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This research aimed to show that using different cutoff points for women and men in nutritional assessment through the Mini Nutritional Assessment (MNA) and different anthropometric variables, improves the diagnostic accuracy of malnutrition among people over 65 years. A cross-sectional study was carried out in a sample of 240 patients of 65 to 104 years in Córdoba (Spain) between 2013 and 2015. Excluded were those with disabling diseases that prevented informed consent. We assessed Nutritional status using the MNA and the Chang Method (Gold Standard). Global cut points per sex were determined for each independent variable using Receiver Operating Characteristic curves, choosing the best of each according to the highest Youden´s index (J). None of the variables studied showed high precision in the diagnosis of malnutrition in the elderly. Different cutoff points were found for all variables by sex, as well as variations in their validity indexes. The number of lymphocytes was more accurate in women (J = 0.58), being the muscular circumference of the arm the best in men (J = 0.8). Regarding MNA, the Long Form version showed higher sensitivity (S) in women (S = 76%) and short versions in men (S = 71% and 59%) at different cutoff points. The introduction of the sex variable seems determinant to achieve a more accurate diagnostic of malnutrition, avoiding biases derivate from a global study without considering its effect in the development of diseases.

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OBJECTIVE: To propose malnutrition screening methods for the elderly population using predictive multivariate models. Due to the greater risk of nutrition deficiencies in ageing populations, nutritional assessment of the elderly is necessary in primary health care. DESIGN: This was a cross-sectional study. Multivariate models were obtained by means of discriminant analysis and binary logistic regression. The diagnostic accuracy of each multivariate model was determined and compared with the Chang method based on receiver operating characteristic curves. The optimal cut-point, sensitivity, specificity and Youden index were estimated for each of the models. SETTING: The province of Cordoba, Spain. PARTICIPANTS: Two hundred fifty-five patients over the age of 65 years from three health centres and three nursing homes. RESULTS: Fourteen models for predicting risk of malnutrition were obtained, six by discriminant multivariate analysis and eight by binary logistic regression. Sensitivity ranged from 55·6 to 93·1 % and specificity from 64·9 to 94 %. The maximum and minimum Youden indexes were 0·77 and 0·49, respectively. We finally selected a model which does not require a blood test. CONCLUSIONS: The proposed models simplify nutritional assessment in the elderly and, except for number 2 of those calculated by binary logistic regression, have better diagnostic accuracy than the Spanish version of the Mini Nutritional Assessment screening tool. The selected model, whose validation is necessary for the future with other different samples, provides good diagnostic accuracy, and it can be performed by non-medical personnel, making it an accessible, easy and rapid tool in daily clinical practice.

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OBJETIVO: Analizar el estado nutricional (EN) de pacientes mayores de 65 años y establecer su relación con variables sociodemográficas y de salud. DISEÑO: Estudio observacional transversal en pacientes mayores de 65 años. Emplazamiento: Tres centros de salud. PARTICIPANTES: Doscientos cincuenta y cinco pacientes: ambulatorios (PI), en atención domiciliaria (PD) o institucionalizados (PR). Completaron el estudio 243 (tasa respuesta 95,3%). Mediciones principales: Se aplicó el método Chang para determinar el EN. Se recogieron variables sociodemográficas, antropométricas, dependencia, estado anímico, cognitivo y parámetros analíticos. Se analizaron asociaciones aplicando Chi cuadrado y análisis de varianza. Se calculó la razón de prevalencia (RP) para desnutrición. Se aplicó un modelo multivariante (regresión logística binaria). Se consideró significación para p < 0,05. RESULTADOS: La edad media fue 81,3 años (DT = 7,4), y el 72,0% fueron mujeres. El 48,9% eran PI, el 26,8% PD y el 24,2% PR. El 29,6% (IC 95%: 23,9-35,8) presentaba malnutrición. Se estableció mayor desnutrición en relación con vivir en una residencia o precisar ayuda domiciliaria (RP = 5,3), edad mayor de 85 años (RP = 4,9), presentar una dependencia moderada o superior para las actividades de la vida diaria básicas (RP = 3,9) e instrumentales (RP = 3,3), precisar ayuda para la movilidad (RP = 2,9) y presentar deterioro cognitivo moderado/severo (RP = 2,1). Los factores determinantes de desnutrición en el modelo multivariante fueron tener más de 85 años y ser PR o PD. CONCLUSIONES: Se debería hacer hincapié en evaluar el EN en pacientes mayores de 85 años y que viven en una residencia o precisan atención domiciliaria, al ser los grupos de mayor riesgo de desnutrición

