EVALUATION OF NUTRITIONAL ASSESSMENT IN ELDER PATIENTS WITH CONTINUOUS AMBULATORY PERITONEAL DIALYSIS: COMPARING THE MINI NUTRITIONAL ASSESSMENT (MNA) WITH THE SUBJECT GLOBAL ASSESSMENT (SGA)

Abstract

The DOQI 2000 recommends the subjective global assessment(SGA)for the nutritional evaluation in patient with continuous ambulatory peritoneal dialysis(CAPD). In 1990s, the mini nutritional assessment (MNA)has been used successfully in the evaluation of the nutrition status in the flail elder person. Is it more suitable for MNA than SGA in assessment the nutrition of elder CAPD patient? In this study, we compared the MNA method with the traditional SGA in the evaluating the nutritional status in elder CAPD patients. We used the cross-sectional study with selection of the patient. Forty-five elder CAPD patients 21 male and 24 female with more than 60 years old, were enrolled in this study. SGA and MN questionnaire, anthropometric parameters and laboratory test were investigated in those patients. The normalized protein equivalent of total nitrogen appearance (nPNA) was calculated. The result were: 1)These patients were classified into three nutritional classes according to the SGA (i.e. normal nutrition SGA considered as A, mild to moderate malnutrition SGA as B, and severe malnutrition SGA as C). The corresponding, classification according to the MNA was normal nutrition(MNAl), at risk of malnutrition(MNA2), and severe malnutrition(MNA 3). In the SGA classification, 49% were assessed as A, 31% in B and 20% in C, while the corresponding figures in MNA Was 40% in MNA 1, 38% in MNA 2 and 22% in MNA 3. Either in SGA or in MNA assessment . the dietary protein intake (DPI), dietary energy intake (DEI), serum albumin(Alb), nPNA, months On CAPD, residual renal function(RRF), and the adequacy indices(Kt/v, Ccr) were significantly different among three groups(P0.05). Only in severe malnutrition group, both in SGA and MNA, the abnormal rates of all measures were above 80% for DEI or DPI and Alb, except for Prealbumin. 2) There were no significant differences between the classes, irrespective of methods. The kappa test, was used to compare the result of two methods, and the kappa value was 0.545 5(P<0.05). 3) Pearson correlation coefficients between the SGA and serum albumin concentration (r=0.347) nPNA (r=0.329)and months on CAPD(r=−0.360) were all significant whereas the MNA had significant correlation with serum albumin concentration (r=0.362)nPNA(r=0.394), months on CAPD(r=−0.335) and RRF(r=0.576).