Academic literature on the topic 'Short Nutritional Assessment Questionnaire (SNAQ)'

Introduction: Hospital malnutrition is associated with the worsening of the patient’s general condition and its early diagnosis allows the reduction of related complications. The aim of this study was to verify the agreement of the Short Nutritional Assessment Questionnaire (SNAQ) screening tool and the Subjective Global Assessment (SGA). Methods: Cross-sectional study, carried out in a general hospital in the city of Porto Alegre (RS). The SNAQ was applied by previously trained nutritionists and nurses, and the patient was considered at nutritional risk when the score was ≥2. SGA was applied by nutritionists in all patients and considered the gold standard for comparison. The Kappa coefficient was used to assess the degree of agreement between the screening and nutritional assessment tools. Kappa values between 0.21-0.60 were considered as low agreement, 0.61-0.8 as moderate agreement and greater than 0.81, as strong agreement. Results: Between January and March 2017, 186 patients were evaluated, of them 115 (62%) were women. The mean age was 65.7 ± 16.6 years and the body mass index (BMI) mean was 26.5 ± 5.5 kg/ m². According to SGA classification, 73.7% of the sample was considered to be well nourished, 14% moderately malnourished and 12.4% severely malnourished. Low agreement was observed between the nutritional risk diagnosed by nursing vs. nutrition through SNAQ (Kappa=0.58) and good agreement of SNAQ applied by the nutrition team with the nutritional diagnosis of SGA (Kappa=0.73). The SNAQ presented sensitivity of 85.7% (95% CI 73.3 - 92.9) and specificity of 90.5% (95% CI 84.4 - 94.4); positive predictive value of 76.4% (95% CI 65.7 - 84.5) and negative predictive value of 94.7% (95% CI 90 - 97.2). Conclusion: We conclude that the screening tool SNAQ when conducted by nutritionists can be used for early detection of hospital malnutrition.

Abstract Objectives We aimed to assess the polypharmacy effect on appetite and malnutrition risk among Lebanese nursing home residents. We hypothesized that polypharmacy will be associated to lower appetite and increased of malnutrition. Methods A cross-sectional pilot study was carried out in two nursing homes in the North-Lebanon region. Fifty-three older adults (OA) aged 60 and above were recruited and were interviewed face-to-face. A general questionnaire was administered to gather information about their socio-demographics, dietary habits and physical activity routine. Appetite was evaluated by the Simplified Nutritional Appetite Questionnaire (SNAQ) validated for use with nursing homes residents. The participants' nutritional status was assessed using the Short Form of the Mini-Nutritional Assessment (MNA-SF). Polypharmacy was determined if OA were taking 5 or more medications. Information about attitudes towards the use, the number and the cost of medications was also collected. Differences in SNAQ and MNA scores based on polypharmacy were tested using Independent t-tests. Logistic regression was performed to assess the association between polypharmacy and nutritional status after adjusting for several factors. Results Our sample constituted of 49.1% females with an average age of 67.6 ± 3.8 and BMI of 22.3 ± 1.7 kg/m2. The majority were widowed (79.2%) and had a low level of education (85% elementary education). Regarding the MNA scores, 33% had a normal nutritional status while 59% were at risk of malnutrition and 8% were malnourished, with an average MNA score of 10.1 ± 2.2. The average SNAQ score was 11.0 ± 3.3, with 85% scoring ≤14, indicating an significant risk of at least 5% weight loss withing 6 months. Regarding medication use, 50.9% of OA take at least 5 drugs/d with an average of 4.3 ± 2 drugs. Independent t-tests showed that MNA scores were significantly lower in those taking 5 drugs/d vs those taking less (9.4 ± 2.5 vs 10.8 ± 1.6, P = .024) while no significant difference was observed for SNAQ scores (10.3 ± 2.9 vs 11.6 ± 3.6, P = .13). Logistic regressions did not show any significant association between polypharmacy and MNA or SNAQ categories. Conclusions Lower MNA scores were observed in OA taking ≥5 drugs/d indicating a higher risk of malnutrition with polypharmacy. This is significant since malnutrition can further worsen the aging process. Funding Sources N/A.

