Diagnostic accuracy of the Mini Nutritional Assessment – Short Form to identify malnutrition among older adults: protocol for a systematic review and meta-analysis

Anne Griffin; Sorcha McGarry; Caoimhe Moloney; Rose Galvin

doi:10.12688/hrbopenres.13358.1

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Diagnostic accuracy of the Mini Nutritional Assessment – Short Form to identify malnutrition among older adults: protocol for a systematic review and meta-analysis

[version 1; peer review: 1 approved with reservations, 1 not approved]

Anne Griffin ^1,2, Sorcha McGarry¹, Caoimhe Moloney¹, Rose Galvin^1,2

PUBLISHED 29 Jul 2021

Author details Author details

¹ School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
² Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland

Anne Griffin
Roles: Conceptualization, Investigation, Methodology, Project Administration, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Sorcha McGarry
Roles: Data Curation, Formal Analysis, Investigation, Methodology, Visualization, Writing – Review & Editing

Caoimhe Moloney
Roles: Data Curation, Formal Analysis, Investigation, Methodology, Visualization, Writing – Review & Editing

Rose Galvin
Roles: Conceptualization, Funding Acquisition, Methodology, Supervision, Validation, Visualization, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

Malnutrition has many associated physiological and psychological consequences for older adults that can result in reduced quality of life, poor disease outcomes and more frequent and longer hospital stays. Early recognition of malnutrition allows for timely intervention and treatment. There are several screening tools for nutrition risk. The most common one for malnutrition developed and validated for older adults is the short-form of the Mini Nutritional Assessment (MNA-SF). It can be completed in just a few minutes and applied in all health care settings. This systematic review and meta-analysis serves to synthesise the totality of evidence regarding the diagnostic accuracy of the MNA-SF tool compared with the full-form of the Mini Nutritional Assessment (MNA-FF) in older adults for the diagnosis of malnutrition in healthcare settings. Systematic searches of five bibliographical databases will be performed and will include the Pubmed, EMBASE, Cochrane Library, CINAHL and Web of Science to identify all studies that validate the MNA-SF for malnutrition among older adults in healthcare settings. Risk of bias will be assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pre-specified MNA-SF scores will be used to identify patients’ risk of malnutrition. Using data from 2x2 tables, studies will be pooled to generate summary estimates of sensitivity and specificity using a bivariate random effects model. The findings of this systematic review of diagnostic accuracy will provide evidence for healthcare professionals to make informed decisions regarding the optimum use of the MNA-SF as a nutrition risk screening tool to identify malnutrition among older people.
Registration details: Prospero registration number CRD42019131847

Keywords

malnutrition, mini nutritional assessment short form, older person, healthcare, screening tool, validation.

Corresponding author: Anne Griffin

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2021 Griffin A et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Griffin A, McGarry S, Moloney C and Galvin R. Diagnostic accuracy of the Mini Nutritional Assessment – Short Form to identify malnutrition among older adults: protocol for a systematic review and meta-analysis [version 1; peer review: 1 approved with reservations, 1 not approved]. HRB Open Res 2021, 4:83 (https://doi.org/10.12688/hrbopenres.13358.1) First published: 29 Jul 2021, 4:83 (https://doi.org/10.12688/hrbopenres.13358.1) Latest published: 29 Jul 2021, 4:83 (https://doi.org/10.12688/hrbopenres.13358.1)

Introduction

Malnutrition can be described as a condition resulting from a deficit in the uptake or intake of nutrition due to starvation, disease or ageing. As a consequence, decreased fat free mass, altered body composition and body cell mass result in weakened physical and mental function and impair the health, function and quality of life clinical outcomes of disease¹. There is a close relationship between malnutrition and frailty, sarcopenia and poor outcomes among older adults. It is often referred to as both “a cause and consequence of adverse outcomes”, and an increase in mortality is reported^2,3. The therapeutic aim of clinical nutrition in older adults is to provide adequate food and hydration to maintain or improve individual independence, quality of life, clinical outcomes, capacity for rehabilitation and thereby reduce the risk of morbidity and mortality².

It is estimated that 145,000 community and hospital patients in Ireland are malnourished or at risk of becoming malnourished (4% of the total population) at any given time⁴. Malnutrition among older people varies in prevalence according to settings ranging from 3% among community dwelling older people, to 6% among those attending outpatients and 8.7% among those receiving home care services, with considerable heterogeneity between studies⁵. In particular, malnutrition is highly prevalent in hospitals among older adults with reports that 39% are at risk of malnutrition⁶. In a recent study, over one third of patients (n=209) admitted to an Irish Emergency Department were identified as at risk of malnutrition or malnourished⁷. This study also found that those diagnosed as malnourished were more likely to report hospital or nursing home readmission, reduced quality of life and functional decline at 30-days follow up compared to older adults who had normal nutrition status.

Screening for malnutrition in older adults is an important step in the early detection of risk or diagnosis of malnutrition². Despite the observed prevalence, malnutrition screening frequently is not performed due to perceived barriers of application in hospital settings including nursing time, competence with the tool, and resources^8,9. Effective malnutrition screening can enable a nutrition care pathway and prevent further complications to the older adult’s nutritional status^2,10. Malnutrition can be identified by combining multiple measures including weight, height, body mass index (BMI), weight change, disease stage, changes in food intake and/or functional capacity. A nutrition screening tool incorporates data from these measures to generate a score and classify an individual’s nutrition status as normal, at risk of malnutrition, or malnourished. A total of 48 malnutrition screening tools have been identified and rated according to a scoring system to recommend the best tools across healthcare settings¹¹.

To assess the validity of a tool, a comparison needs to be made with a gold standard nutrition screening tool. There is no agreed gold standard for the assessment of malnutrition and, therefore, various reference standards are used in validation studies of screening tools¹². The Mini Nutritional Assessment (MNA®) is an accepted reference standard for validation studies of nutrition screening tools in many different settings, such as community, home care, nursing homes and hospitals^5,13,14. It was originally developed as a 18-item Mini Nutritional Assessment - full form (MNA-FF) instrument to screen and assess malnutrition as part of the geriatric assessment¹⁵. In 2001, the Mini Nutritional Assessment - short form (MNA-SF) was developed and validated, including a combination of six items from the MNA- FF¹⁶. This includes two items that account for a pre-existing risk of malnutrition: mobility and neuropsychological problems that regularly contribute to the development of malnutrition². The short form malnutrition screening tool was further revised and validated in 2009 to include a three-category scoring system that included a classification of “malnourished” that the original tool lacked¹⁷. This revision allows the MNA-SF to provide a nutritional assessment for the older adult. Further, the use of either BMI or calf circumference measurements enables its use with immobile individuals or in those circumstances where weight and height cannot be measured¹⁷. It is recommended for use by the European Society for Clinical Nutrition and Metabolism (ESPEN) guideline (2018) on clinical nutrition and hydration in geriatrics². The MNA-SF is the most common screening tool developed for older adults with the criterion validity tested in all healthcare settings, and thus would have applicability to healthcare professionals to identify malnutrition in the field of integrated care programmes for older people^2,10,11. However, the MNA-SF may overestimate the nutritional risk in hospitalised older adults based on a poor validity (low specificity) of the tool^18,19. To date, there has not been a systematic review of diagnostic accuracy to assess the totality of evidence from validation studies.

