Comparison of two malnutrition risk screening methods (MNA and NRS 2002) and their association with markers of protein malnutrition in geriatric hospitalized patients

Background: Malnutrition occurs frequently in the elderly and is associated with increased morbidity and mortality. The mini-nutritional assessment (MNA) has been used most frequently in the geriatric literature. The nutritional risk screening 2002 (NRS) has been proposed as universal screening method for hospitalized patients. The aim of our study was to compare both tools as they are correlated with protein malnutrition. Methods: MNA, NRS, and markers of protein malnutrition were measured in 104 consecutive inpatients admitted to an acute geriatric ward. Results: The median age was 84 years (IQR: 78-89), 81 were females. The median body mass index was 23.1 kg/m(2) (IQR: 20-27.3), the median upper-arm and calf circumferences were 25cm (IQR: 23-29) and 33cm (IQR: 29-36). According to MNA, 23 patients were malnourished, 50 at risk of malnutrition, and 31 had a normal nutritional status. The NRS indicated that 35 were at moderate to severe risk of malnutrition and 69 at low risk. Serum prealbumin and retinol-binding protein concentrations were inversely associated with the severity of malnutrition as indicated by the NRS (P = 0.06 and <0.01, respectively), whereas the MNA was not associated with these serum proteins. After adjustment for C-reactive protein and creatinine clearance, only retinol-binding protein concentrations were consistently associated with both malnutrition scores. Conclusions: The NRS seems to be superior compared with the MNA and serum proteins in identifying elderly patients at risk of malnutrition during acute intercurrent illness. European Journal of Clinical Nutrition (2010) 64, 887-893; doi: 10.1038/ejcn.2010.64; published online 19 May 2010