The effect of inflammation on appetite and food intake has been rarely studied in humans. In this study, we examined the association of C-reactive protein (CRP), as an inflammatory marker, with appetite and food intake among older hospitalized patients. A total of 200 older individuals, who were consecutively admitted to a geriatric acute care ward, participated in this prospective observational study. Appetite was evaluated using the Edmonton Symptom Assessment System (ESAS) and the Simplified Nutritional Appetite Questionnaire (SNAQ), respectively. Food intake was measured according to plate diagram method and participants were categorized as having food intake <75% and ≥75% of meals served. Nutritional status was evaluated using the Mini Nutritional Assessment Short Form (MNA-SF). In addition, serum CRP was analyzed and the levels >3.0 (mg/dL) were considered as moderate to severe inflammation. Of total population with mean age 81.4 ± 6.6 years (62.5% females), 51 (25.5%) had no inflammation and 88 (44.0%) and 61 (30.5%) had mild and moderate to severe inflammation, respectively. According to MNA-SF, 9.0% and 60.0% had normal nutritional status or a risk of malnutrition, respectively, whereas 31.0% were malnourished. Based on the SNAQ-appetite-question, 32.5% of the patients demonstrated poor and very poor appetite whereas 23.5% reported severe loss of appetite according to ESAS. Ninety-five (48.0%) of the participants had food intake <75% of the meals offered. Significant associations between SNAQ-appetite (p = 0.003) and ESAS-appetite (p = 0.013) scores and CRP levels were observed. In addition, significant differences were observed in CRP levels between intake ≥75% and <75% of meals served (p < 0.001). Furthermore, there were significant associations between appetite and nutritional status whereas malnourished older patients demonstrated a decreased appetite compared to those with normal nutritional status (p = 0.011). In a regression analysis, inflammation was the major independent risk factor for patients’ appetite (p = 0.003) and food intake (p = 0.011) whereas other variables such as infection (p = 0.960), chronic inflammatory diseases (p = 0.371), age (p = 0.679) and gender (p = 0.447) do not show any impact on appetite. Our findings confirm that poor appetite and low food intake are associated with inflammation in older hospitalized patients, suggesting that inflammation may contribute an important aspect to the development of malnutrition in these patients.

Abstract Declined food intake is prevalent among long-term care (LTC) residents with dementia and associated with deleterious health outcomes. This study explores food intake, nutritional status, and function and its associated factors in LTC residents with dementia. Data from 82 LTC residents with dementia were used in this secondary analysis. In the primary study, appetite was assessed using the Short Nutritional Assessment Questionnaire (SNAQ). Dementia level, comorbidity, agitation, pain, mood, food intake, nutritional status, and function variables were extracted from the electronic medical record, including the most recent Minimum Data Set (version 3.0) assessment. The majority of residents were either malnourished or at risk of being malnourished and demonstrated a worse appetite than previously described in the literature. Comorbid illness, depressed mood, and appetite were associated with 37.1% of the variance in food intake over 30 days. Dementia level and appetite were associated with 22.2% of the variance in nutritional status. Food intake and nutritional status were associated with 29.1% of the variance in function. This study also highlights a new demographic that may require extra assistance in combating declined food intake: LTC residents with dementia who reside in a facility that follows restrictive food practices such as a kosher diet. The potential reversibility of factors associated with food intake and nutritional status provides opportunities for intervention.

