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      Nutritional assessment of community-dwelling older adults in rural Nepal

      1 , * , 2 , 1

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          Abstract

          Background

          Demographic transition in Nepal, like in many developing countries, has resulted in a burgeoning elderly population whose health status is not currently monitored. One pillar of health is adequate nutrition. Yet, little is known about the nutritional health status of the elderly in Nepal. The financial, material, and personnel limitations in Nepal’s health delivery services necessitate health screening instruments that require minimal clinical staff and resources. To our knowledge, no such nutritional assessment tool has been validated in Nepal. Therefore, our aims are two-fold: To assess the nutritional status of the elderly population in one typical Nepali village, Okharpauwa, in Nuwakot District, Nepal; and concurrently, to validate the Mini Nutritional Assessment (MNA) tool.

          Methods

          A cross-sectional field study was conducted with a sample of 242 elderly people in Okharpauwa, Nepal to obtain prevalence of malnutrition. Differences in demographic and lifestyle factors between these who were malnourished, those at risk of malnourishment, and those who had adequate nutritional status were analyzed. The MNA tool was evaluated using receiver operating characteristic (ROC) curve analysis; sensitivity, specificity, and diagnostic accuracy were calculated.

          Results

          111 males and 131 females, with a mean age of 69.8±7.4 years, participated in this study. The mean BMI of the participants was 21.4±3.9 kg/m 2; the mean MNA score was 19.3±4.2. BMI was significantly correlated with the total MNA score (r = 0.58; p<0.001). The diagnostic accuracy, sensitivity and specificity of MNA were 81%, 86% and 67% respectively. Of the 242 elderly sampled, 24% were malnourished and 65% were at risk of malnutrition. Malnutrition was more prevalent among females (29%) than males (18%), and most prevalent among the marginalized Dalit ethnic group (40%). Elderly persons who were married and literate had better nutritional health than their counterparts.

          Conclusions

          The MNA appears to be a valid and sensitive tool for rapid nutritional screening of the elderly in Nepal. The prevalence of malnutrition was high among Nepalese elderly in the Okharpauwa VDC, which requires urgent health monitoring and management attention.

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          Most cited references 36

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          The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients.

          The Mini Nutritional Assessment (MNA) has recently been designed and validated to provide a single, rapid assessment of nutritional status in elderly patients in outpatient clinics, hospitals, and nursing homes. It has been translated into several languages and validated in many clinics around the world. The MNA test is composed of simple measurements and brief questions that can be completed in about 10 min. Discriminant analysis was used to compare the findings of the MNA with the nutritional status determined by physicians, using the standard extensive nutritional assessment including complete anthropometric, clinical biochemistry, and dietary parameters. The sum of the MNA score distinguishes between elderly patients with: 1) adequate nutritional status, MNA > or = 24; 2) protein-calorie malnutrition, MNA < 17; 3) at risk of malnutrition, MNA between 17 and 23.5. With this scoring, sensitivity was found to be 96%, specificity 98%, and predictive value 97%. The MNA scale was also found to be predictive of mortality and hospital cost. Most important it is possible to identify people at risk for malnutrition, scores between 17 and 23.5, before severe changes in weight or albumin levels occur. These individuals are more likely to have a decrease in caloric intake that can be easily corrected by nutritional intervention.
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            The accuracy of self-reported health behaviors and risk factors relating to cancer and cardiovascular disease in the general population: a critical review.

            To critically review the literature concerning the accuracy of self-reported health behaviors and risk factors relating to cancer and cardiovascular disease among the general population. A literature search was conducted on three major health research databases: MEDLINE, HealthPLAN, and PsychLit. The bibliographies of located articles were also checked for additional relevant references. Studies meeting the following five inclusion criteria were included in the review: They were investigating the accuracy of self-report among the general population, as opposed to among clinical populations. They employed an adequate and appropriate gold standard. At least 70% of respondents consented to validation, where validation imposed minimal demands on the respondent; and 60% consent to validation was considered acceptable where validation imposed a greater burden. They had a sample size capable of estimating sensitivity and specificity rates with 95% confidence intervals of width +/-10%. The time lag between collection of the self-report and validation data for physical measures did not exceed one month. Twenty-four of 66 identified studies met all the inclusion criteria described above. In the vast majority, self-report data consistently underestimated the proportion of individuals considered "at-risk." Similarly, community prevalences of risk factors were considerably higher according to gold standard data sources than they were according to self-report data. This review casts serious doubts on the wisdom of relying exclusively on self-reported health information. It suggests that caution should be exercised both when trying to identify at-risk individuals and when estimating the prevalence of risk factors among the general population. The review also suggests a number of ways in which the accuracy of individuals' self-reported health information can be maximized.
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              • Record: found
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              Assessing the nutritional status of the elderly: The Mini Nutritional Assessment as part of the geriatric evaluation.

               P Garry,  Y Guigoz,  B Vellas (1995)
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                14 February 2017
                2017
                : 12
                : 2
                Affiliations
                [1 ]Department of Environmental and Occupational Health, School of Community Health Sciences, University of Nevada, Las Vegas, Nevada, United States of America
                [2 ]Department of Biochemistry, Nepal Medical College and Teaching Hospital, Kathmandu, Nepal
                Oslo Universitetssykehus, NORWAY
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                • Conceptualization: SG BKB.

                • Data curation: SG.

                • Formal analysis: SG KC.

                • Investigation: BKB.

                • Methodology: SG BKB.

                • Project administration: SG BKB.

                • Resources: BKB.

                • Supervision: SG.

                • Visualization: SG KC.

                • Writing – original draft: SG KC.

                • Writing – review & editing: SG BKB KC.

                Article
                PONE-D-16-26208
                10.1371/journal.pone.0172052
                5308814
                28196115
                © 2017 Ghimire et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Figures: 2, Tables: 3, Pages: 15
                Product
                Funding
                Funded by: None
                The authors received no specific funding for this work.
                Categories
                Research Article
                People and Places
                Population Groupings
                Age Groups
                Elderly
                Medicine and Health Sciences
                Geriatrics
                People and Places
                Geographical Locations
                Asia
                Nepal
                Biology and Life Sciences
                Nutrition
                Medicine and Health Sciences
                Nutrition
                Biology and Life Sciences
                Nutrition
                Malnutrition
                Medicine and Health Sciences
                Nutrition
                Malnutrition
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Mood Disorders
                Depression
                Geriatric Depression
                Medicine and Health Sciences
                Geriatrics
                Geriatric Psychiatry
                Geriatric Depression
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Geriatric Psychiatry
                Geriatric Depression
                Medicine and Health Sciences
                Epidemiology
                Ethnic Epidemiology
                Medicine and Health Sciences
                Health Care
                Geriatric Care
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

                Uncategorized

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