This systematic review and meta-analysis will synthesise the totality of evidence regarding the diagnostic accuracy of the MNA-SF in older adults when compared to the full form Mini Nutritional Assessment to identify malnutrition.

Protocol

Study design

This protocol describes a systematic review and meta-analysis that will be conducted using the principles in the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy²⁰ and will be reported using the Preferred Reporting Items for Systematic reviews and Meta-Analysis for Diagnostic Test Accuracy (PRISMA-DTA)²¹. In accordance with the guideline, this protocol was registered on 31/05/2019 with the International Prospective Register of Systematic Reviews (PROSPERO), number CRD42019131847.

Eligibility criteria

Types of study. Cross-sectional or prospective or retrospective cohort studies will be included in this review. Studies published in all languages will be included in the search.

Participants. This review will consider studies with older adults aged greater than or equal to 65 years of age at the time of nutrition screening with the MNA-SF. Settings include and are limited to acute-care hospitals, long-term care facilities, such as nursing homes, and urgent-care and emergency medical services.

Experimental test

Interventions. The diagnostic accuracy of the revised MNA-SF¹⁷ screening tool for malnutrition will be explored. This will include studies where the MNA-SF is administered by a health professional (e.g., Dietitian, Registered Nurse or others) trained in administering the screening tool to identify older adults who are nourished, at risk of malnutrition or malnourished. It will not include studies where the MNA-SF is self-administered by the patient or carer as it has been shown that the resulting scores differ substantially from those assessed by healthcare professionals²².

Reference standard. The MNA-FF is a validated screening tool that identifies older adults who are at risk of malnutrition or are malnourished to a maximum score of 30. Threshold value ranges are: scores less than 17 points indicate malnutrition, scores between 17 and 23 are risk for malnutrition and scores > 23 have, in general, an adequate nutritional status^15,23.

Outcomes

The primary outcome is the diagnostic accuracy of the MNA-SF to identify malnutrition among older adults in healthcare settings. Anticipated secondary outcomes that are clinically relevant may include the predictive accuracy of the MNA-SF including mortality, functional decline, length of stay, readmission, performance status, activities of daily living (ADLs), quality of life measures and falls.

Exclusion criteria

Studies published prior to January 2009 will be excluded in order to limit the search to studies that relate to the latest revision and validation of the MNA – SF (as the latest revision includes calf circumference and a revised three category scoring classification)¹⁷. Poster session, commentary, letter to editor, “grey” literature: technical reports from government agencies or scientific research groups, working papers from research groups or committees, white papers, position papers, abstracts, conference reports or preprints will be excluded. Finally, where multiple publications from the same study exist, all will be included to extract data from the full set of data.

Search

To identify all studies that validate the revised MNA-SF for malnutrition among older adults the following databases will be searched: Pubmed, EMBASE, Cochrane Library, CINAHL and Web of Science. Search terms will include controlled terms from MeSH in Medline, EMtree in EMBASE.com, CINAHL Headings in CINAHL, keywords in Cochrane, and topic searches as well as free text terms in titles and abstracts. The search strategy was developed in consultation with an academic librarian (LD, University of Limerick). A logic grid that uses Boolean operators will structure searches. The search terms relate to the population of interest “older adults”, the intervention “MNA-SF” and the primary outcome of interest “malnutrition”; full search strategy is available in the extended data²⁴. References of included articles will be hand searched for MNA-SF validation studies. The MNA ® website will also be consulted for potential validation studies.

Data selection

All articles identified by database searches and those from additional sources will be downloaded into EndnoteX8 reference management software and duplicates removed. Titles and abstracts of retrieved studies will be screened independently by authors SMcG and CM to identify those that potentially meet the inclusion/exclusion criteria described above. If the selection criteria cannot be verified based on the title and/or abstract, full text screening will be applied using the same criteria. Any disagreement over eligibility will be resolved through discussion with AG as third reviewer. A PRISMA flowchart will detail the search and study selection process.

Data extraction

A standardised Excel (Microsoft Office Professional Plus 2016) database will be used to extract data from the included studies for assessment of the study quality and for evidence synthesis. Extracted study information will include: patient demographics; study setting, design and sample size; patient type (medical, surgical, etc.); administrator of the MNA-SF (dietitian, clinician, registered nurse, etc.); reported clinical findings of weight loss, BMI or reduced muscle mass; number categorised as normal nutritional status, at risk of malnourishment, or malnourished; additional outcome(s) measured and times of measurement; and main conclusion. Where participants are not classified dichotomously as malnourished or well nourished, or diagnostic accuracy tests were not performed, raw data extracted from the results will be used to determine diagnostic accuracy where possible. Missing data will be requested from the study authors by AG. Eligible studies that are missing some critical data will be excluded from meta-analysis where all attempts to contact the authors fail. RG will independently extract data from approximately 25% of the included studies as a quality assurance mechanism.

Risk of bias

The methodological quality of the studies will be assessed by two independent authors (SMcG and CM) using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool²⁵. Assessment will be carried out at the study level. The QUADAS-2 tool will be tailored and refined to this systematic review by considering each signaling question’s application to the domains of patient selection, index test, reference standard and flow of participants through the study and the timing of the MNA-SF and MNA-FF. Each domain is assessed in terms of the risk of bias using signalling questions and the first three domains are also assessed in terms of concerns regarding applicability²⁵. Once tool content has been agreed, a review-specific rating guide will be developed. CM and SM will independently pilot the tool on 10% of the included primary studies and identify any further refinement required of the rating tool to judge the risk of bias. Risk of bias is judged as “low”, “high”, or “unclear”. If all signalling questions for a domain are answered “yes” then risk of bias can be judged “low”. If any signalling question is answered “no” this flags the potential for bias. In the event of disagreement, the reviewers will discuss using the review-specific rating guide before consulting a third reviewer, AG. A figure will be created summarising the results of the QUADAS-2 assessment for all included studies.