We previously found that neurocritically ill patients are prone to refeeding syndrome (RFS), a potentially life-threatening complication. However, there is no unified or validated consensus on the screening tool for RFS so far. We aimed to validate and compare the performance of four screening tools for RFS in neurocritically ill patients. We conducted a single-center, observational, retrospective cohort study among neurocritically ill adult patients who were admitted to the neurocritical care unit (NCU), and who received enteral nutrition for 72 h or longer. They were scored on the Short Nutritional Assessment Questionnaire (SNAQ), the Global Leadership Initiative on Malnutrition (GLIM), the modified criteria of the Britain’s National Institute for Health and Care Excellence (mNICE), and ASPEN Consensus Recommendations for Refeeding Syndrome (ASPEN) scales to predict RFS risk via admission data. The performance of each scale in predicting RFS was evaluated. Logistic regression analysis was used to identify the independent risk factors for RFS, and they were added to the above scales to strengthen the identification of RFS. Of the 478 patients included, 84 (17.57%) developed RFS. The sensitivity of the SNAQ and GLIM was only 20.2% (12.6–30.7%), although they had excellent specificities of 84.8% (80.8–88.1%) and 86.0% (82.1–89.2%), respectively; mNICE predicted RFS with a sensitivity of 48.8% (37.8–59.9%) and a specificity of 65.0% (60.0–69.9%); ASPEN had the highest Youden index, with a sensitivity and specificity of 53.6% (42.4–64.4%) and 64.7% (59.8–69.4%), respectively. The Area Under the receiver operating characteristic Curves (AUC) of SNAQ, GLIM, mNICE, and ASPEN to predict RFS were 0.516 (0.470–0.561), 0.533 (0.487–0.579), 0.568 (0.522–0.613), and 0.597 (0.551–0.641), respectively. We identified age, Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), and Glasgow Coma Scale (GCS) score as independent risk factors of RFS, and the combination of GCS and age can improve the AUC of ASPEN to 0.664 (0.620–0.706) for predicting RFS. SNAQ, GLIM, mNICE, and ASPEN do not perform well in identifying neurocritically ill patients at high risk of RFS, although ASPEN appears to have relatively a good validity among them. Combining GCS and age with ASPEN slightly improves RFS recognition, but it still leaves a lot of room for improvement.

AbstractThe present study aimed to investigate the effect of acute changes in serum C-reactive protein (CRP) on appetite and food intake among older hospitalised patients. A total of 200 patients (age range 65–94 years, 62·5 % women) participated in this prospective longitudinal observational study. Risk of malnutrition was measured according to the Mini Nutritional Assessment Short Form. The Simplified Nutritional Appetite Questionnaire (SNAQ) and Edmonton Symptom Assessment System (ESAS) were used to evaluate patients’ appetite at the time of hospital admission (baseline) and after 7 d (follow-up). Food intake was measured according to the plate diagram and serum CRP was analysed at baseline and follow-up. At baseline, 30·5 % of the patients had moderate to severe inflammation, 31·0 % were malnourished and 48·0 % had food intake <75 % of the meals offered. Also, 32·5 and 23·5 % reported poor and very poor appetite or severe loss of appetite according to the SNAQ and ESAS, respectively. Of the patients, 40 % displayed a pronounced reduction in median CRP levels by −1·2 mg/dl and 19 % demonstrated an increase in median CRP levels by +1·2 mg/dl. Appetite significantly improved (P = 0·006) in patients with a decrease in CRP level and deteriorated in those with an increase in CRP level (P = 0·032). Changes in CRP levels did not show any significant impact on food intake. In a regression analysis, changes of inflammation were the major independent predictor for changes of patients’ appetite. We conclude that inflammation has a significant impact on appetite and should therefore be considered in the diagnosis and treatment of malnutrition.

Abstract Background Malnutrition and poor physical performance are both conditions that increase in prevalence with age; however, their interrelation in a clinically relevant population has not been thoroughly studied. Aims This study aimed to determine the strength of the association between malnutrition and measures of both static and dynamic physical performance in a cohort of geriatric outpatients. Methods This cross-sectional study included 286 older adults (mean age 81.8, SD 7.2 years, and 40.6% male) who were referred to geriatric outpatient mobility clinics. The presence of malnutrition was determined using the Short Nutritional Assessment Questionnaire (SNAQ, cut-off ≥ 2 points). Measures of dynamic physical performance included timed up and go (TUG), 4-m walk test, and chair stand test (CST). Static performance encompassed balance tests and hand grip strength (HGS). Physical performance was standardized into sex-specific Z-scores. The association between malnutrition and each individual measure of physical performance was assessed using linear regression analysis. Results 19.9% of the cohort was identified as malnourished. Malnutrition was most strongly associated with CST and gait speed; less strong but significant associations were found between malnutrition and TUG. There was no significant association between malnutrition and HGS or balance. Discussion Physical performance was associated with malnutrition, specifically, dynamic rather than static measures. This may reflect muscle power being more impacted by nutritional status than muscle strength; however, this needs to be further addressed. Conclusions Malnutrition is associated with dynamic physical performance in geriatric outpatients, which should inform diagnosis and treatment/prevention strategies.