OBJECTIVE: To analyze the nutritional status (NS) of patients older than 65 years and establish their relationship with sociodemographic and health variables. DESIGN: Cross-sectional observational study in patients older than 65 years. LOCATION: 3 health centers. PARTICIPANTS: 255 patients: ambulatory (AP), in domiciliary care (DP) or institutionalized (IP). They completed the study 243 (response rate 95.3%). MAIN MEASUREMENTS: The Chang method was applied to determine the NS. Sociodemographic, anthropometric variables, dependence, mood, cognitive and analytical parameters were collected. Associations were analyzed applying chi-square and analysis of variance. The prevalence ratio (PR) for malnutrition was calculated. A multivariate model was applied (binary logistic regression). Significance was considered for p < 0.05. RESULTS: The average age was 81.3 years (SD = 7.4) and 72.0% were women. 48.9% were AP, 26.8% DP and 24.2% IP. 29.6% (95% CI: 23.9-35.8) presented malnutrition. Greater malnutrition was established in relation to living in a residence or requiring home help (PR = 5.3), age over 85 (PR = 4.9), presenting a moderate or higher dependency for basic activities of daily living (PR = 3.9) and instrumental (PR = 3.3), need help for mobility (PR = 2.9) and present moderate/severe cognitive impairment (PR = 2.1). The determinants of malnutrition in the multivariate model were older than 85 years old and being IP or DP. CONCLUSIONS: Emphasis should be placed on evaluating NS in patients older than 85 years of age who live in a residence or require home care, since they are the groups at greatest risk of malnutrition

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OBJECTIVE: To analyze the nutritional status (NS) of patients older than 65 years and establish their relationship with sociodemographic and health variables. DESIGN: Cross-sectional observational study in patients older than 65 years. LOCATION: 3 health centers. PARTICIPANTS: 255 patients: ambulatory (AP), in domiciliary care (DP) or institutionalized (IP). They completed the study 243 (response rate 95.3%). MAIN MEASUREMENTS: The Chang method was applied to determine the NS. Sociodemographic, anthropometric variables, dependence, mood, cognitive and analytical parameters were collected. Associations were analyzed applying chi-square and analysis of variance. The prevalence ratio (PR) for malnutrition was calculated. A multivariate model was applied (binary logistic regression). Significance was considered for p<0.05. RESULTS: The average age was 81.3 years (SD=7.4) and 72.0% were women. 48.9% were AP, 26.8% DP and 24.2% IP. 29.6% (95% CI: 23.9-35.8) presented malnutrition. Greater malnutrition was established in relation to living in a residence or requiring home help (PR=5.3), age over 85 (PR=4.9), presenting a moderate or higher dependency for basic activities of daily living (PR=3.9) and instrumental (PR=3.3), need help for mobility (PR=2.9) and present moderate/severe cognitive impairment (PR=2.1). The determinants of malnutrition in the multivariate model were older than 85 years old and being IP or DP. CONCLUSIONS: Emphasis should be placed on evaluating NS in patients older than 85 years of age who live in a residence or require home care, since they are the groups at greatest risk of malnutrition.

