Test-retest reliability of the Mini Nutritional Assessment and its relationship with quality of life in patients with stroke

Eating difficulties among Nigerian community-dwelling stroke survivors: prevalence, correlates, and association with quality of life

BACKGROUND

Eating ability is central to human existence and survival, societal acceptance, life satisfaction, and social participation. Although eating difficulties (EDs) are common after stroke, few studies are reporting their impact on the quality of life (QoL) of stroke survivors. This study aimed to assess the prevalence, correlates, and association of EDs with QoL among stroke survivors.

METHODS

A cross-sectional study on 233 (Mean age: 59.6 ± 10.9 years; 52.8% female) Nigerian community-dwelling stroke survivors attending rehabilitation at three public hospitals was conducted. The Minimal Eating Observation Form- version II and WHOQOL-BREF were used to collect data on EDs and QoL respectively. Socio-demographic, stroke-related, and clinical characteristics of patients were assessed using structured questionnaires. The association of EDs with each domain of WHOQOL-BREF (physical health, psychological health, social relationships, environmental health, perceived health status, and overall QoL) was assessed with hierarchical regression analyses.

RESULTS

The majority (60.9%) of stroke survivors had at least one form of ED. Among the three types of EDs assessed, difficulty with energy/appetite (45.1%) was the most prevalent, followed by difficulty with ingestion (43.8%) and deglutition (40.8%). The results showed that EDs were associated with haemorrhagic stroke (r = 0.158; p = 0.016), right-sided hemiplegia (r = 0.172; p = 0.008), increasing stroke severity (r = 0.466; p < 0.001), increasing co-morbidity (r = 0.384; p < 0.001), poor oral health (r = 0.511; p < 0.001), poor mental health (r = 0.260; p < 0.001), poor affected grip strength (r= -0.157; p = 0.016), poor nutritional status (r= -0.362; p < 0.001), low functional ability (r= -0.415; p < 0.001), and low social support (r= -0.257; p < 0.001). After adjustments, EDs independently explained 10.7% of the variance in psychological health (β= -0.467; p < 0.001), 4.7% in social relationships (β= -0.308; p < 0.001), 2.4% in perceived health status (β= -0.221; p = 0.002), and 7.4% in overall QoL (β= -0.383; p < 0.001). However, the variance accounted for by EDs in physical and environmental health domains was insignificant.

CONCLUSION

The prevalence of EDs among Nigerian community-dwelling stroke survivors is high, which is associated with many stroke-related and clinical factors. Meanwhile, increasing in EDs is independently associated with reduced QoL among stroke survivors using WHOQOL-BREF. Emphasis on screening and management of EDs in stroke rehabilitation protocols may assist in improving survivors' QoL.

The nutritional risk in patients with neuromyelitis optica spectrum disorder

BACKGROUND

The effect of nutrition on chronic autoimmune diseases is well known. This study is the first to assess the nutritional status of patients with neuromyelitis optica spectrum disorder (NMOSD) by administering the Mini Nutritional Assessment (MNA), to explore the impacts of nutrition on patients' quality of life and to identify the factors associated with the nutritional status of NMOSD patients.

METHODS

Our study enrolled 70 NMOSD patients and 66 healthy controls. The following data were assessed: demographic information, disease features, and composite evaluations of life status, including nutrition, sleep, anxiety/depression, fatigue, and quality of life. Then, statistical analysis was performed.

RESULTS

The MNA score of NMOSD patients was 20.4 ± 3.3, which was significantly lower than that of HCs (23.3 ± 2.5, P = 0.002), especially for the dimensions of global evaluation and anthropometric assessment. Nearly 85% of patients were at risk of malnutrition or had definite malnutrition. The total MNA score was positively correlated with the patient's quality of life (P<0.01). Lower MNA scores were correlated with gender (P = 0.02), longer disease duration (P<0.001), more severe anxiety (P = 0.004), more severe depression (P = 0.003), more severe sleep disturbances (P<0.001), and more severe fatigue (P = 0.01). Sleep disturbance was revealed to be a significant independent factor for the NMOSD patients' malnutritional risk (P = 0.001).

CONCLUSIONS

These results suggest that the risk of malnutrition is very high in NMOSD patients and that malnutrition is closely related to their quality of life. Malnutrition among NMOSD patients is caused by a combination of various physiological and psychological factors. A multifaceted and personalized intervention is required to improve the prognosis of NMOSD.