Older adults, especially those acutely ill, are vulnerable to developing malnutrition due to a range of risk factors. The high prevalence and extensive consequences of malnutrition in hospitalised older adults have been reported extensively. However, there are few well-designed longitudinal studies that report the independent relationship between malnutrition and clinical outcomes after adjustment for a wide range of covariates. Acutely ill older adults are exceptionally prone to nutritional decline during hospitalisation, but few reports have studied this change and impact on clinical outcomes. In the rapidly ageing Singapore population, all this evidence is lacking, and the characteristics associated with the risk of malnutrition are also not well-documented. Despite the evidence on malnutrition prevalence, it is often under-recognised and under-treated. It is therefore crucial that validated nutrition screening and assessment tools are used for early identification of malnutrition. Although many nutrition screening and assessment tools are available, there is no universally accepted method for defining malnutrition risk and nutritional status. Most existing tools have been validated amongst Caucasians using various approaches, but they are rarely reported in the Asian elderly and none has been validated in Singapore. Due to the multiethnicity, cultural, and language differences in Singapore older adults, the results from non-Asian validation studies may not be applicable. Therefore it is important to identify validated population and setting specific nutrition screening and assessment methods to accurately detect and diagnose malnutrition in Singapore. The aims of this study are therefore to: i) characterise hospitalised elderly in a Singapore acute hospital; ii) describe the extent and impact of admission malnutrition; iii) identify and evaluate suitable methods for nutritional screening and assessment; and iv) examine changes in nutritional status during admission and their impact on clinical outcomes. A total of 281 participants, with a mean (+SD) age of 81.3 (+7.6) years, were recruited from three geriatric wards in Tan Tock Seng Hospital over a period of eight months. They were predominantly Chinese (83%) and community-dwellers (97%). They were screened within 72 hours of admission by a single dietetic technician using four nutrition screening tools [Tan Tock Seng Hospital Nutrition Screening Tool (TTSH NST), Nutritional Risk Screening 2002 (NRS 2002), Mini Nutritional Assessment-Short Form (MNA-SF), and Short Nutritional Assessment Questionnaire (SNAQ©)] that were administered in no particular order. The total scores were not computed during the screening process so that the dietetic technician was blinded to the results of all the tools. Nutritional status was assessed by a single dietitian, who was blinded to the screening results, using four malnutrition assessment methods [Subjective Global Assessment (SGA), Mini Nutritional Assessment (MNA), body mass index (BMI), and corrected arm muscle area (CAMA)]. The SGA rating was completed prior to computation of the total MNA score to minimise bias. Participants were reassessed for weight, arm anthropometry (mid-arm circumference, triceps skinfold thickness), and SGA rating at discharge from the ward. The nutritional assessment tools and indices were validated against clinical outcomes (length of stay (LOS) >11days, discharge to higher level care, 3-month readmission, 6-month mortality, and 6-month Modified Barthel Index) using multivariate logistic regression. The covariates included age, gender, race, dementia (defined using DSM IV criteria), depression (defined using a single question “Do you often feel sad or depressed?”), severity of illness (defined using a modified version of the Severity of Illness Index), comorbidities (defined using Charlson Comorbidity Index, number of prescribed drugs and admission functional status (measured using Modified Barthel Index; MBI). The nutrition screening tools were validated against the SGA, which was found to be the most appropriate nutritional assessment tool from this study (refer section 5.6) Prevalence of malnutrition on admission was 35% (defined by SGA), and it was significantly associated with characteristics such as swallowing impairment (malnourished vs well-nourished: 20% vs 5%), poor appetite (77% vs 24%), dementia (44% vs 28%), depression (34% vs 22%), and poor