In contempo years we accept apparent aberrant all-around demographic change in the ageing of the apple population. This amusing abnormality will abide to abound and experts anticipation that by 2050 the age-old will annual for over a third of the absolute citizenry of some developed countries. At 34.4%, Spain will be the fourth country in the apple with the accomplished allotment of bodies over 65 (Vidal Domínguez & Fernández Portela, 2014).
The age-old are a awful accessible accumulation afflicted to comestible difficulties (Tena & Serrano, 2002) which if not prevented or advised in time access anguish and may advance to aerial bloodshed rates, appropriately acceptable a botheration of abundant personal, ancestors and socio-health acceptation (Tena & Serrano, 2002; Stratton, 2012). The prevalence of malnutrition ranges amid 1% and 6% in the abandonment elderly, but the accident of adversity it may adeptness up to 60% (Tena & Serrano, 2002; Guigoz, 2006; Kaiser et al., 2010; Sánchez-Muñoz et al., 2013). Its accident is aerial in both arrested and added developed countries and it is a claiming for affiliation in acceding of the sustainability of its bread-and-er assets and bloom systems (Stratton, 2012; García de Lorenzo, Álvarez & De Man, 2012).
Currently it is estimated that the majority of the age-old (96.2%) are chargeless active and appetite to abide at their home or at a relative’s home as continued as accessible (Iglesias de Ussell & López Doblas, 2014). The 2012 IMSERSO address (Madrigal Muñoz, 2014) estimates that over 96% of the age-old in the Valencia Region alive at home. One abstraction from the 3rd Plenufar Plan (Nutrition Education by Pharmacists Plan) begin that 3.7% of these abandonment age-old are angular and 22.2% at accident of acceptable so (Plenufar III, 2006). Furthermore, in a antecedent abstraction (Montejano et al., 2013), we begin that 23.3% of this accumulation in the arena of Valencia are at accident of malnutrition.
Given the forcast of experts this citizenry accumulation is set to increase, so it would be appropriate and able to set up bloom programmes in primary healthcare which would accredit aboriginal identification of comestible risk, appropriately alienated malnutrition and its accessible consequences. Alone through adequate, quick and bargain comestible appraisal can some comestible problems be bound or at atomic be alleviated (Tena & Serrano, 2002; Cuesta, 2007).
Various scales accept been acclimated to accomplish a quick and aboriginal akin comestible assessment, and the Mini Comestible Appraisal (MNA) is one of the best acclimated and recommended by experts in the age-old in all areas. One of its capital advantages is the identification of malnutrition accident afore analytic alterations access and appropriately does not crave class tests. Aback 1994 and afterwards 20 years of development and use, the MNA calibration has become accustomed as one of the best frequently acclimated accoutrement by advisers for first-level comestible cachet appraisal of the elderly, irrespective of breadth they live. As it is accessible to use, bargain and reliable it has become allotment of the analytic convenance of bloom professionals and a accurate and capital aspect in absolute age-old appraisal (Guigoz, Vellas & Garry, 1994; Cuesta, 2007; Bauer et al., 2008; Kaiser et al., 2011; Salvà, 2012).
This internationally accurate and acclimated calibration has a short/screening version, the Mini Comestible Appraisal Abbreviate Anatomy (MNA-SF), which was developed and accurate in 2001 (Rubenstein et al., 2001). With the accession of this abbreviate form, the comestible appraisal occurs in two stages, the aboriginal in adjustment to analyze bodies at accident of malnutrition and a added one in which these bodies are adjourned with the abounding MNA calibration (Rubenstein et al., 2001; Bauer et al., 2008; Salvà, 2012). The MNA-SF was revised in 2009 and a malnutrition cachet absolute point was added in adjustment to allocate the age-old into three groups (normal diet status, accident of malnutrition and malnutrition) analogous these three categories in the abounding version. Another new affection is that Anatomy Accumulation Base (BMI) can be replaced by Dogie Ambit (CC) in the age-old breadth there is adversity in barometer acme and weight. If the bodies adjourned get a annual lower than 12 on these abbreviate scales, it is appropriate to complete the abounding MNA calibration to abstain analytic accurateness errors (Kaiser et al., 2009). Furthermore, aback the abounding MNA calibration identifies malnutrition or the accident of malnutrition, added assay should be performed at a added akin including a comestible history to actuate biochemical, immunological and anthropometric ambit since, as acclaimed by some authors and all-embracing organisations, there is no distinct constant by itself which allows comestible assay (Calderón et al., 2010; Durán Alert et al., 2012). The two abbreviate versions of the calibration present acceptable analytic anticipation compared to the abounding calibration (Kaiser et al., 2009; Kaiser et al., 2011; García-Meseguer & Serrano-Urrea, 2013; Lilamand et al., 2015; Lera et al., 2016) but there are abounding added validation studies for the aboriginal abbreviate calibration (BMI-MNA-SF) than the abbreviate one revised in 2009 (CC-MNA-SF).
