Validation of nutritional screening tools against anthropometric and functional assessments among elderly people in Selangor

ABSTRACT

This cross sectional study was conducted to determine the validity of three screening tools, Mini Nutritional Assessment Short Form (MNA-SF), Malnutrition Risk Screening Tool for Community (MRST-C) and Malnutrition Risk Screening Tool for Hospital (MRST-H) among elderly people at health clinics. The screening tools were validated against anthropometric and functional assessments. The anthropometric assessments that were carried out included body weight, height, arm span, body mass index (BMI), calf circumference (CC) and mid upper arm circumference (MUAC). A set of questionnaire on manual dexterity, muscular strength, instrumental activities daily living (IADL) and cognitive status was used to assess functional abilities. A total of 156 subjects were recruited from rural (38 subjects) and urban (118 subjects) health clinics at Sabak Bernam and Cheras respectively. Subjects’ age ranged from 60 to 83 years old, with 44.2% were men and 55.8% women. The prevalence of muscle wasting among the subjects assessed from MUAC and CC were both 7.0%. MNA-SF had the highest correlation with BMI (r = 0.497, p<0.001), followed by MUAC (r = 0.398, p<0.001), CC (r = 0.473, p<0.001), cognitive assessment (r = 0.229, p<0.001) and handgrip strength (r = 0.209, p<0.001). Whilst MRST-C had the highest correlation with IADL score (r = -0.320, p<0.001) and MRST-H had the highest correlation with the lock and key test (r = -0.325, p<0.01). Sensitivity was the highest for MNA-SF (93.2%), followed by MRST-H (52.5%) and MRST-C (25.8%). Specificity was the highest for MRST-H (97.3%), followed by MRST-C (90.8%) and MNA-SF (79.4%). Positive predictive value (PPV) for MRST-H, MNA-SF and MRST-C was 55.5%, 18.2% and 14.1%, respectively. In conclusion, among the screening tools being validated, MNA-SF is considered the most appropriate tool to be used in health clinics for identification of elderly individuals who are at high risk of malnutrition.