Preoperative nutritional evaluation of elderly patients: the Mini Nutritional Assessment as a practical tool

Background and goal: Age and malnutrition are each surgical risk factors. B ecause the Mini Nutritional Assessment (MNA) has been specifically designed for assessing the nutritional status of elderly patients, it can be used f or preoperative nutritional evaluation. Therefore, the MNA was included in the preoperative clinical evaluation of patients over 60 years of age to de scribe their nutritional status. Methods: Every patient over 60 years of age, scheduled for elective surgery , was seen in anaesthesiology consultation and was submitted to the MNA. Th e MNA is a clinical score consisting of four additive items: 'Anthropometri c assessment' based on BMI, mid-arm and calf circumferences, weight loss; g lobal evaluation; dietetic assessment, and subjective assessment - these la st three items being obtained through a specific questionnaire. It requires no biological marker. Awarding to the obtained score, the MNA stratifies p atients in the following categories: well-nourished (24 less than or equal to MNA less than or equal to 30), at risk of malnutrition (17 less than or equal to MNA < 23.5), and undernutrition (MNA < 17). Also recorded were: ag e, gender, type of scheduled operation, and the American Society of Anesthe siologists' (ASA) physical status score. Results are given as median (extre mes). Results: Four hundred and nineteen patients (50.4% women) were seen between January and October 1996. The mean age was 72 years (range, 60-98 years) B MI::25.2 (12.8-40.4) kg m(-2). The MNA score was recorded in 408 patients, ranging from 1.5 to 30 (median: 26). According to the score, the patients w ere stratified in: well-nourished, 276 patients (67.6%), at risk, 104 patie nts (25.5%) and suffering from overt malnutrition, 28 patients (6.9%). Acco rding to the ASA score, 290 patients were found to be at low or mild risk f or anaesthesia and surgery (ASA 1 and 2), and 72 patients (24.8%) were stra tified as being at least at risk of malnutrition. One hundred and eighteen other patients were found to be at a higher risk (ASA 3 and 4), and 58 (49. 2%) were not well-nourished (MNA < 24). Conclusion: The MNA was found to be well-suited for the preoperative assess ment during anaesthesia consultation because it required no biological mark er. It showed that approximately one-third of all the examined patients, an d half of the ASA 3-4 patients, were not well-nourished. The ASA score coul d not predict poor nutritional status. The results suggested that nutrition al assessment should be routinely performed in ASA 3-4 patients over 60 yea rs of age. (C) 1999 Harcourt Publishers Ltd.