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Introducción: para el cribado nutricional del anciano, existe una versión corta del Mini Nutritional Assessment Large Form (MNA-LF) denominada Mini Nutritional Assessment Short Form (MNA-SF). Esta permite el uso de la circunferencia de la pantorrilla (CP) o del índice de masa corporal (IMC) y guarda buena correlación con la versión larga. Son escasos los trabajos que han analizado la validez del MNA-SF. Objetivo: establecer la validez de las dos variantes del MNA-SF en su versión al castellano, basado en el IMC (MNA-SF [IMC]) o en la circunferencia de pantorrilla (MNA-SF [CP]) para conocer su fiabilidad. Diseño: estudio de pruebas de diagnósticos con 255 sujetos mayores de 65 años. El método Chang se utilizó como gold standard. Se calcularon el índice Kappa de Cohen, la sensibilidad y la especificidad, los valores predictivos positivos y negativos, el índice de Youden y el índice de validez. Resultados: los índices Kappa del método Chang fueron muy bajos al cotejar los resultados con los de las versiones del MNA-SF (IMC y CP) (0,335 y 0,286, respectivamente). Se obtuvieron los siguientes resultados de validez para MNA-SF (IMC) y MNA-SF (CP): sensibilidad 70% y 67%, especificidad 68% y 66% e índice de Youden 0,38 y 0,33, respectivamente, clasificando correctamente al 68,5% y al 66,5% de los ancianos. Conclusiones: el MNA-SF es una herramienta útil (fácil, no invasiva y rápida de cumplimentar) pero limitada para el cribado nutricional, lo que evidencia la necesidad de mejorar su capacidad discriminatoria

Introduction: a short version of the Mini Nutritional Assessment Large Form (MNA-LF) called Mini Nutritional Assessment Short Form (MNA-SF) is available for nutritional screening of the elderly. This MNA-SF allows the use of the circumference of the calf (CC) or body mass index (BMI) and shows a good correlation with the MNA-LF. However, only a few researches that have analyzed the validity of the MNA-SF can be found. Objective: to analyze the validity of the MNA-SF (including two different methods, based on the BMI (MNA-SF [BMI]) or using the calf circumference (MNA-SF [CC]). Design: study of diagnostic tests with 255 subjects over 65 years of age. The Chang method was used as gold standard. Cohen's Kappa index, sensitivity and specificity, positive and negative predictive values, the Youden index and the validity index were calculated. Results: the Kappa indexes for the Chang method were very low when comparing the results with those of the MNA-SF versions (IMC and CP) (0.335 and 0.286, respectively). The following validity results were obtained for MNA-SF (IMC) and MNA-SF (CP): sensitivity 70% and 67%, specificity 68% and 66% and Youden index 0.38 and 0.33, respectively, correctly classifying to 68.5% and 66.5% of the elderly. Conclusions: MNA SF is a useful tool (easy, non-invasive and quick to complete) but very limited for nutritional screening

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INTRODUCTION: Introduction: a short version of the Mini Nutritional Assessment Large Form (MNA-LF) called Mini Nutritional Assessment Short Form (MNA-SF) is available for nutritional screening of the elderly. This MNA-SF allows the use of the circumference of the calf (CC) or body mass index (BMI) and shows a good correlation with the MNA-LF. However, only a few researches that have analyzed the validity of the MNA-SF can be found. Objective: to analyze the validity of the MNA-SF (including two different methods, based on the BMI (MNA-SF [BMI]) or using the calf circumference (MNA-SF [CC]). Design: study of diagnostic tests with 255 subjects over 65 years of age. The Chang method was used as gold standard. Cohen's Kappa index, sensitivity and specificity, positive and negative predictive values, the Youden index and the validity index were calculated. Results: the Kappa indexes for the Chang method were very low when comparing the results with those of the MNA-SF versions (IMC and CP) (0.335 and 0.286, respectively). The following validity results were obtained for MNA-SF (IMC) and MNA-SF (CP): sensitivity 70% and 67%, specificity 68% and 66% and Youden index 0.38 and 0.33, respectively, correctly classifying to 68.5% and 66.5% of the elderly. Conclusions: MNA SF is a useful tool (easy, non-invasive and quick to complete) but very limited for nutritional screening.