Strategy for data synthesis

An individual participant meta-analysis will be carried out by constructing a series of 2x2 tables and by extracting data on the number of true positives, false positives, true negatives and false negatives from each study. Summary estimates of sensitivity, specificity, positive predictive value and negative predictive value, with 95% confidence intervals (95% CIs), will be calculated using a bivariate random effects model. Cut-off values will be interpreted as good (sensitivity and specificity >80%, kappa >0.6), fair (sensitivity or specificity >80% but both >50%, kappa 0.4-0.6), or poor (sensitivity or specificity <50%, kappa <0.4)^19,22,26. Sensitivity refers to the proportion of older adults who experience malnutrition (MNA-SF score 0–7) or risk of malnutrition (MNA-SF score 8–11) and who are correctly classified as such whereas specificity refers to those who do not experience malnutrition (MNA-SF score 12–14) and are correctly classified.

Results will be graphically represented as paired forest plots: one for sensitivity and one for specificity displaying means, confidence intervals, number of true positives, false positives, true negatives and false negatives for each primary study. A receiver-operating characteristic (ROC) graph will be used to plot individual and summary estimates of sensitivity and specificity. Statistical heterogeneity will be examined using the variance of logit-transformed sensitivity and specificity, with smaller values indicating less heterogeneity between studies. Bayes’ theorem will be applied to determine the post-test probability of malnutrition. Pooled data will be analysed by the Stata V13 software.

Subgroup analysis

If the necessary data are available, subgroup analyses will be completed separately for older adults across different individual healthcare settings (acute care and long-term) and patient characteristics (older adults (65–80 years) and geriatric (>80 years)) to investigate if there are statistically significant subgroup differences. A sensitivity analysis will be conducted to examine the impact of methodological quality on summary estimates of sensitivity and specificity.

Potential limitations

The success of the study depends on the ability to obtain the relevant individual patient data. The proportion of eligible datasets that will be possible to include in the study is not yet known. Incorporation bias is anticipated using the MNA-FF as a reference standard to validate the MNA-SF and this will be interpreted and discussed with caution.

Dissemination

Findings will be disseminated through publication in peer-reviewed journals and through relevant conferences. The rigorous scrutiny of primary studies will identify the strengths and limitations of current research and will provide recommendations for future research. Further, this systematic review of the diagnostic accuracy of the MNA-SF will be of interest to healthcare professionals working in the field of integrated care programmes for older people.

Amendments to protocol

We will carefully report any changes and update PROSPERO should the protocol be amended.

Ethics

As this systematic review will collect secondary data only, ethical approval is not required.

Study status

The study is currently ongoing. The expected end date for the study is December 2021.

Public and patient involvement

Patients and or public were not involved at all in elaborating this systematic review protocol. However, we expect that the findings of this systematic review will assist in the execution of a pilot and feasibility intervention study of early supported discharge from emergency departments with a patient and public involvement component.

Conclusion

The aim of this systematic review is to synthesise the totality of evidence regarding the diagnostic accuracy of the MNA-SF in older adults when compared to the full form Mini Nutritional Assessment to identify malnutrition. This will be conducted through a systematic search of the literature in five bibliographic databases: Pubmed, EMBASE, Cochrane Library, CINAHL and Web of Science. The eligibility criteria for including relevant articles is discussed along with the plans for critical appraisal, data extraction and data synthesis. The systematic review will be written in accordance with the PRISMA statement for systematic reviews. The data extraction and findings will be summarised to present key features, available evidence of MNA-SF performance and an evaluation of the quality of published tests. Findings will then be synthesised narratively. Depending on the nature of the available data from included primary studies, a meta-analysis will be conducted. The findings of the diagnostic accuracy of the MNA-SF will be inform healthcare professionals and researchers working in the field of integrated care programmes for older people where the early intervention of nutrition care can address adverse patient outcomes.

Data availability

Underlying data

No data is associated with this article.

Extended data

Open Science Framework: Diagnostic accuracy of the Mini Nutritional Assessment – Short Form to identify malnutrition among older adults: protocol for a systematic review and meta-analysis. https://doi.org/10.17605/OSF.IO/YFK9X²⁴

This project contains the following extended data:

Search Strategy Prospero CRD42019131847.pdf (search strategy)

Reporting guidelines

Open Science Framework: PRISMA-P checklist for ‘Diagnostic accuracy of the Mini Nutritional Assessment – Short Form to identify malnutrition among older adults: protocol for a systematic review and meta-analysis’. https://doi.org/10.17605/OSF.IO/YFK9X²⁴

Data are available under the terms of the Creative Commons Zero “No rights reserved” data waiver (CC0 1.0 Public domain dedication).

Authors’ contributions

Anne Griffin: Conceptualisation, investigation, methodology, project administration, supervision, validation, visualisation, writing – original draft preparation, review and editing;

Sorcha McGarry & Caoimhe Maloney: Data curation, formal analysis, investigation, methodology, visualisation, writing – review and editing;

Rose Galvin: Conceptualisation, funding acquisition, methodology, supervision, validation, visualisation, writing – review and editing

Acknowledgments

We would like to thank Liz Dore, Librarian of Glucksman Library, University of Limerick, Ireland, for her support with the literature search strategy.

