Determinação da acurácia da utilização da circunferência do braço na Mini Avaliação Nutricional versão reduzida (MNA®-SF) para rastreio nutricional de idosos atendidos na Estratégia Saúde da Família

Abstract

The Mini Nutritional Assessment Short Form (MNA®-SF) is a nutritional status-screening tool in the elderly including body mass index or calf circumference as anthropometric parameter. However, it is not always possible to obtain these parameters. Thus, it is important to search for alternative parameters such as the circumference of the arm that is also used in the evaluation of nutritional status. This dissertation presents an original article entitled ACCURACY OF ARM CIRCUMFERENCE IN THE MINI NUTRITIONAL ASSESSMENT SHORT FORM whose objectives were to describe the nutritional status of elderly patients in primary health care and determine the accuracy of the use of the arm circumference in MNA®-SF for screening of nutritional status. Therefore, a cross-sectional, descriptive and analytical study was conducted, with a sample of 539 individuals aged 60 years or more, registered in the Family Healthcare in Porto Alegre-RS and were evaluated in the Epidemiological and Clinical Study Seniors Attended by the Family Healthcare in the City of Porto Alegre (EMI-SUS). Variables were investigated, such as Socio-demographic (genre, age, race, marital status, family income and education); Anthropometric [body mass index (BMI), calf circumference (CC) and arm circumference (AC)] and nutritional status (MNA® and MNA®-SF). For the classification of the AC, two variations were used, one with three categories (AC3= <21cm: 0 points; ≥21 or ≤22cm: 1.5 points; >22cm: 3 points) and one with two categories (AC2= < 21cm: 0 points and ≥21: 3 points), taking into account the minimum and maximum values established for categories of BMI of MNA® due to its replacement by AC2, AC3. For CC, the cutoff points used were already determined to MNA®-SF (<31cm: 0 points; ≥31cm: 3 points). To determine the accuracy, MNA® was considered the gold standard for nutritional risk. The mean age was 68.7 ± 6.8 years (60-100 years). Most seniors were female (63.1%). Regarding nutritional status, they were classified as being at nutritional risk or undernourished, 24.1% of the elderly by MNA® and 33.4% by MNA®-SF. Regarding the socio-demographic variables, association only between nutritional status and marital status and education was observed. Separate individuals were more often eutrophic and widowers and illiterates were more often malnourished. Correlation analysis between BMI, CC and AC was significant, positive and strong (r> 0.750, P <0.001). The agreement between the MNA®-SF with IMC and MNA®-SF with CC, MNA®-SF with IMC and MNA®-SF with AC2, MNA®-SF with IMC and MNA®-SF with AC3 was excellent (>0.90; P<0.001). The accuracy of the four instruments showed that they all had high accuracy [MNA®-SF with IMC (aucROC= 0.940), MNA®-SF with CP (aucROC = 0.932), MNA®-SF with CB2 (aucROC = 0.926) and MNA®-SF with CB3 (aucROC = 0.927)], with good sensitivity. Thus, it can be concluded that the use of the arm circumference in MNA®-SF proved accurate for tracking the nutritional status of elderly assisted in the Family Healthcare.