Enteral Nutrition and Hydration in Patients with Acute Stroke: Efficacy of an Automatic Pump System for Water Administration and Flushes-A Pilot Study

BACKGROUND

Enteral nutrition is often prescribed in acute stroke to meet energy and fluid needs in patients with dysphagia. Tubes clogging represent a common complication of enteral formula delivery, requiring substitution and influencing nutrition administration. Frequent water flushes are recommended as one of the most effective procedures to prevent tube occlusion, but it might be time demanding and not consistently performed by the healthcare staff. This study aimed to assess the efficacy of an automatic flush pump, compared to a manual flush system, to prevent tubes' occlusions in acute-stroke patients, as this might affect nutrition and hydration.

METHODS

Gastrointestinal symptoms, nutrition and hydration biomarkers were also monitored to determine the different devices' safety. Sixty-two patients were included in the study and allocated to the "manual" or "automatic" flushes device.

RESULTS

The mean duration of data collection was 7 ± 2 days. Tube occlusions occurred in 22.6% of the patients in the "manual" group, whereas only one tube clogging was reported in the "automatic" group (p = 0.023). No significant differences between groups were reported for constipation and diarrhea frequency nor nutrition and hydration status. When the nurses were asked to simulate manual flush administration at the same frequency of the automatic device, they were able to meet the recommendations only 10% of the time.

CONCLUSION

This preliminary study suggests the efficacy of automatic flush systems to prevent enteral tube clogging, without affecting health status compared to standard manual flush systems.

Impact of Daycare Service Interruption during COVID-19 Pandemic on Physical and Mental Functions and Nutrition in Older People with Dementia

This study evaluated changes of cognitive, physical, and nutritional status before and after the interruption and resumption of daycare services during the COVID-19 pandemic in older dementia people in a daycare center. Comprehensive geriatric assessment data were analyzed before and after the lockdown of daycare center services, including mini-mental state examination, activities of daily living (ADL) scores, mini-nutritional assessment-short forms (MNA-SF), and timed up-and-go (TUG) tests. Among 19 dementia people participating in daycare services, 17 participants were enrolled in the study with, finally, two excluded because of incomplete follow-ups. They had a median age of 81 years; their MNA-SF scores and TUG values deteriorated significantly after a 3-month closure of daycare services (p < 0.05), and after resumption of daycare services the MNA-SF scores and TUG values recovered to near the pre-lockdown levels (p < 0.05). Besides, baseline ADL scores predicted a decline and recovery of TUG and MNA-SF values. Our findings suggest that planning continuous support for older dementia adults is important for daycare facilities during COVID-19 pandemic confinement.

Comparison of Content and Psychometric Properties of Malnutrition Outcome Measures: A Systematic Review

OBJECTIVE

To determine the most-often used outcome measures for malnutrition risk and malnutrition, analyse outcome measure content, and assess psychometric properties.

METHODS

MEDLINE, SAGE Journals, Web of Science, SCOPUS, ProQuest and Science Direct databases were searched to identify outcome measures. Outcome measure content was compared using the International Classification of Functioning Disability and Health (ICF). Psychometric properties were also systematically searched and compared. This review was prepared according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

A total of 1,311 studies met the inclusion criteria. The most-often used outcome measures for detecting malnutrition or its risk overall were: body mass index (590), albumin (469), Mini Nutritional Assessment (312), haemoglobin (251), and Subjective Global Assessment (139). The most psychometrically sound outcome measure was Mini Nutritional Assessment, but the most comprehensive measure, covering the most ICF categories, was Patient-Generated Subjective Global Assessment, with a total of 58 meaningful concepts.

CONCLUSION

The results provide an insight into the content and psychometric quality of malnutrition risk and malnutrition outcome measures. There was some variation between the way reviewers linked meaningful concepts to ICF, and literature gaps were identified regarding psychometric properties. These results can be used to help select the most appropriate malnutrition outcome measure.

Interrater reliability of routine screening for risk of malnutrition with the Mini Nutritional Assessment Short-Form in hospital

BACKGROUND/OBJECTIVES

The Mini Nutritional Assessment Short-Form (MNA-SF) is the recommended screening tool for older persons. Data on interrater reliability in clinical routine are rare. Thus, we wanted to quantify the interrater reliability of the MNA-SF in hospital.