Recently, the MNA calibration has been acclimated as the gold accepted to advance added abbreviate comestible appraisal questionnaires for abandonment elderly. Malek Mahdavi et al. (2015) accept fatigued up a calibration with nine questions, all included in the MNA (clinical status, comestible appraisal and self-perception of bloom cachet and diet calm with mid-arm and dogie ambit abstracts afterwards including anatomy accumulation index). In Taiwan, Tsai, Chang & Wang (2013) developed new accoutrement based on the MNA, accumulation some items and alteration the BMI, CC and MNA absolute credibility to acclimate them to their citizenry characteristics. Gutiérrez-Gómez et al. (2015), afterwards assessing a sample of age-old women with MNA and accepting factors associated with malnutrition, advised and accurate a analysis with six items (physical activity, diabetes, hypertension, dentition, cerebral problems and active with family). All of them accept acquired acceptable analytic accurateness after-effects compared to the MNA scale.
Some authors (Phillips et al., 2010; De la Montaña & Miguez, 2011) accept compared the MNA with added comestible screening instruments in the abandonment age-old and classified MNA as one of the best accoutrement for this accumulation due to its aerial sensitivity, believability and validity. However, there are few studies comparing the authority and predictive accommodation of the BMI-MNA-SF and CC-MNA-SF scales with annual to the abounding MNA calibration in abandoned abandonment age-old samples. Best studies use amalgamate samples with abased or non-dependent age-old active in nursing homes, hospitals and the community. In this abstraction we accustomed to appraise the sensitivity, specificity and predictive adeptness of this calibration in both its aboriginal (BMI-MNA-SF) and adapted (CC-MNA-SF) versions adjoin the abounding MNA calibration in a ahead advised abandonment and non-dependent age-old citizenry in Spain (Montejano, 2012; Montejano et al., 2013).
We advised a cross-sectional anecdotic abstraction including 660 bodies of both es age-old 65 or over, abandonment and residing in the arena of Valencia. The abstraction was conducted amid October 2008 and November 2009. We calm abstracts in twelve affiliation centres for the age-old beyond the arena of Valencia, which were called application stratified sampling by blocks to ensure the assorted bounded settings of the arena were represented. We chose a sample admeasurement that would ensure an appraisal of the admeasurement of accident or malnutrition with an accurateness of 5% and a adeptness of 80% for the tests performed, because an estimated citizenry prevalence of 35%.
Inclusion belief for accommodating in the abstraction were actuality age-old 65 or over, active at home, accepting resided in the arena of Valencia for over one year, consistently accessory affiliation centres and voluntarily absent to booty allotment in the study.
National Institute of Statistics (INE) abstracts appearance that in 2009, bodies age-old 65 and over registered in the arena of Valencia accounted for 15.9% of its absolute population. 95% of them lived in the affiliation (in free-living) and were accustomed users of socio-health centres. Valencia’s bloom arrangement is chargeless and accepted and the arena of abstraction has 11 bloom departments with 142 bloom centres and 281 abetting offices broadcast throughout its territory. They draw up bloom affairs for the age-old to advance their advantageous habits and lifestyles (Montejano, 2012).
We acclimated three scales, the abounding MNA and its two abbreviate versions (BMI-MNA-SF and CC-MNA-SF), for the comestible appraisal of the participants. We acclimated the abounding MNA as the gold accepted for comestible assessment.
The abounding MNA calibration has 18 items, provides a best accessible all-embracing appraisal of 30 credibility and its comestible categories are accustomed comestible cachet (24–30 points), accident of malnutrition (17–23.5 points) and malnutrition (<17 points) (Guigoz, Vellas & Garry, 1994). The MNA-SF has two versions depending on the anthropometric altitude used. The BMI-MNA-SF contains the aboriginal six items of the abounding calibration added Anatomy Accumulation Base while the CC-MNA-SF includes Dogie Ambit instead of BMI. In both scales the best accessible annual is 14 credibility and, based on this score, there are three comestible categories analogous the abounding scale, namely accustomed comestible cachet (12–14 points), accident of malnutrition (8–11 points) and malnutrition (0–7 points). According to the authors, a annual lower than 12 suggests accessible malnutrition and makes it appropriate to ample in the MNA to get a added absolute appraisal of comestible cachet (Kaiser et al., 2009).
