes|
|8.7.||If negative findings, was a power calculation reported to address type 2 error?||N/A|
|9.||Are conclusions supported by results with biases and limitations taken into consideration?||Yes|
|9.1.||Is there a discussion of findings?||Yes|
|9.2.||Are biases and study limitations identified and discussed?||Yes|
|10.||Is bias due to study's funding or sponsorship unlikely?||Yes|
|10.1.||Were sources of funding and investigators' affiliations described?||Yes|
|10.2.||Was the study free from apparent conflict of interest?||Yes|