Mini-Nutritional Assessment (MNA) is Useful for Assessing the Nutritional Status of Patients with Chronic Obstructive Pulmonary Disease: A Cross-sectional Study

Figures & data

Table 1.  Basic characteristics and functional and nutritional status of 83 patients with chronic obstructive pulmonary disease (COPD)

Variables	n (%)	Mean (SD)
Age (y)		74.7 (7.0)
58–64	8 (9.6)
65–74	30 (36.1)
>75	45 (54.2)
Smoking habit
Never	13 (15.6)
Past smoker	55 (66.3)
Current smoker	15 (18.1)
Alcohol use^a
No	73 (88.0)
Yes	10 (12.0)
Family history of chronic respiratory disease^b
No	60 (72.3)
Yes	23 (27.7)
Lung function
FEV1 (% predicted)		60.7 (20.4)
FVC (% predicted)		75.9 (18.2)
Serverity of COPD^c
Stage I (mild)	14 (16.9)
Stage II (moderate)	43 (51.8)
Stage III (severe)	22 (26.5)
Stage IV (very severe)	4 (4.8)
MNA score according to COPD severity
Stage I (mild)		24.39 (3.20)^d
Stage II (moderate)		24.97 (3.15)
Stage III (severe)		23.14 (3.50)
Stage IV (very severe)		20.25 (5.42)
6-Minute Walk test
Oxygen saturation at rest (%)		95.3 (2.38)
Oxygen saturation during exercise (%)		86.3 (7.23)
Walking distance (m)		383.0 (99.0)
Anthropometrics
BMI (kg/m^2)		23.7 (3.86)
Mid-arm circumference (cm)		26.5 (3.40)
Calf-circumference (cm)		33.1 (3.36)
Body composition
% body fat		24.28 (5.89)
Fat-free mass index (kg/m^2)		17.81 (2.45)
Distribution by % of ideal body weight
<90%	12 (14.5)
90–110%	37 (44.6)
>110%	34 (41.0)
Blood biochemical indicators
Hemoglobin (g/dL)		13.86 (1.85)
Total lymphocyte count (n/μL)		1883 (775)
Albumin (g/dL)
Average		4.32 (0.31)
≥4 g/dL	63 (80.8)
<4 g/dL	15 (19.2)
C-reactive protein (mg/L)		9.91 (17.3)

FEV₁ = force expiratory volume in 1 second (an indicator of the severity of COPD).

^aAt least once/week.

^bIncluding parents, grandparents and siblings having COPD, asthma, bronchiectasis, or lung cancer.

^cAccording to GOLD (2007), Stage I (mild) is defined as FEV₁ ≥80% of predicted; Stage II ­(moderate) as 50%–79%; Stage III (severe) as 30–49%; and stage IV (very severe) as <30%. In all stages, FEV₁/FVC is < 0.7.

^dAccording to MNA-T2.

Table 2.  MNA item-score patterns of 83 patients with chronic obstructive pulmonary disease