The abstracts to complete the assay was acquired from claimed interviews conducted in the affiliation centres by nurses who had been accomplished avant-garde for that purpose. The instructions in the adviser to commutual the MNA assay (Nestle Diet Institute, 2008) were followed. The anthropometric ambit in the scale, Mid-Arm Ambit (MAC), Dogie Ambit (CC) and Anatomy Accumulation Base (BMI), were gathered.
CC and MAC were abstinent with a SECA 201 band admeasurement (range 0–205 cm and 1 mm accuracy). MAC was abstinent in the non-dominant arm at the beggarly amid the acromion and the olecranon with the arm blind bottomward and alongside to the body. CC was abstinent in the dogie breadth area the ambit is greatest with the actuality sitting down, comatose their bottom on the attic and their knee angled at 90°.
Weight and acme were abstinent with an ASIMED MB201 calibration and acme rod with an accurateness of 100 g for weight (range 0.1–150 kg) and an accurateness of 0.5 cm for acme (maximum accommodation 200 cm). Weight was abstinent with the accountable barefoot and cutting ablaze accouterment to the aing 0.1 kg. Acme was abstinent with the accountable continuing barefoot with heels together, accoutrements at their sides, legs straight, amateur airy and arch accumbent in the Frankfort accumbent alike with heels, ocks, accept blades and the aback of the arch accurate adjoin the acme rod. Abstracts were recorded in centimetres. Anatomy accumulation base was afflicted as weight (kg) disconnected by height2 (m) (BMI = weight (kg)/height2 (m)).
We conducted anecdotic assay of the variables of interest. We acclimated means, accepted deviations, medians and ranges to call quantitative variables and the Kolmogorov–Smirnov assay to analysis normality. We acclimated accommodation to call qualitative variables and analysed beeline affiliation amid the array acquired in the abbreviate forms and the abounding adaptation of the MNA assay by Spearman’s assay for correlations. Based on the categories “malnutrition”, “risk of malnutrition” and “normal comestible status” we acquired Cohen’s kappa base to quantify acceding greater than that accepted by adventitious amid the MNA-SFs and abounding MNA classification. We acquired the aplomb intervals for the estimated kappa ethics application the jackknife adjustment which does not crave course for the variables (Efron & Tibshirani, 1993; Abraira & Pérez de Vargas, 1999). We performed a kappa accord assay to analyze of the kappa base (Fleiss, 1981).
Based on the categories “malnutrition and accident of malnutrition” vs. “normal diet status” and application the abounding MNA as the gold standard, we afflicted sensitivity, specificity and predictive ethics in adjustment to appraise the analytic accurateness of the abbreviate forms of the MNA test. Additionally, we performed a non-parametric admiration of the ROC ambit to appraise the abominable adeptness of the BMI-MNA-SF and CC-MNA-SF apart of the absolute values. We acclimated clear representation and the Hanley and McNeil assay to analyze the analytic adeptness of the two MNA-SFs. We performed statistical analyses with the SPSS (Statistical Package for Amusing Sciences) adaptation 20.0 for Windows XP (SPSS Inc., Chicago, IL, USA) and Epidat 4.2 (Epidat, 2016).
The angle was advised by the Doctoral Committee of the Department of Nursing, Faculty of Bloom Sciences. The abstraction has been accustomed by the Ethics Committee at the University of Alicante (File UA 2016-12-21).
A academic accounting appeal to access permission for the abstraction was fabricated to the administration teams at the affiliation centres for the age-old included in it. All abstraction accommodation were asked to booty allotment on a autonomous basis. They were appropriately a about the abstraction and their anonymity was guaranteed. Acknowledged requirements and guidelines for acceptable analytic convenance and the Apple Medical Affiliation Declaration of Helsinki on Ethical Principles for Medical Analysis involving Human Accommodation (revised in October 2008) were met.
The basal characteristics of the abstraction citizenry are apparent in Table 1. Of the 660 accommodation studied, 319 were men (48.3%) and 341 (51.7%) women with a beggarly age of 74.3 years (SD = 6.6); 54% were age-old amid 65 and 74 and best of them alive with addition abroad (72.7%).
Basic characteristics of the Abstraction Population.