Faculty Opinions recommended

References

1. Jensen GL, Mirtallo J, Compher C, et al.: Adult starvation and disease-related malnutrition: a proposal for etiology-based diagnosis in the clinical practice setting from the International Consensus Guideline Committee. J Parenter Enter Nutr. 2010; 34: 156e9. Clin Nutr. 2010; 29(2): 151–3. PubMed Abstract | Publisher Full Text
2. Volkert D, Beck AM, Cederholm T, et al.: ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr. 2019; 38(1): 10–47. PubMed Abstract | Publisher Full Text
3. Agarwal E, Miller M, Yaxley A, et al.: Malnutrition in the elderly: a narrative review. Maturitas. 2013; 76(4): 296–302. PubMed Abstract | Publisher Full Text
4. Rice N, Normand C: The cost associated with disease-related malnutrition in Ireland. Public Health Nutr. 2012; 15(10): 1966–1972. PubMed Abstract | Publisher Full Text
5. Cereda E, Pedrolli C, Klersy C, et al.: Nutritional status in older persons according to healthcare setting: A systematic review and meta-analysis of prevalence data using MNA^®. Clin Nutr. 2016; 35(6): 1282–1290. PubMed Abstract | Publisher Full Text
6. Kaiser MJ, Bauer JM, Rämsch C, et al.: Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment. J Am Geriatr Soc. 2010; 58(9): 1734–1738. PubMed Abstract | Publisher Full Text
7. Griffin A, O’Neill A, O’Connor M, et al.: The prevalence of malnutrition and impact on patient outcomes among older adults presenting at an Irish emergency department: a secondary analysis of the OPTI-MEND trial. BMC Geriatr. 2020; 20(1): 455. PubMed Abstract | Publisher Full Text | Free Full Text
8. Dent E, Wright O, Hoogendijk EO, et al.: Nutritional screening and dietitian consultation rates in a geriatric evaluation and management unit. Nutr Diet. 2018; 75(1): 11–16. PubMed Abstract | Publisher Full Text
9. Eide HD, Halvorsen K, Almendingen K: Barriers to nutritional care for the undernourished hospitalised elderly: perspectives of nurses. J Clin Nurs. 2015; 24(5–6): 696–706. PubMed Abstract | Publisher Full Text | Free Full Text
10. Roberts HC, Lim S, Cox NJ, et al.: The Challenge of Managing Undernutrition in Older People with Frailty. Nutrients. 2019; 11(4): 808. PubMed Abstract | Publisher Full Text | Free Full Text
11. Power L, Mullally D, Gibney ER, et al.: A review of the validity of malnutrition screening tools used in older adults in community and healthcare settings - A MaNuEL study. Clin Nutr ESPEN. 2018; 24: 1–13. PubMed Abstract | Publisher Full Text
12. Isautier JM, Bosnić M, Yeung SS, et al.: Validity of nutritional screening tools for community-dwelling older adults: a systematic review and meta-analysis. J Am Med Dir Assoc. 2019; 20(10): 1351.e13–1351.e25. PubMed Abstract | Publisher Full Text
13. Guigoz Y, Vellas B: Nutritional Assessment in Older Adults: MNA® 25 years of a Screening Tool & a Reference Standard for Care and Research; What Next? J Nutr Health Aging. 2021; 25(4): 528–583. PubMed Abstract | Publisher Full Text
14. Skipper A, Ferguson M, Thompson K, et al.: Nutrition screening tools: an analysis of the evidence. JPEN J Parenter Enteral Nutr. 2012; 36(3): 292–298. PubMed Abstract | Publisher Full Text
15. Guigoz Y, Vellas B, Garry PJ: Assessing the nutritional status of the elderly: The Mini Nutritional Assessment as part of the geriatric evaluation. Nutr Rev. 1996; 54(1 Pt 2): S59–65. PubMed Abstract | Publisher Full Text
16. Rubenstein LZ, Harker JO, Salvà A, et al.: Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). J Gerontol A Biol Sci Med Sci. 2001; 56(6): M366–M372. PubMed Abstract | Publisher Full Text
17. Kaiser MJ, Bauer JM, Ramsch C, et al.: Validation of the Mini Nutritional Assessment short-form (MNA-SF): a practical tool for identification of nutritional status. J Nutr Health Aging. 2009; 13(9): 782–788. PubMed Abstract | Publisher Full Text
18. Leij-Halfwerk S, Verwijs MH, van Houdt S, et al.: Prevalence of protein-energy malnutrition risk in European older adults in community, residential and hospital settings, according to 22 malnutrition screening tools validated for use in adults ≥65 years: A systematic review and meta-analysis. Maturitas. 2019; 126: 80–89. PubMed Abstract | Publisher Full Text
19. van Bokhorst-de van der Schueren MAE, Guaitoli PR, Jansma EP, et al.: Nutrition screening tools: Does one size fit all? A systematic review of screening tools for the hospital setting. Clin Nutr. 2014; 33(1): 39–58. PubMed Abstract | Publisher Full Text
20. Macaskill P, Gatsonis C, Deeks JJ, et al.: Chapter 10: Analysing and Presenting Results. In: Deeks JJ, Bossuyt PM, Gatsonis C (editors), Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy Version 1.0. The Cochrane Collaboration, 2010. Reference Source
21. McInnes MDF, Moher D, Thombs BD, et al.: Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies: The PRISMA-DTA Statement. JAMA. 2018; 319(4): 388–396. PubMed Abstract | Publisher Full Text
22. Kaiser R, Winning K, Uter W, et al.: Comparison of two different approaches for the application of the mini nutritional assessment in nursing homes: resident interviews versus assessment by nursing staff. J Nutr Health Aging. 2009; 13(10): 863–9. PubMed Abstract | Publisher Full Text
23. Vellas B, Guigoz Y, Garry PJ, et al.: The mini nutritional assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition. 1999; 15(2): 116–122. PubMed Abstract | Publisher Full Text
24. Griffin A: Diagnostic accuracy of the Mini Nutritional Assessment – Short Form to identify malnutrition among older adults: protocol for a systematic review and meta-analysis. 2021. http://www.doi.org/10.17605/OSF.IO/YFK9X
25. Whiting PF, Rutjes AWS, Westwood ME, et al.: QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011; 155(8): 529–36. PubMed Abstract | Publisher Full Text
26. Liberati A, Altman DG, Tetzlaff J, et al.: The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009; 62(10): e1–e34. PubMed Abstract | Publisher Full Text

Comments on this article Comments (0)

Version 1

VERSION 1 PUBLISHED 29 Jul 2021

Author details Author details

¹ School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
² Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland

Anne Griffin
Roles: Conceptualization, Investigation, Methodology, Project Administration, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Sorcha McGarry
Roles: Data Curation, Formal Analysis, Investigation, Methodology, Visualization, Writing – Review & Editing

Caoimhe Moloney
Roles: Data Curation, Formal Analysis, Investigation, Methodology, Visualization, Writing – Review & Editing

Rose Galvin
Roles: Conceptualization, Funding Acquisition, Methodology, Supervision, Validation, Visualization, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

Article Versions (1)

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Published: 29 Jul 2021, 4:83

https://doi.org/10.12688/hrbopenres.13358.1

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© 2021 Griffin A et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Griffin A, McGarry S, Moloney C and Galvin R. Diagnostic accuracy of the Mini Nutritional Assessment – Short Form to identify malnutrition among older adults: protocol for a systematic review and meta-analysis [version 1; peer review: 1 approved with reservations, 1 not approved]. HRB Open Res 2021, 4:83 (https://doi.org/10.12688/hrbopenres.13358.1)

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Open Peer Review

Version 1

VERSION 1

PUBLISHED 29 Jul 2021

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Reviewer Report 13 Jul 2024

Clare A. Corish, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland

Not Approved

https://doi.org/10.21956/hrbopenres.14547.r40741

The protocol under review is for a systematic review and meta-analysis that aims to synthesise evidence on the diagnostic accuracy of the MNA-SF tool compared with the full-form of the Mini Nutritional Assessment (MNA-FF) in older adults for the diagnosis ... Continue reading

The protocol under review is for a systematic review and meta-analysis that aims to synthesise evidence on the diagnostic accuracy of the MNA-SF tool compared with the full-form of the Mini Nutritional Assessment (MNA-FF) in older adults for the diagnosis of malnutrition in healthcare settings. My big concern is that this study was supposed to finish in December 2021 and I wonder has it already been finished? I cannot find its publication.

