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      Estado nutricional de la población mayor de Cataluña de diferentes niveles asistenciales Translated title: Nutritional status of Catalonia’s elderly people with different health care needs

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          Abstract

          Los objetivos de este estudio fueron evaluar la prevalencia de desnutrición a través de la Mini Encuesta Nutricional del Anciano (MNA) en la población mayor de Lleida (Cataluña) de diferentes niveles asistenciales y valorar si dicha escala es un buen método de monitorización en nuestro medio. Para ello se diseñó un estudio transversal en el que se incluyeron personas de ambos sexos, igual o mayores de 65 años, procedentes del centro de salud, del hospital de agudos de la residencia asistida y de centros socio-sanitarios. Se utilizó la MNA en su versión corta (cribado) y versión íntegra (MNA total). Este cuestionario está diseñado para la valoración nutricional de los individuos mayores tanto a la admisión en hospitales e instituciones como para la monitorización durante su estancia. Se incluyeron 398 individuos (184 hombres), con una edad media de 77 años. Según las categorías de la MNA, la prevalencia de desnutrición del total de la muestra fue del 22,6% y de riesgo de desnutrición del 35,4%. La MNA ha sido validada en nuestro medio obteniendo una sensibilidad del 77% y una especificidad del 70%. Se podría afirmar como conclusión que existe una elevada prevalencia de riesgo de desnutrición y desnutrición establecida en Cataluña sobretodo en los centros socio-sanitarios y en el servicio de medicina interna del hospital de agudos. Los resultados son similares a otros estudios contrastados. La MNA es una herramienta útil para el monitoreo nutricional en los distintos niveles asistenciales tanto en el cribado como en su versión íntegra.

          Translated abstract

          The aims of this study were to assess the prevalence of malnutrition through the Mini Nutritional Assessment (MNA) in the elder population of Lleida (Catalonia) from different levels of care and to determine if that scale is a good way of monitoring our population. A cross-sectional study was designed. It included men and women of 65 years or more users of primary health care centre, the acute hospital, nursing home and health and assisted social services. The MNA was used in your short form (MNA-SF) and MNA total (MNA). This questionnaire is designed to screen the nutritional status of elderly people, when they arrived to the hospital and during their stay. Three hundred and ninety-eight individuals (184 men) were included aging 77 on average. According to the categories of the MNA, the prevalence of malnutrition of the total sample was 22.6% and risk of malnutrition of 35.4%. The MNA has been validated in our population getting a sensitivity of 77% and specificity of 70%. In conclusion, it can be affirmed that there was a high prevalence of undernourishment, foremost in health and social care services and in the medicine service of acute hospital. The MNA is a useful tool for monitoring nutritional care at different levels in both the short form and in total form.

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          To screen or not to screen for adult malnutrition?

          There is some controversy about whether all adults receiving healthcare should be routinely screened for nutritional problems. (i) A systematic review examined the proposition that malnutrition is under-recognised and under-treated, and that nutritional interventions in malnourished patients, identified through a screening procedure produce clinical benefits (assessed using randomised controlled trials, RCTs). (ii) A systematic review of nutritional screening interventions in populations of malnourished and well-nourished subjects (RCTs and non-RCTs). (i) The prevalence of malnutrition varies according to the criteria used, but is estimated to affect 10-60% of patients in hospital and nursing homes, 10% or more of older free-living subjects, and less than 5% of younger adults. In the absence of formal screening procedures, more than half the patients at risk of malnutrition in various settings do not appear to be recognised and/or are not referred for treatment. RCTs show that nutritional interventions in malnourished patients produce various clinical benefits. (ii) Interventions with nutritional screening in different care settings also generally suggest clinical benefits, but some are limited by small sample sizes and inadequate methodology. Factors that influence outcomes include validity, reliability and ease of using the screening procedure, the 'care gap' that exists between routine and desirable care and the need for other resources, which may increase or decrease following screening. The frequent failure to recognise and treat malnutrition, especially where it is common, is unacceptable. In such circumstances, the routine use of a simple screening procedure is recommended. Each health care setting should have a transparent policy about nutritional screening, which may vary according to the 'care gap', available resources, and specific populations of patients, in which the prevalence of malnutrition may vary widely.
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            Nutritional status using mini nutritional assessment and subjective global assessment predict mortality in geriatric patients.

