Optimizing mini nutritional assessment as a prognostic tool in oncology: evidence from 50 hospitals

Abstract

Objectives Diagnosing malnutrition in older individuals with excess weight is challenging, as commonly used tools rely on anthropometric measures such as body mass index (BMI) and calf circumference (CC), which can be affected by excess weight. To partially address this concern, we have previously proposed an adaptation of the mini nutritional assessmen–short form (MNA-SF), incorporating sex-, population-, and BMI-adjusted CC cutoff values. However, it still requires exploration and validation across diverse settings, particularly in large cohorts. This study aimed to evaluate the impact of this adapted MNA-SF and compare it with traditional MNA-SF versions regarding malnutrition prevalence and adverse outcomes among older patients with cancer, in the overall sample and in a subsample of patients with excess weight. Methods A multicenter cohort included older patients (≥60 years) with cancer hospitalized in 50 hospitals across two countries. MNA-SF used four approaches: BMI, CC<31, sex-specific unadjusted, and BMI-adjusted CC ≤33/34 cm. Malnutrition was defined as scores ≤ 7. Outcomes of interest were length of hospital stay (LOS) and 60-day mortality. Results A total of 2128 patients were included (mean age: 73 ± 6 years, 56.6% males). The prevalence of malnutrition ranged from 29% using BMI to 47.5% using sex-specific BMI-adjusted CC. Among patients with excess weight, the prevalence of malnutrition ranged from 13.5% (CC < 31 cm) to 32.4% using sex-specific BMI-adjusted CC. MNA-SF score across all approaches was associated with LOS. All MNA-SF methods showed similar survival AUROC: 0.76 to 0.77. Each 1-point decrease in MNA-SF using CC BMI-adjusted was associated with a 30% higher risk in the total cohort (RR adjusted 1.30, 95% CI: 1.18–1.45), and a 32% higher risk among patients with excess weight (RR adjusted 1.32, 95% CI: 1.06–1.61). Conclusion MNA-SF using CC BMI-adjusted and adequate cutoffs is a potential approach to diagnose malnutrition in older patients with cancer, even if they present with excess weight.