Abstract
The abstract requires review and amendment for clarity.
1. I think that the authors mean that early recognition of risk of malnutrition can prevent further deterioration in nutritional status and mitigate the consequences mentioned in the first sentence. It would be useful to clarify this.
2. The screening tools are to identify risk of protein energy malnutrition. Nutrition risk could encompass micronutrient deficiencies. This also requires clarification.

3. MNA-SF is designed to identify risk of malnutrition. This sentence needs to be clarified.

4. What the authors mean by diagnostic accuracy of MNA-SF needs to be clarified i.e., are the authors referring to the ability of both tools to identify an actual diagnosis of malnutrition or are they referring to the ability of both tools to categorise malnutrition and risk of malnutrition? Please clarify.

5. The abstract refers to all studies that validate the MNA-SF for malnutrition.....there are so many forms of validation. The type of validation referred to needs to be clarified.

6. Whether the authors are referring to the sensitivity and specificity of MNA-SF solely for malnutrition or for malnutrition and risk of malnutrition needs to be clarified.

7. The final sentence of the abstract is incorrect. MNA-SF is a tool validated to identify risk of protein-energy malnutrition and not nutrition risk per se i.e., it does not screen for micronutrient deficiency.

In summary, the phrasing of the abstract needs to be reviewed carefully for accuracy and to avoid confusion.

Introduction
The introduction is mainly well-written but a number of corrections are still required.
Paragraph 1
Line 1: Care with phrasing...when referring to the condition of malnutrition, intake always comes before uptake.
Line 9: specify what 'It' refers to....Malnutrition?
Paragraph 2
References 5 and 6: Suggest recent reference(s) be used here?
Clarify whether reference 7 only applied to those who were actually malnourished and specify the tool used.
Paragraph 3 and elsewhere
The term nutrition screening tool is used and I believe the authors mean a malnutrition screening tool....
Paragraph 4
malnutrition screening tool.......
There is no agreed gold standard to assess and diagnose malnutrition..... this is what GLIM is trying to do. Please rephrase this section for clarity and accuracy.
malnutrition screening tools......
I think that it is confusing to state that the MNA-SF provides an assessment? It is clear on the MNA-SF form that it is a screening tool for malnutrition and the score provided is categorised as a screening score. There is potential for significant confusion between screening and assessment from the phrasing here.
Need to clarify
1. MNA-SF is designed to be used more broadly than with HCPs.
2. Integrated care programmes....needs a short explanation.
Paragraph 5
Aim: clarify again here whether the comparison will solely focus on the malnutrition diagnosis or on malnutrition and risk of malnutrition.

Methods
Eligibility criteria
Can all languages be understood by the authors? What is the protocol for managing publications in languages not understood by the authors?
Experimental test
Interventions
Provide the threshold values for malnutrition risk and malnutrition using the MNA-SF.
Reference standard
If MNA-FF is the reference standard, all studies included need to contain all data that are required for MNA-FF?
Is this being applied retrospectively?
These data are not fully captured in the data extraction paragraph as only the following are included: reported clinical findings of weight loss, BMI or reduced muscle mass; number categorised as normal nutritional status, at risk of malnourishment, or malnourished; additional outcome(s) measured and times of measurement; and main conclusion.
Outcomes
Again, it is unclear as to whether malnutrition solely or malnutrition and risk of malnutrition are being examined?
How will the data show if MNA-SF is correctly identifying malnutrition or risk of malnutrition? All variables within the comparator need to be applied.

In summary, exactly what is being compared with what is unclear and needs to be carefully considered prior to publication.

Is the rationale for, and objectives of, the study clearly described?

Partly
Is the study design appropriate for the research question?

Partly
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Nutrition, dietetics, malnutrition, malnutrition screening and assessment, older adults, clinical nutrition

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

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Reviewer Report 12 Jun 2024

Alison Yaxley, Flinders University, Adelaide,, Australia

Jolene Thomas, Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia

Approved with Reservations

https://doi.org/10.21956/hrbopenres.14547.r40279

This article describes the protocol for a systematic review and meta-analysis of published research investigating the diagnostic accuracy of the Mini-Nutritional Assessment Short-Form (MNA-SF) for the diagnosis of malnutrition in older adults, when compared to the Mini-Nutritional Assessment (MNA-FF). In ... Continue reading

This article describes the protocol for a systematic review and meta-analysis of published research investigating the diagnostic accuracy of the Mini-Nutritional Assessment Short-Form (MNA-SF) for the diagnosis of malnutrition in older adults, when compared to the Mini-Nutritional Assessment (MNA-FF). In general, the protocol is easy to follow however there are a few areas for attention which would improve the clarity of the authors’ plans.

Abstract
The final sentence of the abstract is contradictory. Nutrition screening relates to risk not overt identification of malnutrition. We suggest the authors need to be clear while not pre-empting the findings of the review.

Introduction
The authors set the scene well by highlighting the size of the problem and the negative outcomes of malnutrition for older adults, and the benefits of nutritional screening. However, the introduction is quite wordy and there is some inconsistency in the use of the terms screening vs assessment. Furthermore, the prevalence figures cover community dwelling older adults (not a target in this review) but not aged care home residents (included in this review). There needs to be more consistency.

Given that the MNA-SF has a category for ‘malnourished’ we understand this protocol to be seeking to establish the accuracy of that diagnosis, vs the MNA-FF (an accepted reference tool in older adults; needs to be clarified). This seems to be confirmed in the objective as stated but is not completely clear to us from the introduction. Given that the SF is derived from the FF there is likely to be a significant amount of agreement but is the overall point of this exercise to establish whether the SF can be used to diagnose malnutrition and therefore not need further dietetic assessment?

We suggest that the objective should include reference to the setting so as to be clear that this study relates only to healthcare settings, as for the totality of evidence in older adults community dwelling would need to be included. Furthermore, the introduction states that the MNA-SF may overestimate the nutritional risk in hospitalised older adults. A pooled analysis may therefore be subject to bias from that tendency, and some rationale for considering all settings together would be helpful.