INTRODUCCIÓN: Introducción: para el cribado nutricional del anciano, existe una versión corta del Mini Nutritional Assessment Large Form (MNA-LF) denominada Mini Nutritional Assessment Short Form (MNA-SF). Esta permite el uso de la circunferencia de la pantorrilla (CP) o del índice de masa corporal (IMC) y guarda buena correlación con la versión larga. Son escasos los trabajos que han analizado la validez del MNA-SF. Objetivo: establecer la validez de las dos variantes del MNA-SF en su versión al castellano, basado en el IMC (MNA-SF [IMC]) o en la circunferencia de pantorrilla (MNA-SF [CP]) para conocer su fiabilidad. Diseño: estudio de pruebas de diagnósticos con 255 sujetos mayores de 65 años. El método Chang se utilizó como gold standard. Se calcularon el índice Kappa de Cohen, la sensibilidad y la especificidad, los valores predictivos positivos y negativos, el índice de Youden y el índice de validez. Resultados: los índices Kappa del método Chang fueron muy bajos al cotejar los resultados con los de las versiones del MNA-SF (IMC y CP) (0,335 y 0,286, respectivamente). Se obtuvieron los siguientes resultados de validez para MNA-SF (IMC) y MNA-SF (CP): sensibilidad 70% y 67%, especificidad 68% y 66% e índice de Youden 0,38 y 0,33, respectivamente, clasificando correctamente al 68,5% y al 66,5% de los ancianos. Conclusiones: el MNA-SF es una herramienta útil (fácil, no invasiva y rápida de cumplimentar) pero limitada para el cribado nutricional, lo que evidencia la necesidad de mejorar su capacidad discriminatoria.

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AIM: To validate the Mini Nutritional Assessment (MNA) in a Spanish population over 65 years of age with varying degrees of independence. DESIGN: This cross-sectional validation study used the Chang nutritional assessment method as a reference test. PARTICIPANTS: 248 subjects (72.2% female), with a mean age of 81.3, completed the study. They were classified into three groups: (i) autonomous patients who were able to take part in activities outside their home; (ii) patients who require help with daily self-care; (iii) patients living in a residential health care facility. SETTING: Three health centres and three residential care homes situated in Cordoba (Spain). RESULTS: The kappa values for intra-observer and inter-observer agreement were 0.870 and 0.784, respectively. The intra-class correlation coefficient intra-observer was 0.874 and the inter-observer was 0.789. The sensitivity and specificity readings for the diagnostic accuracy of MNA were 63.2% and 72.9% in the total sample, respectively. The area under the curve was 0.726. For patients in the Group A, B and C, the sensitivity was 89.3%, 60.7% and 18.8%, and the specificity was 23.3%, 56.8% and 94.1%, respectively. CONCLUSION: The results for the reliability of the survey were excellent, and its internal consistency was acceptable. The diagnostic accuracy, as measured by the sensitivity and specificity readings, was lower than that obtained with the original survey. It can therefore be considered more suitable for a population with limited autonomy, and less appropriate for independent patients. The results may not be relevant to patients outside of the Cordova region in Spain.

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Objetivo: Analizar el estado nutricional de pacientes mayores de 65 años incluidos en el programa de atención domiciliaria (PAD). Diseño: Estudio observacional transversal. Emplazamiento: Tres centros de salud. Participantes: Un total de 218 pacientes del PAD. Método: Se aplicó el cuestionario Mini Nutritional Assessment (MNA). Se recogieron 57 variables: sociodemográficas, antropométricas, de dependencia, estados anímico y cognitivo y parámetros analíticos. Se analizaron asociaciones mediante la aplicación de la Chi-cuadrado y análisis de varianza. Se consideró un nivel de significación para p < 0,05. Resultados: La edad media fue de 83,9 años (DT = 7,4); el 34,9% estaban institucionalizados y el 80,7% eran mujeres. El 21,2% de los pacientes presentaban malnutrición y el 40,1%, riesgo de la misma. Se estableció asociación significativa entre peor estado nutricional y mayor edad, menor IMC, mayor dependencia en actividades básicas e instrumentales de la vida diaria y mayor deterioro cognitivo. Las menores cifras medias de hemoglobina, albúmina y hierro también se asociaron a desnutrición y riesgo de la misma. Conclusiones: Más de la mitad de los pacientes del PAD presentan desnutrición o riesgo de la misma, y en una proporción elevada, alteración en parámetros analíticos susceptibles de ser corregidos. La alteración cognitiva y dependencia funcional están relacionadas con la desnutrición, por lo que los pacientes con estas características deberían recibir una mayor atención desde el punto de vista nutricional (AU)