The beggarly array we acquired in the three scales are aerial and are actual agnate in the two abbreviate scales. Out of a accessible 14 credibility offered by both versions, the age-old respondents accomplished an boilerplate annual of 12.4 credibility (SD = 1.6) on the BMI-MNA-SF calibration and 12.3 credibility (SD = 1.7) on the CC-MNA-SF scale. On the abounding adaptation of the MNA, out of a accessible 30 credibility they accomplished a beggarly annual of 25.3 credibility (SD = 2.4). Figures 1 and 2 appearance the categories of analytic allocation based on the comestible cachet of respondents for the abounding adaptation and the two abbreviate versions of the MNA. They are bidding as frequencies and percentages. Categorising the three comestible appraisal possibilities offered by the MNA according to the absolute annual shows that of the 660 age-old assessed, 154 (23.3%) were at accident of malnutrition; malnutrition itself was not detected in any of them. There are similarities in the allocation application the two abbreviate scales; with the BMI-MNA-SF, 175 (26.5%) were at accident of malnutrition and six (0.9%) were malnourished, while with the CC-MNA-SF calibration 173 (26.2%) were at accident of malnutrition and 10 (1.5%) were malnourished. Following the instructions of the scale, all those bodies adjourned with the two abbreviate versions who did not access array aloft 11 credibility had to complete the MNA assay in adjustment to analyze their comestible cachet (Kaiser et al., 2009). With the BMI-MNA-SF scale, we begin 181 (27.4%) bodies who had not anesthetized this annual and with the CC-MNA-SF we begin a absolute of 183 (27.7%), all of whom accordingly had to complete the MNA.
The absolute allocation accustomed by the abbreviate versions shows that of the 479 bodies classified with accustomed comestible cachet by the BMI-MNA-SF and the 477 bodies classified with accustomed comestible cachet by the CC-MNA-SF, in both cases there were 41 bodies at accident of malnutrition according to the abounding adaptation of the MNA. In added words, had we not completed the abounding adaptation of the scale, these 41 bodies (6.2% of the absolute sample) would accept anesthetized both screening tests afterwards actuality advised at accident of malnutrition aback in actuality they were (Figs. 1 and 2).
Table 2 shows the allusive abstraction we performed on the sample of abandonment age-old affiliation in the arena of Valencia, the after-effects acquired with the MNA-SF abbreviate versions and the after-effects acquired with the abounding MNA. To get an all-embracing appearance we acquired altered measures of affiliation and agreement. Spearman’s rank alternation coefficients announce a aerial affiliation amid the abounding MNA annual and the MNA-SFs array (BMI-MNA-SF: ρ =0.78 p < 0.001; CC-MNA-SF: ρ = 0.78p < 0.001). There is additionally actual aerial alternation amid the two MNA-SFs (ρ = 0.96p < 0, 001).
Comparative abstraction of abstracts of acceding amid MNA-SFs and abounding MNA.
Since the point of the MNA is classifying abandonment age-old in the three comestible statuses (normal, at accident and malnutrition), we completed this accessory with a admeasurement of agreement. The kappa accessory indicates the acceding over and aloft the bulk we would apprehend by chance. Aback interpreting the ethics of this accessory according to the Landis & Koch (1997) calibration and comparing them with the ethics acquired in added studies, it should be borne in apperception that they are afflicted by the prevalence of the ache in the citizenry considered. In our abstraction the kappa ethics acquired for the MNA-SFs (BMI-MNA-SF: κ = 0.54p < 0.001; CC-MNA-SF: κ = 0.52p < 0.001) announce abstinent acceding with the abounding MNA according to Landis & Koch (1997) allocation and there is actual acceptable acceding amid the BMI-MNA-SF and the CC-MNA-SF (κ = 0.88p < 0.001). If we analyze the BMI-MNA-SF and CC-MNA-SF kappa coefficients application a kappa accord test, we do not access any cogent aberration (p = 0.697).
In adjustment to actuate the adeptness of both MNA-SFs to analyze accommodation not acute any comestible intervention, we advised the dichotomised categorisation in the abounding MNA and the MNA-SFs as “risk of malnutrition” vs. “normal comestible status”. Areas beneath the ROC curves application the abounding MNA as the gold accepted accomplished aerial ethics (BMI-MNA-SF: AUC =0.88p < 0.001; CC-MNA-SF AUC =0.87p < 0.001) (Fig. 3). We do not access a cogent aberration if we analyze the analytic accurateness of the two abbreviate tests (p = 0.581). Because the abounding MNA as the gold standard, the acuteness acquired in the MNA-SFs is agnate (73.4%) and the specificity is hardly college in the BMI-MNA-SF than in the CC-MNA-SF (86.6% and 86.2%). Although prevalence does not affect acuteness or specificity, the acuteness amount will abatement if the amount of malnutrition presented by the age-old is not actual high. Accustomed that the abandonment age-old citizenry resides at home, the prevalence of malnutrition is accepted to be low aback compared to hospitalised populations.
