An alternative short-form Mini-Nutritional Assessment for rating the risk of malnutrition in persons on haemodialysis

Aims and objectives To improve the short-form Mini-Nutritional Assessment (MNA) to ameliorate under-rating the risk of malnutrition in patients on haemodialysis. Background The full MNA was found to be appropriate for rating the risk of malnutrition in persons undergoing haemodialysis but the short-form under-rated the risk. Design A cross-sectional study with purposive sampling. Methods The study recruited 152 adult ambulatory patients on maintenance haemodialysis from one dialysis centre in Taiwan. Each subject was rated with the Subjective Global Assessment (SGA), the original and selected alternative short-forms (by replacing better performing nonshort-form items for lesser performing short-form items) of a Taiwanese-specific MNA (T1). Serum albumin and creatinine concentrations and the SGA were also used as referents. Results were evaluated with Pearson's correlation analysis, binary classification test and receiver operating characteristic (ROC) curves. Results The full MNA showed good consistency with the SGA, but the original short-form rated fewer patients at risk of malnutrition compared with the full MNA. Exchanging item O (self-rated nutritional status) with item E (neuropsychological problems) produced the best results and restored the predictive ability of the short-form. Replacing item P for E produced the next best results. Conclusion Results suggest that the predictive ability of the short-form can be greatly restored by rearranging the component items of the short-form without affecting the performance of the full MNA. The study is probably the first example of a disease-specific version of the MNA. Relevance to clinical practice The revision makes short-form MNA suitable for rating the risk of malnutrition in patients on haemodialysis in clinical practice.