Unintended Weight Loss in Older Adults

UWL: Screening and Assessment Methods (2009)

Citation:

Vellas B, Guigoz Y, Baumgartner M, Garry PJ, Lauque S, Albarede J-L. Relationships between nutritional markers and the Mini-Nutritional Assessment in 155 older persons. J Am Geriatr Soc. 2000; 48(10): 1,300-1,309. 

PubMed ID: 11037019
 
Study Design:
Cross-Sectional Study
Class:
D - Click here for explanation of classification scheme.
Quality Rating:
Neutral NEUTRAL: See Quality Criteria Checklist below.
Research Purpose:

To investigate the relationships between the MNA screening and the nutritional status of older individuals, with respect to anthropometry, clinical chemistry (visceral proteins, vitamins, minerals and hematology) and dietary intake, with a special focus on those persons who score between 17 and 23.5 in the MNA (i.e., those persons classified as at risk for malnutrition). 

Inclusion Criteria:

None specified.

Exclusion Criteria:

None specified.

Description of Study Protocol:

Recruitment

Study participants were recruited from the Geriatric Evaluations unit and from the community. 

Design

  • Cross-sectional study
  • Prospective evaluation of very healthy and severely malnourished older individuals using the Mini Nutrition Assessment (MNA), the Mini-Mental State test, activities of daily living (ADL) and a comprehensive nutritional assessment including anthropometry, laboratory indices and evaluation of dietary intake. 

Statistical Analysis

  • ANCOVA using age as the covariate and one-way ANOVA if the age effect was not significant
  • Correlation coefficients were used to examine the relationship between the MNA and different variables
  • Between group differences were examined using chi-square tests. 
Data Collection Summary:

Timing of Measurements

Comprehensive nutritional assessment. Blood was drawn after an overnight fast. 

Dependent Variables

  • Mini-Mental Test: Standard evaluation
  • Activities of Daily Living (ADL): Standard evaluation
  • Anthropometry: Weight, height, calf and midarm circumference and triceps skinfold were taken at least twice by the same investigator
  • BMICalculated from weight and height derived from knee height
  • Albumin, transferrin, alpha1-acid glycoprotein, transthyretin, ceruloplasmin, retinol-binding protein and C-reactive protein were analyzed by immuno-nephelometry
  • Serum creatinine, total protein, cholesterol, triacylglycerol and gamma-glutamyl transferase were analyzed with a centrifugal analyzer
  • Serum folate, vitamin B12 and Vitamin D were analyzed by radioimmunoassay
  • Serum vitamin A and vitamin E were analyzed by reversed phase high-performance liquid chromatography
  • Serum zinc and copper were analyzed by flame atomic absorption spectrophotometry
  • Activation coefficients for vitamin B1, B2 and B6 were measured according to the procedure from Vuillemier by Hoffman-LaRoche
  • A three-day dietary recall and a checklist of foods was used by a trained dietitian to obtain dietary intakes which were analyzed using the CIQUAL food table.

Independent Variables

MNA score.

Control Variables

Age.

Description of Actual Data Sample:
  • Initial N: 155 subjects (53 males, 102 females)
  • Attrition (final N): 155 subjects
  • Age: Mean age 78 years (range, 56 to 97 years)
  • Other relevant demographics: 105 subjects were from a geriatric evaluation unit; 50 were from the community
  • Location: Toulouse, France.
Summary of Results:

Mini-Nutrition Assessment Score, General Assessment and Anthropometric Measurements in Women

 

Malnourished(Less than 17 Points) N=35

At Risk for Malnutrition (17 to 23.5 Points) N=26

Well Nourished(24 or More Points) N=39

ANOVA or ANCOVA*

Pearson Correlation Coefficient (N=97 to 100)

 

Mean ±SD

Range

Mean ±SD

Range

Mean ±SD

Range

P

R (P)

Age

83.6±5.61

72 to 97

83.0±6.86

69 to 96

70.6±8.72

56 to 85

<0.001

-0.56 (<0.001)

MMS

11.0±8.6

0 to 25

19.0±6.4

0 to 28

28.0±4.6

5 to 30

<0.001

0.80(<0.001)

ADL

1.7±1.8

0 to 6

4.0±1.9

0 to 6

5.9±0.2

5 to 6

<0.001

0.81(<0.001)

Weight (kg)

47.0±12.3

32 to 89

52.1±10.3

38 to 84

60.3±8.4

2 to 81

<0.001

0.59(<0.001)

Calf Circumference (cm)

30.2±4.3

22 to 43

32.3±3.4

27 to 39

35.6±2.6

29 to 40

<0.001

0.62(<0.001)

Midarm Circumference (cm)

24.9±3.4

19 to 34

26.5±3.4

22 to 36

29.8±2.8

25 to 39

<0.001

0.62(<0.001)

*Analysis of covariance with age as covariate (P for age = 0.019). MMS = Mini-Mental State (maximum score = 30 points); ADL = activities of daily living (maximum six points = independent in all daily basic activities).