The predictive ethics independent in Table 2 (PPV, NPV and analytic effectiveness) will be afflicted by the prevalence of malnutrition in the population, with PPV activity bottomward in populations with low prevalence.
In this study, we begin that the BMI-MNA-SF and CC-MNA-SF scales accept able predictive accurateness with annual to the MNA calibration in non-institutionalized elderly. They showed aerial acuteness and accuracy. We additionally acquired a abstinent acceding amid MNA and the two versions of the MNA-SF for anecdotic accommodation with accident of malnutrition. In both cases, the overestimation of the comestible cachet is alone 6.2% compared to the MNA which is advised the gold standard. Malnutrition was not detected in the sample advised in our abstraction (non-institutionalized age-old accessory day affliction centres) and the allotment of adults at accident of malnutrition was 23.3%.
One limitation of our abstraction is that the sample is not adumbrative of the accomplished accumulation of abandonment elderly, as bodies with disabilities accept been excluded.
The backbone of our abstraction is that analytic accurateness tests of the CC-MNA-SF calibration for an abandoned abandonment age-old sample had not ahead been conducted in Spain.
Due to the aerial access of the ache prevalence and its severity on statistical measures acclimated to analyze analytic tests (Burgueño, García-Bastos & Gónzalez-Buitrago, 1995), some studies accept been conducted to appraise the MNA assay and MNA abbreviate versions in altered populations. The advice provided by these studies is absolutely absorbing for the specialist may booty appropriate decisions based on the characteristics of the citizenry on which the tests are actuality performed. As we mentioned above, few studies accept been done up to the moment in non-institutionalized age-old populations and abnormally on the use of CC-MNA-SF on these blazon of populations, breadth it may accept a actual advantageous result.
We accept performed an all-embracing afterlight of afresh studies performed on the MNA, BMI-MNA-SF or CC-MNA-SF in non-institutionalized age-old populations or in alloyed populations. At the all-embracing level, we accept begin one abstraction performed in Germany and Italy with 675 age-old bodies disconnected into three groups: community-dwelling earlier people, nursing homes affiliation and patients in age-old rehabilitation (Kaiser et al., 2011), apropos the analytic attention of the BMI-MNA-SF and CC-MNA-SF scale, admitting the calibration MNA as gold standard. The prevalence ante in institutionalized (malnutrition 18.2% accident 41.9%) or in rehabilitation (malnutrition 40.8% accident 45.9%) earlier patients was actual high. The prevalence in non-institutionalized earlier adults, who were recruited by an commodity in columnist and went to booty the assay on its own, is low (0% malnutrition accident 11%). The akin of acceding amid the two abbreviate forms and the MNA, was acceptable in institutionalized or in rehabilitation earlier patients and was about chastened in non-institutionalized earlier adults, as in our study, actuality the coefficients kappa hardly lower in the CC-MNA-SF than in the BMI-MNA-SF in the three groups. The animadversion by the authors, in the discussion, that the abstinent acceding acquired in non-institutionalized earlier adults is due to the low prevalence rates.
Lera et al. (2016) agitated out a allusive abstraction amid the three scales with abandonment elderly, age-old over 60, in bristles cities in Latin America (São Paulo, Santiago, Havana, Mexico and Montevideo). They conducted a accidental sampling, calling bodies by buzz and visiting them in their homes. The all-embracing prevalence of malnutrition was 3.42% and accident of malnutrition 25%. The akin of acceding amid the three scales is acceptable in the mentioned cities, capricious the kappa accessory based on the altered akin of prevalence empiric in anniversary city. We accede that the akin of acceding is a little bit greater than the acquired in our study, due to the college prevalence of malnutrition on the bristles cities considered. The abstraction on the acuteness and specificity of the CC-MNA-SF was conducted because as gold-standard BMI-MNA-SF, so the after-effects are not commensurable with the ethics acquired in our study.
In Spain we begin two studies (Cuervo et al., 2008; De la Montaña & Miguez, 2011) breadth the sample characteristics are agnate to ours. They alone agitated out tests for the authority and analytic accurateness of the BMI-MNA-SF calibration with annual to the MNA.
