UWL: Screening and Assessment Methods (2009)

Study Design:
- Click here for explanation of classification scheme.
Quality Rating:
Research Purpose:

To assess the nutritional situation of institutionalized, frail elderly living in Austria.

Inclusion Criteria:

None specifically mentioned.

Exclusion Criteria:

None specifically mentioned.

Description of Study Protocol:
  • Recruitment: Residents of a large Viennese nursing home were invited to participate in the study
  • Design: Cross-sectional study  
  • Intervention: 
    • Energy and nutrient intake measured
    • Assessment of general nutritional and health status
  • Statistical analysis: Descriptive statistics, methods not reported.
Data Collection Summary:
  • Timing of measurements: One-time nutritional assessments. Energy and nutrient intake measured during seven consecutive weekdays
  • Dependent variables:
    • General nutritional and health status assessed with Mini Nutritional Assessment (MNA, includes items based on anthropometric assessment, general assessment, short dietary assessment and subjective assessment) and Nutritional Risk Assessment Scale (NuRAS)
    • Individual energy and nutrient intake measured by using the weighed food intake method and compared with DACH reference values for nutrient intake
  • Independent variables: Institutionalized, frail elderly.


Description of Actual Data Sample:
  • Initial N: 245 were assessed with MNA, 89 had energy and nutrient intake measured
  • Attrition (final N): 245 assessed with MNA, 68 in analysis of intake. 21 were excluded without mention of reason. 
  • Age: Mean age 86±7 years
  • Location: Vienna, Austria.
Summary of Results:

Other Findings

  • According to MNA results (N=245), 13.9% had a satisfactory nutritional status, 48.3% were assessed as "at risk of malnutrition" and 37.8% as "malnourished"
  • The most frequently present nutritional risk factors amongst the residents are:
    • High drug consumption (97%)
    • Difficulty in cutting food (70.6%)
    • Depressive illness (63%)
    • Gait disorder (57%)
    • Mental impairment and cognitive impairment (52%)
  • There is evidence that the number of assessed nutritional risk factors has an impact on the nutritional status
  • Further, there is a link between the assessed nutritional status and the individual nutrient intake of the residents
  • The mean BMR based on the Schofield equation for 60- to 100-year-olds is 5.7mJ per day for men and 4.9mJ per day for women
  • The mean energy requirement estimated from BMR and physical activity level is 6.6mJ per day for women and 7.2mJ per day for men
  • The mean energy intake of the nursing home residents was 6.6mJ (6.5mJ for men, 6.6mJ for women)
  • Measured energy intake of 23.5% of the elderly is lower than the calculated BMR and approximately 50% of the sample cannot reach the estimated energy requirement
  • Intake of carbohydrate, cholesterol, protein, vitamin D, vitamin E, thiamine, pantothenic acid, vitamin B6 (men only) and folate, cobalamin, calcium, magnesium and zinc (women only) were lower than reference values, while total fat and saturated fat were higher than recommended values
  • Intake of energy, water, dietary fiber, starch, vitamin D, niacin and sodium is correlated to the MNA score.
Author Conclusion:

There is evidence for nutritional problems in frail, institutionalized elderly nursing home residents. The MNA seems to be a reliable tool to identify individuals at risk for malnutrition. Strategies for effective nutritional intervention should be implemented in long-term care facilities for the elderly in order to prevent and treat malnutrition and to ensure high-quality care. The number of nutritional risk factors has an impact on the nutritional status. Furthermore, there is a link between the assessed nutritional status and the individual nutrient intake of the residents.

Funding Source:
Reviewer Comments:
  • Recruitment methods and inclusion criteria and exclusion criteria were not described
  • Measurements were not made in all subjects
  • Statistical methods were not reported. 
Quality Criteria Checklist: Primary Research
Relevance Questions
  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) N/A
  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) N/A
Validity Questions
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? ???
  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? No
  2.2. Were criteria applied equally to all study groups? ???
  2.3. Were health, demographics, and other characteristics of subjects described? ???
  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? ???
  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%.) ???
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? No
  4.4. Were reasons for withdrawals similar across groups? ???
  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? N/A
  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? N/A
  6.6. Were extra or unplanned treatments described? N/A
  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? No
  8.1. Were statistical analyses adequately described and the results reported appropriately? No
  8.2. Were correct statistical tests used and assumptions of test not violated? N/A
  8.3. Were statistics reported with levels of significance and/or confidence intervals? No
  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? No
  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? No
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