The first sentence of the introduction needs a reference as do a number of other places throughout the intro, eg paragraph 3. P3, line 4, should be (… an 18-item).

Methods
In the participants section, we suggest that the age also be 65 years or over at the time of assessment with the MNA-FF.

The introduction refers to ‘integrated care programmes’ but the in the methods, study inclusions are limited to acute care, long term care such as nursing homes and urgent/emergency care services. I understand that the terminology may be different in Ireland but what about subacute/rehabilitation hospitals (eg neuro, ortho, deconditioning) delivering long term rehabilitation? These settings are often predominantly catering to older people and malnutrition is highly prevalent, with prevalence often increasing during extended length of stay.

In the interventions section, the authors indicate that administration of the MNA-SF should be by a health professional. Given that screening, by definition, should be able to be conducted by anyone and not necessarily a health professional this may result in exclusion of a significant number of studies. For example, in long term care screening is often done by care workers rather than health professionals. We also suggest including the scoring cut-offs for the MNA-SF here, with references.

In the exclusion criteria, the authors indicate that where multiple publications from the same study exist all will be included. This should be clarified. If the sensitivity and specificity are reported in more than one paper using the same dataset these should not be included as separate results. Will you exclude theses?

In the search category, can we clarify that the authors are searching MEDLINE via PubMed? Both are mentioned.

In the data extraction, will the results of diagnostic accuracy be extracted?

In the strategy for data synthesis, the final sentence of paragraph 1 needs references. Fair is indicated by >80%; we believe this should be <80%. The final sentence of this section has contributed to the lack of clarity around the objective of this review.

Are the authors assessing risk of malnutrition and malnourished together?
Are the authors assessing risk of malnutrition and malnourished separately?
Diagnosis of malnutrition is stated to be the primary outcome so why is risk being investigated here as the MNA-SF has already been established as valid for risk?

In the study status, the expected end date is December 2021. Is the review complete or should this be updated?

General
Overall, the protocol is well-written and generally good but the above points should be clarified to aid the overall understanding. We suggest also reviewing referencing throughout to ensure that all work is appropriately acknowledged.

Is the rationale for, and objectives of, the study clearly described?

Partly
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Nutrition and Dietetics, Malnutrition, Older Adults, Aged Care, Healthy Ageing, Clinical Nutrition, Tool Development and Validation, Systematic Reviews.

We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however we have significant reservations, as outlined above.

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VERSION 1 PUBLISHED 29 Jul 2021

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Version 1 29 Jul 21	read	read

Alison Yaxley, Flinders University, Adelaide,, Australia

Jolene Thomas, Flinders University, Adelaide, Australia
Clare A. Corish, University College Dublin, Dublin, Ireland

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13 Jul 2024 | for Version 1

Clare A. Corish, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland

14 Views Cite this report Responses(0)

Not Approved

The protocol under review is for a systematic review and meta-analysis that aims to synthesise evidence on the diagnostic accuracy of the MNA-SF tool compared with the full-form of the Mini Nutritional Assessment (MNA-FF) in older adults for the diagnosis of malnutrition in healthcare settings. My big concern is that this study was supposed to finish in December 2021 and I wonder has it already been finished? I cannot find its publication.

Abstract
The abstract requires review and amendment for clarity.
1. I think that the authors mean that early recognition of risk of malnutrition can prevent further deterioration in nutritional status and mitigate the consequences mentioned in the first sentence. It would be useful to clarify this.
2. The screening tools are to identify risk of protein energy malnutrition. Nutrition risk could encompass micronutrient deficiencies. This also requires clarification.

3. MNA-SF is designed to identify risk of malnutrition. This sentence needs to be clarified.

4. What the authors mean by diagnostic accuracy of MNA-SF needs to be clarified i.e., are the authors referring to the ability of both tools to identify an actual diagnosis of malnutrition or are they referring to the ability of both tools to categorise malnutrition and risk of malnutrition? Please clarify.

5. The abstract refers to all studies that validate the MNA-SF for malnutrition.....there are so many forms of validation. The type of validation referred to needs to be clarified.

6. Whether the authors are referring to the sensitivity and specificity of MNA-SF solely for malnutrition or for malnutrition and risk of malnutrition needs to be clarified.

7. The final sentence of the abstract is incorrect. MNA-SF is a tool validated to identify risk of protein-energy malnutrition and not nutrition risk per se i.e., it does not screen for micronutrient deficiency.

In summary, the phrasing of the abstract needs to be reviewed carefully for accuracy and to avoid confusion.

Introduction
The introduction is mainly well-written but a number of corrections are still required.
Paragraph 1
Line 1: Care with phrasing...when referring to the condition of malnutrition, intake always comes before uptake.
Line 9: specify what 'It' refers to....Malnutrition?
Paragraph 2
References 5 and 6: Suggest recent reference(s) be used here?
Clarify whether reference 7 only applied to those who were actually malnourished and specify the tool used.
Paragraph 3 and elsewhere
The term nutrition screening tool is used and I believe the authors mean a malnutrition screening tool....
Paragraph 4
malnutrition screening tool.......
There is no agreed gold standard to assess and diagnose malnutrition..... this is what GLIM is trying to do. Please rephrase this section for clarity and accuracy.
malnutrition screening tools......
I think that it is confusing to state that the MNA-SF provides an assessment? It is clear on the MNA-SF form that it is a screening tool for malnutrition and the score provided is categorised as a screening score. There is potential for significant confusion between screening and assessment from the phrasing here.
Need to clarify
1. MNA-SF is designed to be used more broadly than with HCPs.
2. Integrated care programmes....needs a short explanation.
Paragraph 5
Aim: clarify again here whether the comparison will solely focus on the malnutrition diagnosis or on malnutrition and risk of malnutrition.

Methods
Eligibility criteria
Can all languages be understood by the authors? What is the protocol for managing publications in languages not understood by the authors?
Experimental test
Interventions
Provide the threshold values for malnutrition risk and malnutrition using the MNA-SF.
Reference standard
If MNA-FF is the reference standard, all studies included need to contain all data that are required for MNA-FF?
Is this being applied retrospectively?
These data are not fully captured in the data extraction paragraph as only the following are included: reported clinical findings of weight loss, BMI or reduced muscle mass; number categorised as normal nutritional status, at risk of malnourishment, or malnourished; additional outcome(s) measured and times of measurement; and main conclusion.
Outcomes
Again, it is unclear as to whether malnutrition solely or malnutrition and risk of malnutrition are being examined?
How will the data show if MNA-SF is correctly identifying malnutrition or risk of malnutrition? All variables within the comparator need to be applied.