Objective: To analyse the nutritional status of patients older than 65 years included in the home care program (PAD). Design: Croos-sectional study. Emplacement: 3 urban health centers. Participants: 218 patients in the PAD. Method: Mini Nutritional Assessment questionnaire (MNA) was applied. Sociodemographic, anthropometric, dependency, emotional and cognitive status and analytical parameters: 57 variables were collected. Possible associations were analysed by applying the chi square and variance analysis. The level of significance was considered to be P<.05 was considered. Results: The mean age was 83.9 years (SD=7.4); 34.9% were institutionalized and 80.7% were women; 21.2% of patients were malnourished and 40.1% were at risk of it. A significant association was established between poorer nutritional status and older age, lower BMI, greater dependence on basic and instrumental activities of daily living and greater cognitive impairment. The lowest mean hemoglobin, albumin, and iron levels were also associated with malnutrition and risk of malnutrition. Conclusions: More than half of PAD patients are malnourished or at risk for it, and a high proportion of them some laboratory abnormality susceptible to be corrected. Most cognitive impairment and functional dependence are closely related to malnutrition; so patients with these characteristics should receive more attention from the nutritional point of view (AU)

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OBJECTIVE: To analyse the nutritional status of patients older than 65 years included in the home care program (PAD). DESIGN: Croos-sectional study. EMPLACEMENT: 3 urban health centers. PARTICIPANTS: 218 patients in the PAD. METHOD: Mini Nutritional Assessment questionnaire (MNA) was applied. Sociodemographic, anthropometric, dependency, emotional and cognitive status and analytical parameters: 57 variables were collected. Possible associations were analysed by applying the chi square and variance analysis. The level of significance was considered to be P<.05 was considered. RESULTS: The mean age was 83.9 years (SD=7.4); 34.9% were institutionalized and 80.7% were women; 21.2% of patients were malnourished and 40.1% were at risk of it. A significant association was established between poorer nutritional status and older age, lower BMI, greater dependence on basic and instrumental activities of daily living and greater cognitive impairment. The lowest mean hemoglobin, albumin, and iron levels were also associated with malnutrition and risk of malnutrition. CONCLUSIONS: More than half of PAD patients are malnourished or at risk for it, and a high proportion of them some laboratory abnormality susceptible to be corrected. Most cognitive impairment and functional dependence are closely related to malnutrition; so patients with these characteristics should receive more attention from the nutritional point of view.

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Objetivo: evaluar el estado nutricional de los pacientes incluidos en el programa de atención domiciliaria (PAD) de un centro de salud y su relación con variables sociodemográficas, clínicas y funcionales. Material y métodos: estudio descriptivo transversal. Tras realizar muestreo sistemático estratificado, se recogieron datos sociodemográficos, enfermedades crónicas, capacidad funcional, cognitiva, síntomas depresivos y/o de ansiedad. Estado nutricional: valoración antropométrica y analítica completa (sideremia, ferritina, ácido fólico, vitamina B12, proteínas totales y albúmina) y riesgo de malnutrición (cuestionario MNA). Resultados: sobre una muestra inicial de 96 pacientes (intervalo de confianza [IC] del 95%, precisión = 0,08), se obtienen datos completos en 91 (94,8%). El 75,8% fueron mujeres, con edad media ± desviación estándar de 80,4 ± 7,4 años. El 70,5% presentaba más de 2 enfermedades crónicas, consumo medio de fármacos 5,4 ± 2,8. Comorbilidad psíquica: cuadro depresivo 47,3%, alteración cognitiva moderada-grave 45,9%, ansiedad 38,6%. Un 89,9% precisaban ayuda para realizar actividades instrumentales y el 82,2%, para las básicas. Un 23,1% (IC del 95%, 14,5-31,7) presentaba malnutrición y el 35,2% (IC del 95%, 25,4-45,0) tenía riesgo de presentarla. Presentaron valores séricos inferiores a los normales: ácido fólico 41,4%, proteínas totales 40,3%, hemoglobina 38,8% y albúmina 33,8%. Se encontró asociación entre malnutrición o riesgo de tenerla con: menor peso, circunferencia braquial y pantorrilla, mayor edad y menor puntuación en escalas de Lawton y Barthel (p < 0,05). Solamente los valores de Barthel y mayor edad mantuvieron asociación en el análisis multivariante. Conclusiones: se destaca la importancia de evaluar de forma sistemática y periódica la situación nutricional de ancianos atendidos en los PAD, estableciendo medidas de prevención e intervención, especialmente en aquellos con peor capacidad funcional y mayor edad

