Diagnostic Performance and Accuracy of the MNA-SF against GLIM Criteria in Community-Dwelling Older Adults from Poland

Abstract

Up to 28% of elderly residents in Europe are at risk of malnutrition. As uniform diagnostic criteria for malnutrition have not been formulated, in autumn 2018, the Global Leadership Initiative on Malnutrition (GLIM) presented a consensus on its diagnosis. According to the consensus, the diagnosis of malnutrition requires a positive screening test result for the risk of malnutrition, and the presence of at least one etiologic and one phenotypic criterion. This study aimed to assess the diagnostic performance and accuracy of the Mini Nutritional Assessment—Short Form (MNA-SF) against GLIM criteria. The analysis involved 273 community-dwelling volunteers aged ≥ 60 years. All participants were screened for malnutrition with the MNA-SF questionnaire. Next, the GLIM phenotypic and etiologic criteria were assessed in all subjects. Based on the presence of at least one phenotypic and one etiologic criterion, malnutrition was diagnosed in more than one-third of participants (n = 103, 37.7%). According to the MNA-SF, only 7.3% of subjects had malnutrition, and 28.2% were at risk of malnutrition. The agreement between the MNA-SF score and the GLIM criteria were observed in only 22.3% of the population. The sensitivity and specificity of MNA-SF against the GLIM criteria were fair (59.2% and 78.8%, respectively). The area under the curve (AUC) was 0.77, indicating the fair ability of MNA-SF to diagnose malnutrition. Based on the present study results, the best solution may be an optional replacement of the screening tool in the first step of the GLIM algorithm with clinical suspicion of malnutrition.

Optimal Assessment of Nutritional Status in Older Subjects with the Chronic Obstructive Pulmonary Disease—A Comparison of Three Screening Tools Used in the GLIM Diagnostic Algorithm

“…Sanchez-Rodriguez et al [32] observed that more than half (60.4%) of community-dwelling older adults (mean age: 73.2 ± 6.05 years) with malnutrition according to the GLIM criteria had MNA-SF score of at least 12 [32]. Similarly, in our previous work [19] involving 273 community-dwelling elderly subjects (mean age: 72.1 ± 7.7 years), etiologic and phenotypic criteria for malnutrition were fulfilled in 103 individuals, of whom 41% (n = 42) had a negative screening result with the MNA-SF [19].…”

“…These findings [19,32] question the value of MNA-SF as a screening tool for malnutrition in elderly subjects when the GLIM algorithm is used, in opposition to earlier reports [5,6]. Other screening tools have also been put under criticism.…”

“…Despite the general acceptance of the GLIM diagnostic criteria for malnutrition published in 2018, the use of screening tools in the first step of diagnostics is the subject of much controversy [18,19,32,33]. Our results show that the use of the MNA-SF questionnaire as a screening tool would preclude the diagnosis of malnutrition in 20 subjects (41.7%), while the application of the MUST or NRS-2002 tool in 25 (52.1%) of patients (different individuals for both questionnaires).…”

“…In reality, such a person may fulfil these criteria. They suggested using clinical suspicion of malnutrition interchangeably with the positive result of a screening test [18,19]. As patients with COPD have a particularly high risk of malnutrition [20][21][22], it may be assumed that all of them have a clinical suspicion of malnutrition.…”

Malnutrition, Sarcopenia, and Malnutrition-Sarcopenia Syndrome in Older Adults with COPD

“…The results of our previous work also demonstrated just fair diagnostics performance of the MNA-SF questionnaire as a screening tool in the GLIM criteria. Thus, we suggested using a clinical suspicion of malnutrition interchangeably with a screening tool in the first step of the GLIM algorithm [ 40 ].…”