Mini-Nutrition Assessment Score, General Assessment and Anthropometric Measurements in Men

 

Malnourished(Less than 17 Points) N=35

At Risk for Malnutrition (17 to 23.5 Points) N=26

Well Nourished(24 or More Points) N=39

Analysis of Variance or Covariance*

Pearson Correlation Coefficient (N=97 to 100)

 

Mean ±SD

Range

Mean ±SD

Range

Mean ±SD

Range

P

R (P)

Age

80.0±5.07

70 to 88

80.4±9.12

61 to 92

69.8±8.47

59 to 81

<0.001

-0.39 (0.005)

MMS

9.0±8.9

0 to 28

18.0±10.1

0 to 30

30.0±0.6

28 to 30

<0.001

 0.71 (<0.001)

ADL

1.1±1.3

0 to 4.5

4.0±1.7

1 to 6

6.0±0.02

6 to 6

<0.001

 0.85 (<0.001)

Weight (kg)

52.6±9.8

32 to 71

57.3±9.2

41 to 73

71.6±12.8

60 to 97

<0.001

 0.62 (<0.001)

Calf circumference

28.2±3.0

23 to 34

32.0±3.0

26 to 38

36.3±4.1

32 to 47

<0.001

 00.73 (<0.001)

Midarm Circumference

24.5±2.7

19 to 29

26.2±3.0

21 to 31

30.6±2.8

27 to 36

<0.001

 0.69 (<0.001)

 *Analysis of covariance with age as covariate (P for age = 0.019). MMS = Mini-Mental State (maximum score = 30 points); ADL = activities of daily living (maximum six points = independent in all daily basic activities). 

Mini-Nutrition Assessment Score and Clinical Chemistry in Women

 

Malnourished (Less than 17 Points) N=35

At Risk for Malnutrition (17 to 23.5 Points) N=26

Well Nourished (24 or More Points) N=39

Analysis of Variance or Covariance*

Pearson Correlation Coefficient (N=88 to 97)

 

Mean ±SD

Range

Mean ±SD

Range

Mean ±SD

Range

P

R (P)

Albumin (g per L)

28.4±5.7

17 to 40

31.4±4.9

23 to 40

39.7±3.0

29 to 45

<0.001

0.69 (<0.001)

Transthyretin (g per L)

0.19±0.07

0.06 to 0.38

0.23±0.07

0.09 to 0.388

0.30±0.04

0.22 to 0.39

<0.001

0.60 (<0.001)

Transferrin (g per L)

2.03±0.47

1.18 to 2.99

2.28±0.55

1.55 to 3.74

2.70±0.39

1.70 to 3.51

<0.001

 0.50 (<0.001)

Retinol Binding Protein (g per L)

0.039±0.018

0.013 to 0.013

0.043±0.012

0.012 to 0.068

0.051±0.010

0.036 to 0.091

0.003

 0.34 (<0.001)

Ceruloplasmin (g per L)

0.35±0.06

0.24 to 0.52

0.34±0.05

0.26 to 0.48

0.30±0.05

0.17 to 0.41

0.018

 -0.35(<0.001)

C-reactive protein (mg per L)

31±39

1 to 127

16±20

1 to 66

3±4

1 to 21

<0.001

 -0.45(<0.001)

Alpha1-acid glycoprotein (g per L)

1.49±0.53

0.81 to 22.73

1.21±0.43

0.58 to 2.43

0.89±0.23

0.54 to 1.52

<0.001

-0.56 (<.001)

Creatinine (µmol per L)

89±37

46 to 214

83±22

63 to 153

80±16

49 to 151

0.371

 

Total serum protein (g per L)

64.7±6.6

55 to 80

66.4±5.9

56 to 76

73.6±4.4

61 to 83

<0.001

0.53 (<0.001)

Cholesterol (mmol per L)

5.2±1.7

2.8 to 10.1

5.5±0.8

3.3 to 6.8

6.6±1.1

4.5 to 10.3

<0.001

0.43(<0.001)

Triglycerides (mmol per L)

1.30±0.61

0.60 to 3.15

1.26±0.46

0.75 to 2.61

1.13±0.44

0.52 to 2.45

0.333

 

Retinol (mg per L)

415±206

128 to 1,254

491±170

115 to 800

632±130

332 to 857

<0.001

0.50 (<0.001)

Alpha-tocopherol (mg per L)

12.0±3.0

6.3 to 18.9

11.8±2.6

8.0 to 17.9

15.9±3.5

7.3 to 23.5

0.022*

0.45 (<0.001)