SUBJECTS/METHODS

This observational cross-sectional study was undertaken retrospectively. The study population comprised 105 participants. Risk of malnutrition was measured twice with the routine MNA-SF performed by nurses (within 24 h after admission) and a dedicated dietician (one to three days after the first MNA-SF). The MNA-SF score was analyzed for interrater reliability between nurse and dietician.

RESULTS

Participants' mean age was 82.4 (±7.1) years and 71 (68%) were women. The mean total MNA-SF score was 7.4 (±2.4) assessed by dietician and 7.8 (±2.3) assessed by nurse. The intra-class correlation coefficient between the total MNA-SF scores was 0.74 (0.61; 0.82), indicating moderate reliability. For the MNA-SF nutritional status, Cohens Kappa was 0.37 (p < 0.05) showing a fair agreement.

CONCLUSION

Multiple misclassifications were observed between malnutrition and risk of malnutrition. Because mean scores were near the border between malnutrition and risk of malnutrition, we recommend to consider the total MNA-SF score in addition to the three risk groups to assess nutritional risk in geriatric hospital patients.

Health-related quality of life profiles and their dimension-specific associated factors among Malaysian stroke survivors: a cross sectional study

Background

Apart from maximizing functional abilities and independence after stroke, improving overall health-related quality of life (HRQoL) should also become part of the stroke treatment and rehabilitation process goals. This study aimed to assess the HRQoL profiles and explore the dimension-specific associated factors of HRQoL among stroke survivors.

Methods

This was a cross-sectional study of stroke survivors attending post-stroke care clinics in three public hospitals in the states of Pahang and Terengganu, Malaysia. The HRQoL was assessed by EuroQol-5 dimension-5 levels. Data on socio-demographic, clinical profiles, malnutrition risk, and physical activity level were collected through an interviewer-administered survey. Descriptive analyses for HRQoL profiles and multiple logistic regression analyses for its associated factors were performed. Crude and adjusted odds ratios were reported.

Results

A total of 366 stroke survivors were recruited with a mean age of 59 ± 11 years. The most -commonly reported health problems were mobility (85%), followed by usual activities (82%), pain/discomfort (63%), anxiety/depression (51%) and self-care (41%). The mean of the EQ visual analogue scale and the median of the EQ5D summary index was reported at 60.3 ± 14.2 and 0.67 ± 0.37, respectively. Malnutrition risk (mobility, usual activities, and self-care), wheelchair users (self-care and usual activities), speech impairment (usual activities and pain/discomfort), number of stroke episodes (self-care and pain/discomfort), body mass index, physical activity level and types of strokes (usual activities), age and use of a proxy (anxiety/depression), working and smoking status (mobility), were factors associated with either single or multiple dimensions of HRQoL.

Conclusion

Routine malnutrition screening, tailored program for speech therapy, prevention of recurrent stroke, and physical activity promotion should be addressed and further reinforced in current rehabilitation interventions to improve the HRQoL among stroke survivors in Malaysia.

Inadequate Intake of Energy and Nutrients Is Common in Older Family Caregivers

The aim of this study was to investigate the nutritional status, determinants of nutritional status, and adequacy of energy and nutrient intake of older family caregivers (FC). Nutritional status was measured using the Mini Nutritional Assessment (MNA), plasma albumin, plasma pre-albumin, and blood hemoglobin concentrations. Dietary intake was assessed with a three-day food record. Comorbidity (B −0.283, 95% CI: −0.492, −0.073), quality of life (B 0.045, 95% CI: 0.018, 0.072) and energy intake (B 0.001, 95% CI: 0.000, 0.002) were significantly associated with the MNA scores of the older FCs (n = 125). It was common for FCs to have lower than recommended intakes of energy and several nutrients, independent of the risk of malnutrition assessed by the MNA. Over half of the FCs had inadequate intake of protein, vitamin A, folate, and fiber, and 25–40% of the FCs had a low intake of vitamin D, vitamin E, thiamine, magnesium, iron, and selenium. It is important to follow both the nutritional status and dietary intake of older FCs regularly to find those with lower than recommended nutrient intake and to avoid poor nutritional status and its adverse effects hampering their ability to serve as FCs.

Effects of a food preparation program on dietary well-being for stroke patients with dysphagia: A pilot study

BACKGROUND

Dysphagia is one of the common issues observed in patients with stroke. Stroke patients with dysphagia have to eat blended food or similar types of food for each meal, resulting in dietary dissatisfaction. The purpose of this study was to investigate the effects of a food preparation program on dietary well-being for stroke patients with dysphagia.

