Prognostic Utility of the Mini Nutritional Assessment for Three-Month mortality in adult palliative care patients: A prospective cohort study

Abstract

Malnutrition is highly prevalent among individuals receiving palliative care and represents a major, yet often under-recognized, determinant of adverse clinical outcomes, including mortality. In adult patients receiving palliative care, the interplay between malnutrition, frailty, and disease burden further exacerbates vulnerability. Despite its clinical relevance, the prognostic value of standardized nutritional screening tools in palliative care settings remains insufficiently characterized. This study aimed to determine the prevalence of malnutrition and to evaluate its association with mortality using the Nutrition Risk Screening-2002 (NRS-2002) and the Mini Nutritional Assessment (MNA). This prospective observational cohort study was conducted in the palliative care unit of a university hospital. Patients were recruited between November 2022 and March 2023, and follow-up was completed in June 2023. A total of 250 patients receiving inpatient or outpatient palliative care were included. Nutritional status was assessed at baseline using NRS-2002 and MNA and reassessed after three months. Demographic characteristics and anthropometric measurements were recorded. The association between nutritional status and mortality was examined using multivariable logistic regression and ROC analyses. The mean age of the cohort was 62.82 ± 12.43 years, and 45.6% were female. At baseline, 68.2% of patients with available NRS-2002 data were identified as being at nutritional risk, whereas this proportion was 90.2% among those who died during follow-up. According to the available full MNA assessments, 45.7% of patients were classified as malnourished at baseline, compared with 84.8% among patients who died. In multivariable logistic regression models adjusted for age and sex, higher full MNA score was associated with lower odds of three-month mortality (OR: 0.784; 95% CI: 0.720–0.854; p < 0.001). ROC analysis showed that the full MNA score had higher discriminatory performance than NRS-2002 among patients with both measurements available (AUC: 0.871 vs. 0.728; DeLong test, p < 0.001). Malnutrition and nutritional risk were common among patients receiving palliative care and were associated with three-month mortality. The full MNA may provide clinically useful prognostic information and showed greater discriminatory performance than NRS-2002 among patients with both assessments available. However, these findings should be interpreted cautiously because of the limited number of mortality events, incomplete nutritional assessment data, and lack of adjustment for several established palliative prognostic factors. Routine nutritional assessment may support the identification of clinically vulnerable patients, although these prognostic findings require confirmation in larger, multicenter cohorts.