Cuervo et al. (2008) conducted a abstraction on malnutrition in Spain with patients not institutionalized application the MNA and the BMI-MNA-SF, afterwards because CC-MNA-SF. The abstraction included 22,007 patients 65 years or older. The patients were recruited in pharmacies, breadth they bought their medicines. The prevalence was hardly college than ours, as in Lera’s et alt. abstraction (malnutrition 4.3% and accident 25.4%) possibly aback were recruited in pharmacies while they were affairs medicines. The akin of acceding amid MNA and BMI-MNA-SF on this abstraction is good, due to the aforementioned affidavit we accept mentioned previously.
De la Montaña & Miguez (2011) conducted the abstraction in the north-western of Spain amid age-old active in their homes and defective amusing care, to appraise the adequacy of the BMI-MNA-SF assay for this population. The sample admeasurement was 728 and the prevalence was actual aerial (12.5% malnutrition and 57% at risk). Both the acuteness and specificity are college than ours, which may be due to the severity of malnutrition in patients based in this environment. The PPV was actual aerial and the NPV was actual low, possibly due to the aerial prevalence, adverse to the after-effects of our abstraction breadth the PPV is low and the NPV is high, due to the low prevalence. The all-around predictive amount is similar.
The alone abstraction we accept begin in Spain, breadth the CC-MNA-SF is compared to the MNA assay is the one by García-Meseguer & Serrano-Urrea (2013), developed in Albacete in patients institutionalized with a aerial prevalence (2.8% malnutrition and 37.3% at risk). On this abstraction was accomplished a acceptable acceding amid BMI-MNA-SF and MNA, a abstinent acceding amid CC-MNA-SF and MNA and college ethics for specificity and sensitivity, possibly associated with college akin of malnutrition.
It may be empiric in above studies, that aback we are alive on a citizenry breadth de prevalence of malnutrition is low, as in our case, the actuality of an alterity amid the allotment of age-old bodies in a accustomed comestible accompaniment and the allotment of age-old bodies at accident or malnourished, does the accidental acceding be greater and the kappa accessory has abate values. Also, the low prevalence of malnutrition has abrogating access on the predictive absolute amount and absolute on the abrogating predictive value. On the added hand, alike admitting prevalence does not accept a absolute access on the acuteness and specificity of analytic test, these ethics are afflicted by the akin of malnutrition, because of the adversity of audition age-old bodies with balmy akin of malnutrition.
This justifies the accent of accomplishing studies on these analytic tests on altered populations to be able to get able decisions based on the after-effects obtained. On the few studies done up to this moment, in populations with a malnutrition prevalence and a akin of malnutrition agnate to that of the patients analysed on this study, after-effects are agnate to ours. Also, we anticipate this is one of the aboriginal studies breadth the CC-MNA-SF assay has been analysed with non-institutionalized elders in Spain.
Bearing in apperception that the abandonment age-old citizenry is growing and that inexpensive, quick and able comestible appraisal accoutrement are bare for use in primary healthcare settings, we advance that the CC-MNA-SF calibration is a advantageous screening apparatus and a accurate another to the BMI-MNA-SF, although the characteristics of the citizenry charge consistently be taken into annual to accomplish the appropriate decisions based on the MNA-SF scales. Aback malnutrition prevalence is usually not actual aerial in this blazon of population, the akin of acceding amid the BMI-MNA-SF, CC-MNA-SF and the MNA will be moderate. On the added hand, accustomed that malnutrition is not usually present at an avant-garde date in abandonment elderly, the acuteness of short-forms scales additionally may be affected. Therefore, aback the CC-MNA-SF after-effects are not in accordance with added added advice and the doctor is in doubt, the able accommodation will be to complete the abounding MNA or accomplish added examinations.
To sum up, in our study, both versions of the MNA-SF accept aerial predictive adeptness to analyze comestible accident in abandonment age-old people. In both cases there was an overestimation of their comestible cachet of alone 6.2%. The new adaptation (CC-MNA-SF) is easier to use as the BMI constant can be replaced by CC in primary affliction centres, demography beneath time and actuality beneath costly, as it does not crave scales and a ample accessories to admeasurement weight and height.
However, added studies would be bare in adjustment to bigger accept their abominable accommodation in non-institutionalised age-old populations. It would additionally be advantageous to abstraction the problems to analyze abeyant malnutrition in this blazon of population, aback its amount of malnutrition is low and additionally to investigate the achievability of adopting the CC-MNA-SF absolute point for this group.
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