functional status (MBI 48.3+29.8 vs 65.1+25.4). The SGA had the highest completion rate (100%) and was predictive of the highest number of clinical outcomes: LOS >11days (OR 2.11, 95% CI [1.17- 3.83]), 3-month readmission (OR 1.90, 95% CI [1.05-3.42]) and 6-month mortality (OR 3.04, 95% CI [1.28-7.18]), independent of a comprehensive range of covariates including functional status, disease severity and cognitive function. SGA is therefore the most appropriate nutritional assessment tool for defining malnutrition. The TTSH NST was identified as the most suitable nutritional screening tool with the best diagnostic performance against the SGA (AUC 0.865, sensitivity 84%, specificity 79%). Overall, 44% of participants experienced weight loss during hospitalisation, and 27% had weight loss >1% per week over median LOS 9 days (range 2-50). Wellnourished (45%) and malnourished (43%) participants were equally prone to experiencing decline in nutritional status (defined by weight loss >1% per week). Those with reduced nutritional status were more likely to be discharged to higher level care (adjusted OR 2.46, 95% CI [1.27-4.70]). This study is the first to characterise malnourished hospitalised older adults in Singapore. It is also one of the very few studies to (a) evaluate the association of admission malnutrition with clinical outcomes in a multivariate model; (b) determine the change in their nutritional status during admission; and (c) evaluate the validity of nutritional screening and assessment tools amongst hospitalised older adults in an Asian population. Results clearly highlight that admission malnutrition and deterioration in nutritional status are prevalent and are associated with adverse clinical outcomes in hospitalised older adults. With older adults being vulnerable to risks and consequences of malnutrition, it is important that they are systematically screened so timely and appropriate intervention can be provided. The findings highlighted in this thesis provide an evidence base for, and confirm the validity of the current nutrition screening and assessment tools used among hospitalised older adults in Singapore. As the older adults may have developed malnutrition prior to hospital admission, or experienced clinically significant weight loss of >1% per week of hospitalisation, screening of the elderly should be initiated in the community and continuous nutritional monitoring should extend beyond hospitalisation.

Background: Studies have consistently found a high prevalence of vitamin D deficiency in adolescents. Few validated dietary intake assessment tools for vitamin D exist for adolescents. Objective: The aim of this study was to determine if a short food frequency questionnaire (SFFQ) can be used to effectively assess vitamin D intake in adolescents compared to a previously validated long food frequency questionnaire (LFFQ). Participants/setting: 140 healthy 6-12 year old (male n=81) Caucasian and African American (n=94) children from Pittsburgh, Pennsylvania completed a SFFQ and LFFQ at two time points 6 months apart. Main outcome measures: Reliability and validity of a SFFQ by comparison with a previously validated LFFQ for children and adolescents. Statistical analysis: Reliability, validity, sensitivity, specificity, positive, and negative predictive values were assessed using Pearson correlation coefficients. Results: Mean vitamin D intake from the SFFQ (range, 434 to 485 IU) was higher than the LFFQ (range, 320 to 378 IU). Overall association between the SFFQ and the LFFQ for vitamin D intake was modest (r=0.36, P<0.001). When stratified by race, the overall degree of association was weak for African Americans (r=0.26, P=0.001) and moderate for Caucasians (r=0.57, P<0.001). Overall reliability testing results were modest and significant for the LFFQ (r=0.28, P=0.002) and SFFQ (r=0.33, P<0.001). Association between mean vitamin D intake from LFFQs and SFFQs was used to determine validity. The association for validity was found to be modest (r=0.51, P<0.001). Sensitivity, specificity, positive predictive value, and negative predictive value for the SFFQ were 90%, 64%, 0.78, and 0.58, respectively. Conclusion: The SFFQ was found to be modestly valid and reliable in an early adolescent population. Associations between African Americans were not as strong as Caucasians which may be due to errors in reporting dietary consumption related to higher body weight.

