The 'Mini Nutritional Assessment' (MNA) and the 'Determine Your Nutritional Health' Checklist (NSI Checklist) as predictors of morbidity and mortality in an elderly Danish population

Abstract

The purpose of the present study was to evaluate the capacity of the 'Determine Your Nutritional Health' Checklist (NSI Checklist) and the 'Mini Nutritional Assessment' (MNA) methods to predict nutrition-related health problems. Data were from the Danish part of the 'Survey in Europe of Nutrition in the Elderly, a Concerted Action' (SENECA) baseline survey from 1988, and the follow-up study from 1993. Based on the baseline survey thirty-nine (19.3%) of the subjects were classified at high nutritional risk, 103 (51%) were considered at moderate nutritional risk and sixty (29.7%) were within the 'good' range according to the criteria in the NSI Checklist. With the MNA, 171 subjects were classified according to their nutritional risk into a well-nourished group, comprising 78.4%, and a group who were at risk of undernutrition, comprising 21.6% at baseline. A total of 115 subjects participated in the follow-up study. The mortality rate and the prevalence of various morbidity indicators were compared between the different risk groups. The analysis showed that subjects with a high MNA score (> or = 24) had significantly lower mortality (rate ratio estimate: 0.35; 95% Cl 0.18, 0.66) compared with subjects with a low MNA score (< or = 23.5). In contrast, the NSI Checklist score was not a significant predictor of mortality (rate ratio estimate: 1.45; 95% Cl 0.78, 2.71). The sixteen Danes judged to be at high nutritional risk by the NSI Checklist in 1988, had more acute diseases (P < 0.001) than the rest of the participants, between 1988 and 1993. No significant differences were found in the participation rates, hospitalization rates, physician visits, need of help or weight loss between the groups. The thirteen Danes judged to be at risk of undernutrition in 1988 by the MNA, had a lower participation rate (P < 0.01) and higher occurrence of acute disease (P < 0.05), need of help (P < 0.05), and weight loss (P < 0.001) than the well-nourished group, between 1988 and 1993. No significant differences were found in hospitalization rates and physician visits between the two groups. In conclusion, the results indicate that modified versions of the NSI Checklist and the MNA are capable of identifying a group of 70-75-year-old subjects with increased risk of certain nutrition-related health problems. Further, an MNA score < or = 23.5 predicts mortality in a Danish population.