Screening for malnutrition in elderly acute medical patients: the usefulness of MNA-SF.

BACKGROUND: Malnutrition is often over-seen in elderly acute medical patients. It is a need for a simple and robust screening tool. OBJECTIVE: The aim was to evaluate, with regard to validity, the Mini Nutritional Assessment-Short Form (MNA-SF) as a screening tool for malnutrition in elderly acute medical patients. DESIGN: This is an observational study where a nurse's scoring of MNA-SF is compared to comprehensive assessment by a clinical nutritionist (gold standard). Sixty-nine patients aged 70 years and older and admitted to a general medical department in year 2000 and 2001 were included. RESULTS: The mean MNA-SF score was 7.8 (SD +/- 2.88, range 2 to 12). Fifty-one patients (74%) scored positive for malnutrition or risk of malnutrition (MNA-SF < 11), whereas only 21 (30%) were scored to have malnutrition by the nutritionist. Sensitivity of the MNA-SF was 1.0 and specificity 0.38, giving 0.57 correctly classified subjects. Best subset logistic regression showed BMI < 23 to be the only item explaining the gold standard. When using BMI < 23, 32 (46%) subjects screened positive for malnutrition (sensitivity 0.86, specificity 0.71), giving 0.75 correctly classified subjects. CONCLUSIONS: When screening elderly acute medical patients in general wards for malnutrition or risk of malnutrition, the MNA-SF have a high sensitivity and can be useful. The sole use of BMI < 23 may be equally effective, but will give no information leading towards an explanation. We recommend that a score of BM < 23 should be followed by MNA-SF when the aim is to identify poor nutritional status in elderly acute medical patients.

Oats induced villous atrophy in coeliac disease.

The current trend is to allow coeliac disease (CD) patients to introduce oats to their gluten free diet. We sought further data from the clinical setting with regards to oats consumption by coeliac patients. Several oat products were tested for wheat contamination using a commercial enzyme linked immunoassay (ELISA) kit, and six samples were examined by an ELISA using a cocktail of monoclonal antibodies, mass spectrometry, and western blot analysis. Nineteen adult CD patients on a gluten free diet were challenged with 50 g of oats per day for 12 weeks. Serological testing and gastroduodenoscopy was performed before and after the challenge. Biopsies were scored histologically and levels of mRNA specific for interferon gamma were determined by reverse transcription-polymerase chain reaction analysis. Oats were well tolerated by most patients but several reported initial abdominal discomfort and bloating. One of the patients developed partial villous atrophy and a rash during the first oats challenge. She subsequently improved on an oats free diet but developed subtotal villous atrophy and dramatic dermatitis during a second challenge. Five of the patients showed positive levels of interferon gamma mRNA after challenge. Some concerns therefore remain with respect to the safety of oats for coeliacs.

Morbid obesity treated with gastric partitioning and gastrogastrostomy.

Between April 1981 and July 1983, 30 patients were operated on for morbid obesity with gastric partitioning and a gastrogastrostomy (GP). The patients were checked 3, 6, 9, 12, and 24 months postoperatively. Radiological investigations were performed on the 5th postoperative day and after 2-32 months. All patients lost weight postoperatively, ranging from 14 to 45 kg after 9 months, but thereafter a slight increase in weight was noted. The weight loss was not correlated with radiologically measured stoma size or volume of the upper gastric pouch. Thus, in contrast studies combined with Gastroluft (sodium bicarbonate, tartaric acid, and dimethicone), pouch distention does not yield prognostic information on anticipated weight loss. More reliable methods for measuring stoma and pouch size are needed, but other factors like patient motivation and a careful postoperative follow-up study with dietetic advice are probably more important for a satisfactory outcome.

Methionine sulphoxide as a source of sulphur-containing amino acids for the young rat.

1. Young male rats were used in five experiments to study the utilization for growth of methionine sulphoxide, and the relationship between the sulphoxide content in the diet and the level of microbiologically determined methionine activity in blood or blood plasma. In one nitrogen-balance experiment methionine and methionine sulphoxide were compared as supplements to a casein diet and a fish-meal diet. 2. Methionine sulphoxide was poorly utilized for growth when testd as the sole sulphur amino acid in an amino acid diet. Substitution of one-third of the sulphoxide with cystine improved utilization so that it approached that of methionine. 3. Methionine alone and in combination with methionine sulphoxide were added to a soya-bean-meal diet. The sulphoxide showed no adverse effect on growth. 4. Fish meal in which methionine had been oxidized to methionine sulphoxide was tested alone and in combinations with unoxidized fish meal. Only when the oxidized meal was given alone was there an appreciable effect on growth. The fish meal used were low in cystine. 5. Whereas both methionine and methionine sulphoxide improved the N balance when a casein diet was given, there was no effect when a fish-meal diet was given. 6. There was a linear relationship between methionine sulphoxide content in the amino acid diets and the methionine activity in the blood plasma. Methionine sulphoxide added to a soya-bean-meal diet or present in oxidized fish meal gave a curvilinear relationship, and the observed activities were lower than with the amino acid diets. Methionine activity in blood could not be used as an indicator of moderate amounts of methionine sulphoxide in protein-containing diets.