Tese de mestrado, Nutrição Clínica, Universidade de Lisboa, Faculdade de Medicina, 2018
Introdução: O envelhecimento demográfico é um fenómeno transversal. Portugal segue também esta tendência resultando num aumento do número de pessoas idosas institucionalizadas em residências geriátricas. Os residentes geriátricos são uma população de risco que apresentam significativas percentagens de desnutrição e ainda superiores de risco de desnutrição que trazem consequências para a sua saúde, têm um impacto negativo no seu bem-estar psicossocial, na sua qualidade de vida e levam ainda a um aumento dos gastos económicos com cuidados saúde a título individual e coletivo. Para que se consiga prevenir e minimizar estas consequências, é necessária uma deteção precoce da desnutrição, pois só assim poderá haver uma intervenção nutricional atempada. Existe, portanto, uma necessidade de se encontrar uma ferramenta simples de rápida aplicação que permita o rastreio nutricional de residentes geriátricos. Perante estas necessidades o recente questionário de identificação do risco nutricional Short Nutritional Assessement Questionnaire for Residential Care (SNAQ RC) parece ser uma possível solução para que seja realizado regularmente o rastreio nutricional nas residências geriátricas portuguesas. Objetivo: Testar a eficácia do questionário SNAQ RC como ferramenta de deteção de desnutrição em residências geriátricas portuguesas. Metodologia: Estudo analítico observacional transversal multicêntrico realizado em pessoas idosas institucionalizadas (idade ≥ 65 anos) de 6 residências geriátricas da área Metropolitana de Lisboa (n=183). Foram aplicados os questionários Mini Nutritional Assessment® Short-Form (MNA®-SF), SNAQ RC e Mini Nutritional Assessment (MNA®). Para além das questões e medições necessárias à aplicação dos questionários foram ainda recolhidas algumas informações clínicas e sociodemográficas adicionais junto dos residentes e dos seus processos clínicos. Para avaliação da eficácia e precisão de rastreio da desnutrição do questionário SNAQ RC e comparação com o questionário MNA®-SF procedeu-se ao cálculo do coeficiente de Kappa, da Sensibilidade (Sen), Especificidade (Esp), Valor preditivo positivo (VPP) e Valor preditivo negativo (VPN) tendo por base de diagnóstico o questionário de avaliação do estado nutricional MNA® e os novos critérios de desnutrição da European Society for Clinical Nutrition and Metabolism (ESPEN) tendo em conta o Índice de Massa Corporal (IMC). Foi ainda estudada a relação entre as variáveis recolhidas e a prevalência de desnutrição ou de risco nutricional e quais os fatores preditores da desnutrição ou de risco de desnutrição na amostra. Resultados: A amostra foi constituída por 183 residentes geriátricos e relativamente às suas características sociodemográficas destaca-se que 70,5% eram do sexo feminino, com uma média de idades de 83,8 ± 6,7 (65 - 98) anos, cujo tempo médio de residência na instituição foi de 45,6 ±42,5 Meses e que 39,3% possuía o equivalente à 4ªclasse de escolaridade e cerca de 