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Long-term Changes in Nutritional Status Are Associated with Functional and Mortality Outcomes among Community-living Older Persons

Wei, Kai, Nyunt, Ma Shwe Zin, Gao, Qi, Wee, Shiou Liang, Ng, Tze Pin
Nutrition 2019
at-risk population, cohort studies, confidence interval, elderly, mortality, nutrition assessment, nutrition risk assessment, nutritional intervention, nutritional status, odds ratio, quality of life, regression analysis, screening, Singapore
Older persons who are malnourished are at high risk of adverse functional and mortality outcomes.To assess the long-term changes in nutritional status among community-living older adults and their associations with adverse health outcomes.population-based observational cohort study (Singapore Longitudinal Aging Study, SLAS 1), with a 4-5-year follow-up.2075 community-living adults aged ≥60 years.Nutritional status (Mini Nutritional Assessment Short-Form [MNA-SF] and Nutritional Screening Initiative [NSI]), instrumental/basic activities of daily living (IADL/ADL) and quality of life (QOL) were assessed at both baseline and the 4-5-year follow-up. The 10-year mortality was assessed from the date of 4-5-year follow-up to March 2017.Estimates of associations between changes in nutritional status and adverse health outcomes were analyzed using multinomial logistic regression or Cox proportional hazards regression, and indicated by odds ratios/hazard ratios (ORs/HRs) and 95% confidence intervals (CIs).Nutritional status was dynamic from baseline to the 4-5-year follow-up according to both MNA-SF and NSI. Compared to persistent normal nutrition, nutritional deterioration was associated with increased incident IADL/ADL disability (MNA-SF: OR 3.22, 95% CI 1.13-9.16), poor QOL (MNA-SF: OR 4.53, 95% CI 2.13-9.64) and mortality (MNA-SF: HR 4.76, 95% CI 2.82-8.03; NSI: HR 1.99, 95% CI 1.27-3.14); nutritional improvement was associated with decreased incident IADL/ADL disability (NSI: OR 0.17, 95% CI 0.05-0.59); persistent poor nutrition (MNA-SF at risk/malnourished or NSI moderate/high nutritional risk) was associated with elevated incidence of poor QOL (MNA-SF: OR 1.92, 95% CI 1.05-3.52; NSI: OR 2.31, 95% CI 1.19-4.49) and mortality (MNA-SF: HR 2.57, 95% CI 1.59-4.15; NSI: HR 1.97, 95% CI 1.17-3.32). Compared to persistent poor nutrition, nutritional improvement was also associated with decreased incidence of mortality (MNA-SF: HR 0.43, 95% CI 0.23-0.80).Changes in nutritional status are associated with adverse health outcomes, and should be monitored with simple screening tools to identify older adults at high risk of adverse functional and mortality outcomes for selective nutritional interventions.