25-OH cholecalciferol (µmol per L)

12.1±7.4

4.2 to 31.4

10.5±6.4

4.2 to 29.0

24.0±8.9

6.1 to 44.4

<0.001*

0.53(<0.001)

Folate (ng per L)

13.2±45.5

2.4 to 266

4.7±1.8

1.9 to 10.2

12.0±4.7

3.2 to 22.2

0.492

 

Cobalamin (mcg per L)

647±690

224 to 3,921

423±242

150 to 1,333

624±1,051

253 to 6,796

0.551

 

Zinc (mcg per L)

711±131

442 to 997

717±128

518 to 1,009

889±89

702 to 1,082

0.001*

0.54(<0.001)

Copper (mcg per L)

1347±240

966 to 2,189

1331±213

1,057 to 1,970

1,218±194

620 to 1,640

0.027

 

Author Conclusion:

The MNA is a practical, non-invasive and cost-effective instrument allowing for rapid nutritional evaluation and effective intervention in frail older persons. 

Funding Source:
Industry:
Nestle Research Center
Pharmaceutical/Dietary Supplement Company:
Reviewer Comments:

Inclusion and exclusion criteria were not described. The authors failed to acknowledge limitations of the study. They mentioned some difficulty in agreement on MNA scores between 17 and 23.5 in the original MNA study. The authors report that this is a prospective study, but it is also a cross-sectional study since measures were taken only once.   

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) Yes
  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
  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
  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
  4. Is the intervention or procedure feasible? (NA for some epidemiological studies) Yes
 
Validity Questions
  1. Was the research question clearly stated? 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
  1.1. 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
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated? Yes
  1.3. Were the target population and setting specified? Yes
  1.3. Were the target population and setting specified? Yes
  2. Was the selection of study subjects/patients free from bias? ???
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
  2.1. 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? ???
  2.2. Were criteria applied equally to all study groups? ???
  2.3. Were health, demographics, and other characteristics of subjects described? ???
  2.3. Were health, demographics, and other characteristics of subjects described? ???
  2.4. Were the subjects/patients a representative sample of the relevant population? ???
  2.4. Were the subjects/patients a representative sample of the relevant population? ???
  3. Were study groups comparable? ???
3. Were study groups comparable? ???
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) 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
  3.2. 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
  3.3. 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? ???
  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? ???
  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.) ???
  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.) ???
  3.6. If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? 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. Was method of handling withdrawals described? Yes
  4.1. Were follow-up methods described and the same for all groups? 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
  4.2. 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
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? Yes
  4.4. Were reasons for withdrawals similar across groups? N/A
  4.4. 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
  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? ???
5. Was blinding used to prevent introduction of bias? ???
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? N/A
  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.) ???
  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.) ???
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? ???
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? ???
  5.4. In case control study, was case definition explicit and case ascertainment not influenced by exposure status? N/A
  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
  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. 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
  6.1. 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
  6.2. 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
  6.3. 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
  6.4. 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
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described? N/A
  6.6. Were extra or unplanned treatments 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
  6.7. 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
  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. Were outcomes clearly defined and the measurements valid and reliable? Yes
  7.1. Were primary and secondary endpoints described and relevant to the question? N/A
  7.1. Were primary and secondary endpoints described and relevant to the question? N/A
  7.2. Were nutrition measures appropriate to question and outcomes of concern? 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? N/A
  7.3. Was the period of follow-up long enough for important outcome(s) to occur? N/A
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? 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? ???
  7.5. Was the measurement of effect at an appropriate level of precision? ???
  7.6. Were other factors accounted for (measured) that could affect outcomes? No
  7.6. Were other factors accounted for (measured) that could affect outcomes? No
  7.7. Were the measurements conducted consistently across groups? Yes
  7.7. Were the measurements conducted consistently across groups? Yes
  8. Was the statistical analysis appropriate for the study design and type of outcome indicators? Yes
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
  8.1. 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
  8.2. 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
  8.3. 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
  8.4. 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)? No
  8.5. Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? No
  8.6. Was clinical significance as well as statistical significance reported? Yes
  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
  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? ???
9. Are conclusions supported by results with biases and limitations taken into consideration? ???
  9.1. Is there a discussion of findings? Yes
  9.1. Is there a discussion of findings? Yes
  9.2. Are biases and study limitations identified and discussed? No
  9.2. Are biases and study limitations identified and discussed? No
  10. Is bias due to study's funding or sponsorship unlikely? ???
10. Is bias due to study's funding or sponsorship unlikely? ???
  10.1. Were sources of funding and investigators' affiliations described? Yes
  10.1. Were sources of funding and investigators' affiliations described? Yes
  10.2. Was the study free from apparent conflict of interest? ???
  10.2. Was the study free from apparent conflict of interest? ???