Is mini-nutritional assessment a reliable tool in detecting malnutrition in elderly with body weight excess?

PURPOSE: The rising proportion of elderly population in high-income societies has resulted in increasing number of subjects with chronic disabling diseases and nutritional deficiency. Elderly's nutritional status is usually assessed through the mini-nutritional assessment (MNA®). However, its effectiveness may be influenced by weight excess or obesity. We tested the performance of MNA® questionnaire in subjects aged ≥ 65 years from Northern Sardinia, Italy, according to overweight/obesity, and we tried to identify the factors associated with malnutrition. METHODS: A modified version of MNA® (mMNA) test, not including BMI, was compared with the conventional MNA® (cMNA) test, and the overall test performance was assessed by calculating sensitivity, specificity and accuracy. In addition, indexes of cognitive health, disability, comorbidity and polypharmacy were compared between patients with concordant and discordant MNA tests. RESULTS: cMNA® sensitivity, specificity and accuracy were 67%, 99% and 84% compared with the mMNA test, due to malnourished patients misclassified as normal because of excess weight. Predictors of malnutrition were: depression (p < 0.0001), disability (p < 0.0001) and polypharmacy (p < 0.0001). Interestingly, the average scores of the "global", "subjective" and "dietary" components of the cMNA®, were significantly lower compared with the corresponding scores of the mMNA. CONCLUSIONS: Excess of weight, a condition progressively rising in the elderly population, may reduce the performance of cMNA® test in detecting malnutrition. LEVEL OF EVIDENCE: Level III, case‒control analytic study.

Sociodemographic, Clinical and Functional Profile of Nonagenarians from Two Areas of Sardinia Characterized by Distinct Longevity Levels.

Introduction: Among the world's longest-lived communities the so-called Longevity Blue Zone (LBZ) of Sardinia, Italy, has attracted a lot of interest. In the present study, health profile and functional characteristics of LBZ oldest-old were compared with an age-matched sample from Northern Sardinia (NSS) with a lower longevity level. Methods: Cognitive status, symptomatic depression, disability, and nutritional status were assessed by standardized instruments. In addition, the proportion of escapers (illness-free medical history), delayers (illness only after age 80), and survivors (at least one disease before age 80) was calculated. Results: Three hundred individuals, 150 from the LBZ (age range 89-101, 89 women), and 150 from NSS (age range 89-101, 101 women) were enrolled. The proportion of married individuals in the LBZ cohort was significantly greater compared with the NSS (55% vs. 32%, p = 0.0001). The educational level among nonagenarians in the LBZ was almost half compared with NSS (p < 0.0001). Unskilled workers, shepherds, and peasants prevailed in the LBZ (79% vs. 21%, p < 0.0001). Institutionalized subjects were 1% in the LBZ and 14% in the NSS (p < 0.0001). Disability, comorbidity, and daily physical activity were more represented in LBZ. There was a significantly higher percentage of delayers (37% vs. 18%, p < 0.0002), and a reduction in the number of survivors (30% vs. 44%, p = 0.012) in the LBZ compared with the NSS group. The proportion of escapers was similar in both groups (33% vs. 38%, n.s.). Conclusion: These findings suggest that in the LBZ there are factors enabling frail individuals to live longer despite a greater burden of comorbidity.

Constipation in the elderly from Northern Sardinia is positively associated with depression, malnutrition and female gender.

OBJECTIVES: Constipation is a common complaint in older adults. The rise in life expectancy may amplify the problem and increase social expenditure. We investigated the major risk factors associated with constipation in a large sample of elderly. METHODS: Outpatients from Northern Sardinia attending a Geriatric Unit between 2001 and 2014 were enrolled. Demographic and anthropometric data, income, education and self-reported bowel function were collected. The presence of constipation was adjusted for cognitive status, assessed by the Mini-Mental State Examination (MMSE) test; single and cumulative illness rating scale (CIRS); current or past symptomatic depression and anxiety measured by the Geriatric Depression Scale (GDS); nutritional status, evaluated using the Mini-Nutritional Assessment (MNA); type and number of different medications used. RESULTS: 1328 elderly patients (mean age 77.7 ± 7.2 years) were enrolled. Constipation was present in 32.1%, more commonly in women (35.4% vs 28.3%) and increased with age. The multivariate analysis showed a significantly greater risk of constipation in patients with a risk of malnutrition (OR = 1.745, 95% CI: 1.043-2.022; p = .034), female gender (OR = 1.735, 95% CI: 1.068-2.820; p = .026) and depression (OR = 1.079, 95% CI: 1.022-1.140; p = .006). Other potential predisposing factors assessed such as MMSE, CIRS, body mass index, marital status, smoking habit, education, income and number of taken drugs did not show a statistically significant association. Aging was a risk for constipation also in patients free of medications. CONCLUSIONS: Knowledge of risk factors associated with bowel alterations in elderly individuals may provide important clues for caregivers to prevent or reduce constipation.