In summary, exactly what is being compared with what is unclear and needs to be carefully considered prior to publication.

Is the rationale for, and objectives of, the study clearly described?

Partly
Is the study design appropriate for the research question?

Partly
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Nutrition, dietetics, malnutrition, malnutrition screening and assessment, older adults, clinical nutrition

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

Respond to this report

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Reviewer Report

26 Views

12 Jun 2024 | for Version 1

Alison Yaxley, Flinders University, Adelaide,, Australia

Jolene Thomas, Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia

26 Views Cite this report Responses(0)

Approved With Reservations

This article describes the protocol for a systematic review and meta-analysis of published research investigating the diagnostic accuracy of the Mini-Nutritional Assessment Short-Form (MNA-SF) for the diagnosis of malnutrition in older adults, when compared to the Mini-Nutritional Assessment (MNA-FF). In general, the protocol is easy to follow however there are a few areas for attention which would improve the clarity of the authors’ plans.

Abstract
The final sentence of the abstract is contradictory. Nutrition screening relates to risk not overt identification of malnutrition. We suggest the authors need to be clear while not pre-empting the findings of the review.

Introduction
The authors set the scene well by highlighting the size of the problem and the negative outcomes of malnutrition for older adults, and the benefits of nutritional screening. However, the introduction is quite wordy and there is some inconsistency in the use of the terms screening vs assessment. Furthermore, the prevalence figures cover community dwelling older adults (not a target in this review) but not aged care home residents (included in this review). There needs to be more consistency.

Given that the MNA-SF has a category for ‘malnourished’ we understand this protocol to be seeking to establish the accuracy of that diagnosis, vs the MNA-FF (an accepted reference tool in older adults; needs to be clarified). This seems to be confirmed in the objective as stated but is not completely clear to us from the introduction. Given that the SF is derived from the FF there is likely to be a significant amount of agreement but is the overall point of this exercise to establish whether the SF can be used to diagnose malnutrition and therefore not need further dietetic assessment?

We suggest that the objective should include reference to the setting so as to be clear that this study relates only to healthcare settings, as for the totality of evidence in older adults community dwelling would need to be included. Furthermore, the introduction states that the MNA-SF may overestimate the nutritional risk in hospitalised older adults. A pooled analysis may therefore be subject to bias from that tendency, and some rationale for considering all settings together would be helpful.

The first sentence of the introduction needs a reference as do a number of other places throughout the intro, eg paragraph 3. P3, line 4, should be (… an 18-item).

Methods
In the participants section, we suggest that the age also be 65 years or over at the time of assessment with the MNA-FF.

The introduction refers to ‘integrated care programmes’ but the in the methods, study inclusions are limited to acute care, long term care such as nursing homes and urgent/emergency care services. I understand that the terminology may be different in Ireland but what about subacute/rehabilitation hospitals (eg neuro, ortho, deconditioning) delivering long term rehabilitation? These settings are often predominantly catering to older people and malnutrition is highly prevalent, with prevalence often increasing during extended length of stay.

In the interventions section, the authors indicate that administration of the MNA-SF should be by a health professional. Given that screening, by definition, should be able to be conducted by anyone and not necessarily a health professional this may result in exclusion of a significant number of studies. For example, in long term care screening is often done by care workers rather than health professionals. We also suggest including the scoring cut-offs for the MNA-SF here, with references.

In the exclusion criteria, the authors indicate that where multiple publications from the same study exist all will be included. This should be clarified. If the sensitivity and specificity are reported in more than one paper using the same dataset these should not be included as separate results. Will you exclude theses?

In the search category, can we clarify that the authors are searching MEDLINE via PubMed? Both are mentioned.

In the data extraction, will the results of diagnostic accuracy be extracted?

In the strategy for data synthesis, the final sentence of paragraph 1 needs references. Fair is indicated by >80%; we believe this should be <80%. The final sentence of this section has contributed to the lack of clarity around the objective of this review.

Are the authors assessing risk of malnutrition and malnourished together?
Are the authors assessing risk of malnutrition and malnourished separately?
Diagnosis of malnutrition is stated to be the primary outcome so why is risk being investigated here as the MNA-SF has already been established as valid for risk?

In the study status, the expected end date is December 2021. Is the review complete or should this be updated?

General
Overall, the protocol is well-written and generally good but the above points should be clarified to aid the overall understanding. We suggest also reviewing referencing throughout to ensure that all work is appropriately acknowledged.

Is the rationale for, and objectives of, the study clearly described?

Partly
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Nutrition and Dietetics, Malnutrition, Older Adults, Aged Care, Healthy Ageing, Clinical Nutrition, Tool Development and Validation, Systematic Reviews.

We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however we have significant reservations, as outlined above.

Respond to this report

Responses (0)

[1] 1. Jensen GL, Mirtallo J, Compher C, et al.: Adult starvation and disease-related malnutrition: a proposal for etiology-based diagnosis in the clinical practice setting from the International Consensus Guideline Committee. J Parenter Enter Nutr. 2010; 34: 156e9. Clin Nutr. 2010; 29(2): 151–3. PubMed Abstract | Publisher Full Text

[2] 2. Volkert D, Beck AM, Cederholm T, et al.: ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr. 2019; 38(1): 10–47. PubMed Abstract | Publisher Full Text

[3] 3. Agarwal E, Miller M, Yaxley A, et al.: Malnutrition in the elderly: a narrative review. Maturitas. 2013; 76(4): 296–302. PubMed Abstract | Publisher Full Text

[4] 4. Rice N, Normand C: The cost associated with disease-related malnutrition in Ireland. Public Health Nutr. 2012; 15(10): 1966–1972. PubMed Abstract | Publisher Full Text

[5] 5. Cereda E, Pedrolli C, Klersy C, et al.: Nutritional status in older persons according to healthcare setting: A systematic review and meta-analysis of prevalence data using MNA^®. Clin Nutr. 2016; 35(6): 1282–1290. PubMed Abstract | Publisher Full Text

[6] 6. Kaiser MJ, Bauer JM, Rämsch C, et al.: Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment. J Am Geriatr Soc. 2010; 58(9): 1734–1738. PubMed Abstract | Publisher Full Text