Items (item score)	Score	n (%)	Items (item score)	Score	n (%)
A. Appetite status over past 3 months (2)			K. Consumption of protein-rich foods every day (1)
Severe loss of appetite	0	0 (0)	0 or 1 “yes”	0	5 (7.2)
Moderate loss of appetite	1	43 (51.8)	2 “yes”	0.5	15 (18.1)
No loss of appetite	2	40 (48.2)	3 “yes”	1	62 (74.7)
B. Weight loss during the last 3 months (3)			L. Consumes ≥2 servings of fruits or vegetables/day (1)
Weight loss greater than 3 kg	0	6 (7.2)	No	0	20 (24.1)
Does not know	1	1 (1.2)	Yes	1	63 (75.9)
Weight loss between 1 and 3 kg	2	4 (4.8)	M. Cups of fluid/water consumed/day (1)
No weight loss	3	72 (86.7)	<3	0	0 (0)
C. Mobility (2)			3–5	0.5	40 (48.2)
Bed or chair bound	0	0 (0)	>5	1	43 (51.8)
Able to get out of bed / chair but does not got out	1	0 (0)	N. Mode of feeding (2)
Goes out	2	83 (100)	Unable to eat without assistance	0	0 (0)
D. Has suffered psychological stress or acute disease (2)			Self-fed with some difficulty	1	0 (0)
No	2	60 (72.3)	Self-fed without any problem	2	83 (100)
Yes	0	23 (27.7)	O. Self-view of nutritional status (2)
E. Neuropsychological problems (2)			View self as being malnourished	0	25 (30.1)
Severe dementia or depression	0	5 (6.0)	Uncertain of nutritional state	1	11 (13.3)
Mild dementia	1	27 (32.5)	Views self as having no nutritional problem	2	47 (56.6)
No psychological problems	2	51 (61.4)	P. Self-rated health status (2)
F. Body Mass Index (kg/m^2) (3)			Not as good	0	32 (38.6)
(a) MNA-T1			Does not know	0.5	3 (3.6)
<17	0	3 (3.6)	As good	1	26 (31.3)
17–19	1	4 (4.8)	Better	2	22 (26.5)
19–21	2	12 (14.5)	Q. Mid-arm circumference* (cm)
≥21	3	64 (77.1)	(a) MNA-T1 (1)
(b) MNA-T2 (This item was omitted)			<22.5/<21	0	9 (10.8)
G. Can live independently (1)			22.5–23.4/21–21.9	0.5	9 (10.8)
No	0	0 (0)	≥23.5/≥22	1	65 (78.3)
Yes	1	83 (100)	(b) MNA-T2 (2)
H. Takes 4 or more prescription drugs/day (1)			<22.5/<21	0	9 (10.8)
Yes	0	66 (79.5)	22.5–23.4/21–21.9	1	9 (10.8)
No	1	17 (20.5)	≥23.5/≥22	2	65 (78.3)
I. Pressure sore or skin ulcers (1)			R. Calf circumference* (cm)
Yes	0	2 (2.4)	(a) MNA-T1 (1)
No	1	81 (97.6)	<28/<25	0	5 (6.0)
J. Number of full meals the patient eats daily (2)			≥28/≥25	1	78 (94.0)
1	0	0 (0)	(b) MNA-T2 (3)
2	1	7 (8.4)	<28/<25	0	5 (6.0)
3	2	76 (91.6)	28–29/25–26	1	2 (2.4)
			29–30/26–27	2	5 (6.0)
			≥30/≥27	3	71 (85.5)

MNA = Mini Nutritional Assessment; T1 = Taiwan version-1; T2 = Taiwan version-2.

MNA-T1 rated 4 (4.8%) patients as malnourished (MNA score ≤ 16.5), 28 (33.7%) as at risk of malnutrition (MNA score 17–23.5) and 51 (61.4%) as normal (MNA score ≥24), whereas MNA-T2 rated 4 (4.8%) patients as malnourished, 26 (31.3%) as at risk of malnutrition and 53 (63.9%) as normal.

* Values are for men/women respectively.

Table 3.  Cross-tabulation test of the nutritional scores between MNA-T1 and MNA-T2 of 83 patients with chronic obstructive pulmonary disease

	MNA-T1
Item	Undernutrition*	Normal
MNA-T2
Undernutrition*	30 (93.8)	0 (0)
Normal	2 (6.2)	51 (100)
Kappa (95% CI)	0.949 (0.878–1.000)

MNA = Mini Nutritional Assessment; T1 = Taiwan version-1; T2 = Taiwan version-2.*Including those rated as malnutrition or at risk of malnutrition.

Table 4.  Correlation coefficients (r) of MNA scores with anthropometric, biochemical and pulmonary function status of 83 patients with chronic obstructive pulmonary disease

Variables	MNA-T1	MNA-T2
Age	0.117	0.106
Anthropometrics
BMI	0.426**	0.419**
MAC	0.446**	0.489**
CC	0.419**	0.460**
FFMI	0.423**	0.429**
Lung function
FEV1% predicted	0.274*	0.268*
FVC% predicted	0.286*	0.291*
Severity of COPD (GOLD stage)^a	−0.295*	−0.283*
Exercise capacity
SaO2 at rest	0.244*	0.288**
SaO2 during exercise	0.298**	0.315**
6-minute walking distance	0.217	0.273*
Biochemical indicators
Hemoglobin	0.107	0.105
Total lymphocyte count	0.007	−0.034
Albumin	0.076	0.163
C-reactive protein	−0.010	−0.059

MNA = Mini Nutritional Assessment; T1 = Taiwan version-1; T2 = Taiwan version-2;

MAC = Mid-arm circumference; CC = Calf circumference; FFMI = Fat-free mass index;

SaO₂ = Oxygen saturation.

^aAll correlations, except COPD stages, were based on Pearson's correlation analysis. COPD stages was based on Spearman's correlation analysis.

*p < 0.05, **p < 0.01.

Figure 1.  Receiver operating characteristic (ROC) curves generated for the MNAT1(— — –) and MNA-T2(–– –) scores against fat-free mass index using 16kg/m2 and 15 kg/m² as cutoffs for men and women, respectively.