METHODS

This study was a pilot randomized clinical trial. Twenty-two patients were assigned randomly into the food preparation group (n = 11) and control group (n = 11). The food preparation group received oral motor exercises, recognition of food texture and thickener, and hands-on food preparation for 6 weeks. Outcome measures included the Dietary Well-Being Scale, brief version of the World Health Organization Quality of life, Swallowing Quality of Life Questionnaire, and Mini Nutritional Assessment.

RESULTS

Patients in the food preparation group showed significant improvements in the Dietary Well-Being Scale, psychological and environmental domains of the brief version of the World Health Organization Quality of life (P = .001-.024) with small to large effect sizes (success rate difference = 0.23-0.46). The Swallowing Quality of Life Questionnaire and Mini Nutritional Assessment displayed non-significant differences (P = .053-.092) and revealed small to moderate effect sizes (success rate difference = 0.23-0.32).

CONCLUSIONS

The food preparation program showed a positive impact on dietary well-being and a potential improvement in the health-related quality of life, quality of life related to the process of swallowing, and nutritional status for stroke patients with dysphagia. We recommend that stroke patients with dysphagia receive adequate knowledge and hands-on food preparation training to increase their dietary intake and well-being.

Nutritional status as a predictor of comprehensive activities of daily living function and quality of life in patients with stroke

BACKGROUND

Nutritional status could affect functional capacity and reduce quality of life in patients with stroke. Although the associations between nutritional status, basic activities of daily living (BADL)/Instrumental ADL, and quality of life (QOL) in older people have been identified, the relationships have not yet been examined in patients with stroke, using the full Mini Nutritional Assessment (MNA) or MNA-short form (MNA-SF).

OBJECTIVE

This study aimed to examine the relationship between nutritional status (using full MNA and MNA-SF), comprehensive ADL function, and QOL in patients with stroke.

METHODS

Eighty-two patients with ischemic stroke participated in this cross-sectional design study. Each participant was assessed with the full MNA, MNA-SF, comprehensive ADL function (including Barthel Index and Frenchay Activities Index), and WHO Quality of Life Questionnaire (WHOQOL-BREF) once.

RESULTS

The MNA-SF was only significantly correlated with the comprehensive ADL function (rho = 0.27, p = 0.013), whereas, the full MNA was found to be significantly correlated with the comprehensive ADL function and WHOQOL-BREF (rho = 0.24, p = 0.029 and rho = 0.30, p = 0.005, respectively). The MNA-SF was a significant predictor of comprehensive ADL function, accounting for 44% of the variance. The full MNA was the only significant predictor of the WHOQOL-BREF, explaining 17% of the variance.

CONCLUSIONS

This study has revealed a relationship between nutritional status, comprehensive ADL function, and QOL among patients with stroke. Patients with stroke with better nutritional status had higher ADL function as well as better QOL. The MNA-SF was useful in predicting comprehensive ADL, whereas, the full MNA could be used to predict QOL. Knowledge and evidence of the association and predictive power of the MNA-SF and full MNA could guide clinicians to choose tools for assessing the nutritional status of patients with stroke more effectively.

Nutritional Assessment in Older Adults : MNA® 25 years of a Screening Tool and a Reference Standard for Care and Research; What Next?

A tool to assess nutritional status in older persons was really needed. It took 5 years to design the MNA® (Mini Nutrition Assessment) tool, complete the first validations studies both in Europe and in the U.S. and to publish it. After the full MNA®, the MNA® short form and the self-MNA® have been validated. As well as Chinese and other national MNA® forms. Now more than 2000 clinical research have used the MNA® all over the world from community care to hospital. At least 22 Expert groups included the MNA® in new clinical practice guidelines, national or international registries. The MNA® is presently included in almost all geriatric and nutrition textbook and part of the teaching program for medicine and other health care professional worldwide. The urgent need is to target the frail older adults more likely to have weight loss and poor appetite and to prevent frailty and weight loss in the robust. We present in this paper the review of 25 years of clinical research and practice using the MNA® worldwide.

Neuromuscular Electrical Stimulation and High-Protein Supplementation After Subarachnoid Hemorrhage: A Single-Center Phase 2 Randomized Clinical Trial

INTRODUCTION

Aneurysmal subarachnoid hemorrhage (SAH) survivors live with long-term residual physical and cognitive disability. We studied whether neuromuscular electrical stimulation (NMES) and high-protein supplementation (HPRO) in the first 2 weeks after SAH could preserve neuromotor and cognitive function as compared to standard of care (SOC) for nutrition and mobilization.

