The prognostic significance of malnutrition as assessed by the Mini Nutritional Assessment (MNA) in older hospitalized patients with a heavy disease burden

Background & aims: Malnutrition is common in older persons. However, it is unclear whether malnutrition diagnosed with the Mini Nutritional Assessment (MNA) predicts mortality in older hospitalized patients. Methods: We prospectively studied the impact of the MNA-short form (MNA-SF) and co-morbidities on long-term mortality in 444 patients (mean age 85.3 +/- 6.7; 74.0% women) receiving geriatric inpatient care. In a cross-sectional study we studied the interplay between the MNA, nutritional markers and comorbidities (using the Cumulative Illness Rating Scale, CIRS). Results: The prevalence of malnutrition and "at risk of malnutrition", defined by MNA-SF, was 25.5 and 50.5% respectively in our prospective study. CIRS scores (HR = 1.09, p < 0.001) and a low BMI (HR = 0.96, p < 0.05), but not the MNA-SF (HR = 0.79 and 0.89 for "at risk" and malnutrition respectively, P = NS), were associated with 4-year mortality. CIRS scores, albumin and other nutritional markers were similar between MNA categories. High CIRS scores and hypoalbuminemia were observed even in patients with normal MNA scores. There was good agreement (>80%) between the MNA-SF and the complete MNA. Conclusions: Malnutrition as diagnosed with the MNA at admission failed to predict long-term mortality in older inpatients, likely due to the overriding impact of co-morbidities and acute disease. (C) 2011 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.