Comparison of the Mini-Nutritional Assessment short and long form and serum albumin as prognostic indicators of hip fracture outcomes

Abstract

Introduction: Malnutrition is common among older hip fracture patients and associated with adverse outcomes. We examined Mini Nutritional Assessment short (MNA-SF) and long form (MNA-LF) and serum albumin as prognostic indicators of mobility, living arrangements and mortality after hip fracture.Methods: Population-based prospective data were collected on 594 hip fracture patients aged 65 and over. MNA-SF, MNA-LF and serum albumin were assessed on admission. Outcomes were poorer mobility; transfer to more assisted living accommodation and mortality one month, four months and one year post fracture. Logistic regression analyses for mobility and living arrangements with odds ratios (OR) and Cox proportional hazards model for mortality with hazard ratios (HR) and 95% confidence intervals (CI) were used, adjusted for age, gender, ASA grade and fracture type.Results: All measures predicted mortality at all time-points. Risk of malnutrition and malnutrition measured by MNA-LF predicted mobility and living arrangements within four months of hip fracture. At one year, risk of malnutrition predicted mobility and malnutrition predicted living arrangements, when measured by MNA-LF. Malnutrition, but not risk thereof, measured by MNA-SF predicted living arrangements at all time-points. None of the measures predicted one-month mobility.Conclusions: All measures were strong indicators of short-and long-term mortality after hip fracture. MNA-LF was superior in predicting mobility and living arrangements, particularly at four months. All measures were relatively poor in predicting short-term outcomes of mobility and living arrangements.

Predictive value of the mini-nutritional assessment short form (MNA-SF) and nutritional risk screening (NRS2002) in hip fracture

“…Of the patients at risk of malnutrition and with normal nutritional status respectively 21% and 10% died within four months. Similar results have been reported earlier (10,11,18,26). No significant difference could be seen between groups when using NRS2002.…”

“…This indicates the patient's overall condition and high scores predict a greater number of comorbidities and mortality after hip fracture treatment (24). Over half of the malnourished patients had memory disorder but only 22% of the patients with normal nutritional status, thereby corroborating earlier reports (5,11).…”

“…Lim et al in their prospective cohort study on diagnosis-related groups (DRG) found that malnutrition led to longer hospital stay, more readmissions and mortality (8). In many studies malnutrition in hip fracture patients has been found to be associated with increased risk of perioperative complications, prolonged LOS, loss of mobility, a need for more assisted form of living arrangements and increased risk of mortality (6,7,(9)(10)(11). Identifying patients likely to benefit from nutritional support could reduce morbidity and mortality, improve quality of life and reduce medical costs.…”

The geriatric nutrition risk index versus the mini-nutritional assessment short form in predicting postoperative delirium and hospital length of stay among older non-cardiac surgical patients: a prospective cohort study

“…Previous studies have demonstrated that the MNA-SF and the GNRI were more suitable for assessing nutritional status than serum albumin [13,33]. In addition, the GNRI and MNA-SF had better performance in predicting adverse outcomes than serum albumin [34,35]. Thus, more comprehensive and systematic nutritional screening methods, such as the GNRI and the MNA-SF, are needed to evaluate nutritional status or nutrition-related complications among surgical patients.…”

Using frailty and quality of life measures in clinical care of the elderly in Canada to predict death, nursing home transfer and hospitalisation - the frailty and ageing cohort study

“…Depression was assessed with the 5-point Geriatric Depression Scale (GDS) 22–24. The Mini-Nutritional Assessment Short Form (MNA-SF),18 25–28 Nestlé (https://www.mna-elderly.com/) was used to assess nutritional risk. Because of the high prevalence of oedema, only body mass index and not calf circumference was used for the MNA-SF.…”