METHODS

SAH subjects with a Hunt Hess (HH) grade > 1,modified Fisher score > 1 and BMI < 40 kg/m² were randomly assigned to SOC or NMES + HPRO. NMES was delivered to bilateral quadricep muscles daily during two 30-min sessions along with HPRO (goal:1.8 g/kg/day) between post-bleed day (PBD) 0 and 14. Primary endpoint was atrophy in the quadricep muscle as measured by the percentage difference in the cross-sectional area from baseline to PBD14 on CT scan. All subjects underwent serial assessments of physical (short performance physical battery, SPPB) cognitive (Montreal Cognitive Assessment Scale, MoCA) and global functional recovery (modified Rankin Scale, mRS) at PBD 14, 42, and 90.

RESULTS

Twenty-five patients (SOC = 13, NMES + HPRO = 12) enrolled between December 2017 and January 2019 with no between-group differences in baseline characteristics (58 years old, 68% women, 50% HH > 3). Median duration of interventions was 12 days (range 9-14) with completion of 98% of NMES sessions and 83% of goal HPRO, and no reported serious adverse events. There was no difference in caloric intake between groups, but HPRO + NMES group received more protein (1.5 ± 0.5 g/kg/d v 0.9 ± 0.4 g/kg/d, P < 0.01). Muscle atrophy was less in NMES + HPRO than the SOC group (6.5 ± 4.1% vs 12.5 ± 6.4%, P 0.01). Higher atrophy was correlated with lower daily protein intake (ρ = - 0.45, P = 0.03) and lower nitrogen balance (ρ = 0.47, P  = 0.02); and worse 3 month SPPB (ρ = -  0.31, P = 0.1) and mRS (ρ = 0.4, P  = 0.04). NMES + HPRO patients had a better median [25%,75] SPPB (12[10, 12] v. 9 [4, 12], P = 0.01) and mRS (1[0,2] v.2[1, 3], P = 0.04) than SOC at PBD 90.

CONCLUSIONS

NMES + HPRO appears to be feasible and safe acutely after SAH and may reduce acute quadriceps muscle wasting with a lasting benefit on recovery after SAH.

Clinical measurement properties of malnutrition assessment tools for use with patients in hospitals: a systematic review

BACKGROUND

The use of malnutrition outcome measures (OM) by registered dietitians (RD) with inpatients in hospitals has increased promoting the achievement of nutritional care goals and supporting decision-making for the allocation of nutritional care resources in hospitals. There are 3 commonly used OMs: Subjective Global Assessment (SGA), Patient Generated-Subjective Global Assessment (PG-SGA) and Mini Nutritional Assessment (MNA). The purpose of this current study was to systematically review the evidence of the clinical measurement properties of malnutrition assessment tools for use with patients admitted in hospitals.

METHODS

MEDLINE, Cinahl, EMBASE, and PubMed were searched for articles published between 2000 and 2019. Research articles were selected if they established reliability, validity, and responsiveness to change properties of the SGA, PG-SGA and MNA tools, were written in English, and used any of these OMs as an outcome measure. Abstracts were not considered. The risk of bias within studies was assessed using the Quality Appraisal for Clinical Measurement Study (QA-CMS).

RESULTS

Five hundred five studies were identified, of which 34 articles were included in the final review: SGA (n = 8), PG-SGA (n = 13), and MNA (n = 13). Of the 34 studies, 8 had a quality score greater than 75%; 23 had a quality score of 40-75% and 3 studies had a quality score of less than 40%. PG-SGA was found to have excellentdiagnostic accuracy (ROC: 0.92-0.975; Sensitivity: 88.6-98%; Specificity: 82-100%), sufficient internal consistency (Cronbach's alpha: 0.722-0.73), and strong test-retest reliability (r = 0.866). There was insufficient evidence to suggest adequate diagnostic accuracy and good inter-rater reliability for SGA. Only one study examined the minimum detectable change of MNA (MDC = 2.1).

CONCLUSIONS

The evidence of validity for the existing malnutrition assessment tools supports the use of these tools, but more studies with sound methodological quality are needed to assess the responsiveness of these OMs to detect the change in nutritional status.