42,6% uma escolaridade superior. No que diz respeito às características clínicas a maioria dos residentes da amostra eram independedentes (65%) e tinham uma mobilidade normal (66,7%), tomavam em média 8,3 ±5,0 fármacos diferentes por dia, 23,7% tinha tido um internamento hospitalar e 21,9% tinham tido algum episódio de queda ou de fractura óssea no último ano e a maioria (90,2%) possuíam próteses dentárias, implantes dentários e/ou falta de peças dentárias. Verificou-se ainda que apenas 42,1% dos residentes é que tinham tido alguma intervenção por parte de um nutricionista ou dietista. No que diz respeito aos parâmetros antropométricos, em média, os residentes apresentaram um peso de 66,9±12,3Kg, uma altura de 1,50±0,1m, um IMC de 28,2±4,8 Kg/m2, um perímetro braquial (PB) de 28,1±4,0 cm e perímetro geminal (PG) de 34,0±3,7 cm. No que diz respeito à identificação do risco nutricional, segundo o SNAQ RC, 15,3% dos residentes encontravam-se desnutridos; 31,1% em risco de desnutrição e 53,6% com um estado nutricional normal enquanto que segundo o MNA®-SF 6,6% dos residentes encontravam-se desnutridos; 38,8% em risco de desnutrição e 54,6% com um estado nutricional normal. No que diz respeito à avaliação do estado nutricional segundo o MNA®, 6,0% encontravam-se desnutridos; 48,6% em risco de desnutrição e apenas 45,4% com um estado nutricional normal enquanto que segundo os novos critérios de desnutrição da ESPEN 7,1% encontravam-se desnutridos. Em termos de concordância o SNAQ RC apresentou uma concordância moderada com o MNA®-SF (k=0.488 e k=0.604). Em termos de eficácia tendo por base o MNA® o SNAQ RC apresentou Sen= 76%; Esp=89,2%; VPP=89,4% e VPN=75,5% enquanto que o MNA®-SF apresentou Sen= 78%; Esp=94%; VPP=94% e VPN=78%. Em termos de eficácia tendo por base os critérios da ESPEN o SNAQ RC apresentou Sen= 100%; Esp=57,6%; VPP=15,3% e VPN=14,5% enquanto que o MNA®-SF apresentou Sen= 92,3%; Esp=58,2%; VPP=14,5% e VPN=99%. Verificou-se ainda neste estudo uma associação entre a desnutrição ou risco nutricional dos residentes e a sua mobilidade (p=0.001), depêndencia para as AVDs (p=0.001), IMC (p=0.001), perda de peso nos últimos 3 meses (p=0.001), perímetro geminal (p=0.001), número de fármacos diferentes que tomavam diariamente (p=0.038) e o número de internamentos que tiveram no último ano (p=0.031). Em relação à associação com um baixo IMC apenas se verificou uma associação significativa com a dependência para as AVDS (p=0.025). Os únicos fatores preditores da desnutrição e do risco nutricional encontrados no estudo foram a perda de peso entre 1Kg a 3Kg nos últimos 3 meses (p=0,001) e um perímetro geminal inferior a 31 cm (p=0,012) foram os únicos fatores encontrados neste estudo como dos residentes geriátricos. Conclusão: O SNAQ RC apresentou uma concordância moderada com o MNA®-SF e uma eficácia razoável quando utilizado o MNA® como diagnóstico. Tendo em conta estes resultados, o SNAQ RC parece ser uma opção de rastreio nutricional a ser tido em conta para utilização em residências geriátricas portuguesas.