Objective: to evaluate the risk of malnutrition in patients included in a home care program in a health center and its association with sociodemographic, clinical, and functional variables. Material and methods: we performed a cross-sectional descriptive study. Stratified systematic sampling was performed and data on sociodemographic characteristics, chronic diseases, functional and cognitive status, and symptoms of depression and/or anxiety were gathered. Nutritional assessment included anthropometric evaluation, complete blood analysis (iron, ferritin, folic acid, vitamin B12, total proteins and albumin) and risk of malnutrition (mini-nutritional assessment [MNA] questionnaire). Results: of an initial sample of 96 patients (95% confidence interval [CI], precision = 0.08), data collection was complete in 91 (94.8%); 75.8% were women, and the mean age ± standard deviation was 80.4 ± 7.4 years. More than two chronic diseases were found in 70.5% and the mean number of drugs was 5.4 ± 2.8. Depressive symptoms were present in 47.3%, with moderate-severe cognitive impairment in 45.9% and symptoms of anxiety in 38.6%. A total of 89.9% required help for instrumental activities and 82.2% for basic activities. Risk of malnutrition was found in 35.2% (95% CI = 25.4-45.0) and malnutrition was found in 23.1% (95% CI = 14.5-31.7). Levels were below normal for serum folic acid (41.4%), total serum proteins (40.3%), haemoglobin (38.8%) and albumin (33.8%). Malnutrition or malnutrition risk was associated with low weight, smaller brachial and calf circumference, greater age, and lower Lawton and Barthel scores (p < 0.05). The only statistically significant association in the multivariate analysis was between lower Barthel scores and greater age. Conclusions: systematic nutritional assessment should be performed periodically in elderly patients in home care programs. Prevention and intervention measures should be established, especially in patients with worse functional capacity and greater age

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FUNDAMENTO: Se realiza la adaptación transcultural y validación del Short Portable Mental Status Questionnaire (SPMSQ) de Pfeiffer para la detección de posible deterioro cognitivo en personas de más de 65 años. PACIENTES Y MÉTODO: Inicialmente se realizó la adaptación transcultural, obteniendo la versión española del cuestionario (SPMSQ-VE). En una segunda fase, el médico/enfermera de cada sujeto aplicó el cuestionario a personas mayores que acudían al centro de salud. De éstos, 30 fueron examinados por dos profesionales para medir la fiabilidad interobservador y cincuenta pacientes se citaron a la semana para medir la fiabilidad intraobservador. Posteriormente, otro investigador, de forma ciega, realizó a todos los sujetos una evaluación neuropsicológica estableciendo el diagnóstico de demencia según los criterios establecidos en la CIE-10. El resultado final de esta exploración fue considerado como el Patrón Oro de referencia para el cálculo de los parámetros de validez. RESULTADOS: Completaron el estudio 255 sujetos, el 66,7 por ciento mujeres y el 65,5 por ciento sin ningún grado de escolarización y con una media de edad de 74,5 años. La fiabilidad inter e intraobservador del SPMSQ-VE fue de 0,738 y 0,925, respectivamente, alcanzando la consistencia interna un valor de 0,82. La validez convergente fue del 0,74 y la discriminación del 0,23. El área bajo la curva ROC fue de 0,89, siendo la sensibilidad y especificidad de 85,7 y 79,3, respectivamente, para un punto de corte de 3 o más errores, observándose variaciones según nivel de escolarización y edad. CONCLUSIONES: Los parámetros de la adaptación transcultural realizada han demostrado ser aceptables y similares a los del cuestionario en su versión original. El punto de corte que parece más recomendable para el SPMSQ-VE sería de 3 o más errores, en el caso de personas que al menos sepan leer y escribir, y de 4 o más para los analfabetos (AU)

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