[7] 7. Griffin A, O’Neill A, O’Connor M, et al.: The prevalence of malnutrition and impact on patient outcomes among older adults presenting at an Irish emergency department: a secondary analysis of the OPTI-MEND trial. BMC Geriatr. 2020; 20(1): 455. PubMed Abstract | Publisher Full Text | Free Full Text

[8] 8. Dent E, Wright O, Hoogendijk EO, et al.: Nutritional screening and dietitian consultation rates in a geriatric evaluation and management unit. Nutr Diet. 2018; 75(1): 11–16. PubMed Abstract | Publisher Full Text

[9] 9. Eide HD, Halvorsen K, Almendingen K: Barriers to nutritional care for the undernourished hospitalised elderly: perspectives of nurses. J Clin Nurs. 2015; 24(5–6): 696–706. PubMed Abstract | Publisher Full Text | Free Full Text

[10] 10. Roberts HC, Lim S, Cox NJ, et al.: The Challenge of Managing Undernutrition in Older People with Frailty. Nutrients. 2019; 11(4): 808. PubMed Abstract | Publisher Full Text | Free Full Text

[11] 11. Power L, Mullally D, Gibney ER, et al.: A review of the validity of malnutrition screening tools used in older adults in community and healthcare settings - A MaNuEL study. Clin Nutr ESPEN. 2018; 24: 1–13. PubMed Abstract | Publisher Full Text

[12] 12. Isautier JM, Bosnić M, Yeung SS, et al.: Validity of nutritional screening tools for community-dwelling older adults: a systematic review and meta-analysis. J Am Med Dir Assoc. 2019; 20(10): 1351.e13–1351.e25. PubMed Abstract | Publisher Full Text

[13] 13. Guigoz Y, Vellas B: Nutritional Assessment in Older Adults: MNA® 25 years of a Screening Tool & a Reference Standard for Care and Research; What Next? J Nutr Health Aging. 2021; 25(4): 528–583. PubMed Abstract | Publisher Full Text

[14] 14. Skipper A, Ferguson M, Thompson K, et al.: Nutrition screening tools: an analysis of the evidence. JPEN J Parenter Enteral Nutr. 2012; 36(3): 292–298. PubMed Abstract | Publisher Full Text

[15] 15. Guigoz Y, Vellas B, Garry PJ: Assessing the nutritional status of the elderly: The Mini Nutritional Assessment as part of the geriatric evaluation. Nutr Rev. 1996; 54(1 Pt 2): S59–65. PubMed Abstract | Publisher Full Text

[16] 16. Rubenstein LZ, Harker JO, Salvà A, et al.: Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). J Gerontol A Biol Sci Med Sci. 2001; 56(6): M366–M372. PubMed Abstract | Publisher Full Text

[17] 17. Kaiser MJ, Bauer JM, Ramsch C, et al.: Validation of the Mini Nutritional Assessment short-form (MNA-SF): a practical tool for identification of nutritional status. J Nutr Health Aging. 2009; 13(9): 782–788. PubMed Abstract | Publisher Full Text

[18] 18. Leij-Halfwerk S, Verwijs MH, van Houdt S, et al.: Prevalence of protein-energy malnutrition risk in European older adults in community, residential and hospital settings, according to 22 malnutrition screening tools validated for use in adults ≥65 years: A systematic review and meta-analysis. Maturitas. 2019; 126: 80–89. PubMed Abstract | Publisher Full Text

[19] 19. van Bokhorst-de van der Schueren MAE, Guaitoli PR, Jansma EP, et al.: Nutrition screening tools: Does one size fit all? A systematic review of screening tools for the hospital setting. Clin Nutr. 2014; 33(1): 39–58. PubMed Abstract | Publisher Full Text

[20] 20. Macaskill P, Gatsonis C, Deeks JJ, et al.: Chapter 10: Analysing and Presenting Results. In: Deeks JJ, Bossuyt PM, Gatsonis C (editors), Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy Version 1.0. The Cochrane Collaboration, 2010. Reference Source

[21] 21. McInnes MDF, Moher D, Thombs BD, et al.: Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies: The PRISMA-DTA Statement. JAMA. 2018; 319(4): 388–396. PubMed Abstract | Publisher Full Text

[22] 22. Kaiser R, Winning K, Uter W, et al.: Comparison of two different approaches for the application of the mini nutritional assessment in nursing homes: resident interviews versus assessment by nursing staff. J Nutr Health Aging. 2009; 13(10): 863–9. PubMed Abstract | Publisher Full Text

[23] 23. Vellas B, Guigoz Y, Garry PJ, et al.: The mini nutritional assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition. 1999; 15(2): 116–122. PubMed Abstract | Publisher Full Text

[24] 24. Griffin A: Diagnostic accuracy of the Mini Nutritional Assessment – Short Form to identify malnutrition among older adults: protocol for a systematic review and meta-analysis. 2021. http://www.doi.org/10.17605/OSF.IO/YFK9X

[25] 25. Whiting PF, Rutjes AWS, Westwood ME, et al.: QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011; 155(8): 529–36. PubMed Abstract | Publisher Full Text

[26] 26. Liberati A, Altman DG, Tetzlaff J, et al.: The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009; 62(10): e1–e34. PubMed Abstract | Publisher Full Text

Diagnostic accuracy of the Mini Nutritional Assessment – Short Form to identify malnutrition among older adults: protocol for a systematic review and meta-analysis

Abstract

Keywords

Introduction

Protocol

Study design

Eligibility criteria

Experimental test

Outcomes

Exclusion criteria

Search

Data selection

Data extraction

Risk of bias

Strategy for data synthesis

Subgroup analysis

Potential limitations

Dissemination

Amendments to protocol

Ethics

Study status

Public and patient involvement

Conclusion

Data availability

Underlying data

Extended data

Reporting guidelines

Authors’ contributions

Acknowledgments

References

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Open Peer Review

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Diagnostic accuracy of the Mini Nutritional Assessment – Short Form to identify malnutrition among older adults: protocol for a systematic review and meta-analysis

Abstract

Keywords

Introduction

Protocol

Study design

Eligibility criteria

Experimental test

Outcomes

Exclusion criteria

Search

Data selection

Data extraction

Risk of bias

Strategy for data synthesis

Subgroup analysis

Potential limitations

Dissemination

Amendments to protocol

Ethics

Study status

Public and patient involvement

Conclusion

Data availability

Underlying data

Extended data

Reporting guidelines

Authors’ contributions

Acknowledgments

References

Comments on this article Comments (0)

Open Peer Review

Comments on this article Comments (0)

Open Peer Review

Reviewer Status

Reviewer Reports

Comments on this article

Competing Interests Policy

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Are you a HRB-funded researcher?

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