Introduction: Demographic aging is a transversal phenomenon. Portugal also follows this trend, resulting in an increase in the number of elderly people institutionalized in nursing homes. Nursing home residents are a high-risk population with significant percentages of malnutrition and even higher of malnutritio risk that have consequences for their health, have a negative impact on their psychosocial well-being and quality of life, and still lead to an increase of economic expenditures with health care on individual and collective level. In order to prevent and minimize these consequences, an early detection of malnutrition is necessary, since only then can intervention take place in a timely manner. There is, therefore, a need to find a simple quick tool that allows the nutritional screening of nursing home residents. Given these needs the recent nutritional screening questionnaire Short Nutritional Assessment for Residential Care (SNAQ RC) seems to be a possible solution for a regular nutritional screening in the Portuguese nursing homes. Objective: To test the efficacy of the SNAQ RC as a screening tool in Portuguese nursing homes. Methods: Multicenter observational, cross-sectional study of institutionalized elderly people (age ≥ 65 years) from 6 Nursing homes in the metropolitan area of Lisbon (n = 183). The Mini Nutritional Assessment® Short-Form (MNA®-SF), SNAQ RC and Mini Nutritional Assessment (MNA®) questionnaires were applied. In addition to the questions and measurements required for the application of the questionnaires, additional clinical and sociodemographic information was collected from residents and their clinical processes. In order to evaluate the efficacy and accuracy of screening for malnutrition in the SNAQ RC questionnaire and comparison with the MNA®-SF questionnaire it was calculates the Kappa coefficient ,the sensitivity (Sen), specificity (Esp), positive predictive value (PPV), and the prevalence of malnutrition in the SNAQ RC questionnaire and negative predictive value (NPV) based on the diagnosis of the MNA® nutritional status assessment questionnaire and based in the new malnutrition definition of the European Society for Clinical Nutrition and Metabolism (ESPEN), taking only into account the Body Mass Index (BMI). It was also studied the relationship between the variables collected and the prevalence of malnutrition or nutritional risk and which factors predict malnutrition or nutritional risk in the sample. Results: The sample consisted of 183 nursing home residents and, in relation to their sociodemographic characteristics, 70.5% were female, with a mean age of 83.8 ± 6.7 (65-98) years, a mean time of residence at the institution of 45.6 ± 42.5 months and that 39.3% had the equivalent of the 4th grade of school and about 42.6% had a higher education level. Regarding the clinical characteristics, most of the were independent (65%) and had a normal mobility (66.7%), were taking on average 8.3 ± 5.0 different drugs per day, 23.7% had a hospitaization and 21.9% had had an episode of fall or bone fracture in the last year and most (90.2%) had dental prostheses, dental implants and / or missing teeth. It was also found that only 42.1% of residents had had any intervention by a dietitian. Regarding the anthropometric parameters, on average, the residents had a weight of 66.9±12.3kg, a height of 1.50±0.1m, a BMI of 28.2±4.8 kg/m2, a mid upper arm circunference of 28.1±4.0 cm and a calf circumference of 34.0±3.7 cm. With regard to nutritional screening, according to SNAQ RC, 15.3% were malnourished; 31.1% at risk of malnutrition and 53.6% with normal nutritional status, while according to MNA-SF 6.6% were malnourished; 38.8% at risk of malnutrition and 54.6% with a normal nutritional status. Regarding the nutritional assessment according to MNA®, 6.0% of the residents were malnourished; 48.6% at risk of malnutrition and 45.4% with a normal nutritional status whereas according to the new definition of malnutrition of ESPEN considering only the BMI 7,1% were malnourished. In terms of agreement the SNAQ RC showed a moderate agreement with the MNA®-SF (k = 0.488 and k = 0.604). In terms of effectiveness based on the MNA® the SNAQ RC presented Sen = 76%; Esp = 89.2%; VPP = 89.4% and NPV = 75.5% while MNA-SF presented Sen = 78%; Esp = 94%; PPV = 94% and NPV = 78%. In terms of effectiveness based on the ESPEN criteria the SNAQ RC presented Sen = 100%; Esp = 57.6%; VPP = 15.3% and NPV = 14.5% while MNA-SF presented Sen = 92.3%; Esp = 58.2%; VPP = 14.5% and VPN = 99%. An association between malnutrition or malnutrition risk of the residents and their mobility (p = 0.001), dependence of ADLs (p = 0.001), BMI (p = 0.001), and weight loss in the last 3 months (p = 0.001), calf circumference (p = 0.001), the number of different drugs they took daily (p = 0.038), and the number of hospitalizations they had in the last year (p = 0.031) was observed in this study. In relation to the association with a low BMI there was only found a significant association with ADL dependence (p = 0.025). The only predictors of malnutrition and nutritional risk found in the study were weight loss between 1 kg to 3 kg in the last 3 months (p = 0.001) and a calf circumference less than 31 cm (p = 0.012). Conclusion: The SNAQ RC showed fair agreement with MNA®-SF and a reasonable efficacy when using the MNA® as a diagnosis. Considering these results, the SNAQ RC seems an option to be taken into account for the nutritional screening in the portuguese nursing homes.