            To evaluate the clinical assessment of nutritional status and mortality in geriatric patients. Prospective follow-up study. Acute geriatric inpatient ward. Eighty-three consecutive acute geriatric patients (mean age +/- standard deviation = 83 +/- 7; 68% women). Patients were classified as (1) having protein-energy malnutrition (PEM), (2) having moderate PEM or being at risk for PEM, or (3) being well nourished according to Subjective Global Assessment (SGA) and Mini Nutritional Assessment (MNA). Body mass index ((BMI) kg/m2), arm anthropometry, and handgrip strength were determined. In a subgroup of patients (n = 39), body composition was analyzed using dual energy x-ray absorption and bioelectrical impedance. Three-year mortality data were obtained from the Swedish population records. Twenty percent and 26% of the patients were classified as having PEM based on SGA and MNA, respectively, whereas 43% and 56%, respectively, were classified as having moderate PEM or being at risk for PEM. Objective measures, such as BMI, arm anthropometry, handgrip, and body fat were 20% to 50% lower in the malnourished group than in the well-nourished subjects (P <.05). Moreover, mortality was higher in those classified as being malnourished, ranging from 40% after 1 year to 80% after 3 years, compared with 20% after 1 year (P =.03-0.17) and 50% after 3 years (P <.01) in patients classified as being well nourished. Fewer than one-third of newly admitted geriatric patients had a normal nutritional status according to SGA and MNA. BMI, arm anthropometry, body fat mass, and handgrip strength were reduced, and 1-, 2-, and 3-year mortality was higher in patients classified as malnourished. The present data justify the use of SGA and MNA for the assessment of nutritional status in geriatric patients.
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              Relationships between nutritional markers and the mini-nutritional assessment in 155 older persons.

              To investigate the relationships between nutritional status measured by a comprehensive nutritional assessment including anthropometric measurements, nutritional biological markers, evaluation of dietary intake, and the Mini-Nutritional Assessment (MNA) nutrition screening tool. A prospective study. One hundred fifty-five older subjects (53 men and 102 women; mean age = 78 years; range = 56-97 years). These participants were hospitalized in a geriatric evaluation unit (n = 105) or free living in the community (n = 50). Weight, height, knee height, midarm and calf circumferences, triceps and subscapular skinfolds, albumin, transthyretin (prealbumin), transferrin, ceruloplasmin, C-reactive protein, alpha1-acid glycoprotein, cholesterol, vitamins A, D, E, B1, B2, B6, B12, folate, copper, zinc, a 3 day food record combined with a food-frequency questionnaire; the MNA nutritional screening. The MNA scores have been found to be significantly correlated to nutritional intake (P < .05 for energy, carbohydrates, fiber, calcium, vitamin D, iron, vitamin B6, and vitamin C), anthropometric and biological nutritional parameters (P < .001 for albumin, transthyretin, transferrin, cholesterol, retinol, alpha-tocopherol, 25-OH cholecalciferol zinc). An MNA score between 17 and 23.5 can identify those persons with mild malnutrition in which nutrition intervention may be effective. The MNA is a practical, noninvasive, and cost-effective instrument allowing for rapid nutritional evaluation and effective intervention in frail older persons.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                alan
                Archivos Latinoamericanos de Nutrición
                ALAN
                Sociedad Latinoamericana de Nutrición (Caracas )
                0004-0622
                March 2009
                : 59
                : 1
                : 38-46
                Affiliations
                [1 ] Universidad de Lleida España
                Article
                S0004-06222009000100006
                f97de1ec-23e4-4ecf-97a6-2e0610e11c6e

                http://creativecommons.org/licenses/by/4.0/

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                Product

                SciELO Venezuela

                Self URI (journal page): http://www.scielo.org.ve/scielo.php?script=sci_serial&pid=0004-0622&lng=en
                Categories
                NUTRITION & DIETETICS

                Nutrition & Dietetics
                Nutrition,Mini Nutritional Assessment,health care services,elderly,Nutrición,Mini encuesta Nutricional del Anciano (MNA),centros asistenciales,personas mayores

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