This cross sectional study was conducted to determine the validity of three screening tools, Mini Nutritional Assessment Short Form (MNA-SF), Malnutrition Risk Screening Tool for Community (MRST-C) and Malnutrition Risk Screening Tool for Hospital (MRST-H) among elderly people at health clinics. The screening tools were validated against anthropometric and functional assessments. The anthropometric assessments that were carried out included body weight, height, arm span, body mass index (BMI), calf circumference (CC) and mid upper arm circumference (MUAC). A set of questionnaire on manual dexterity, muscular strength, instrumental activities daily living (IADL) and cognitive status was used to assess functional abilities. A total of 156 subjects were recruited from rural (38 subjects) and urban (118 subjects) health clinics at Sabak Bernam and Cheras respectively. Subjects' age ranged from 60 to 83 years old, with 44.2% were men and 55.8% women. The prevalence of muscle wasting among the subjects assessed from MUAC and CC were both 7.0%. MNA-SF had the highest correlation with BMI (r = 0.497, p<0.001), followed by MUAC (r = 0.398, p<0.001), CC (r = 0.473, p<0.001), cognitive assessment (r = 0.229, p<0.001) and handgrip strength (r = 0.209, p<0.001). Whilst MRST-C had the highest correlation with IADL score (r =-0.320, p<0.001) and MRST-H had the highest correlation with the lock and key test (r = -0.325, p<0.01). Sensitivity was the highest for MNA-SF (93.2%), followed by MRST-H (52.5%) and MRST-C (25.8%). Specificity was the highest for MRST-H (97.3%), followed by MRST-C (90.8%) and MNA-SF (79.4%). Positive predictive value (PPV) for MRST-H, MNA-SF and MRST-C was 55.5%, 18.2% and 14.1%, respectively. In conclusion, among the screening tools being validated, MNA-SF is considered the most appropriate tool to be used in health clinics for identification of elderly individuals who are at high risk of malnutrition.
Introduction: Nutrition screening is recommended as a first step of nutrition care to allow early identification and intervention of malnourished patients. The present study determined the validities and reliabilities of two malnutrition screening tools namely, the Malnutrition Universal Screening Tool (MUST) and Malnutrition Screening Tool (MST) among adult patients at the Hospital Kuala Lumpur. Methods: The sensitivity, specificity and predictive value of MUST and MST were conducted against the Subjective Global Assessment (SGA), anthropometric parameters including body mass index (BMI), calf circumference (CC), mid-upper arm circumference (MUAC) and energy intake. Inter-rater reliability was evaluated using kappa value (κ) to determine the level of agreement between raters. Results: A total of 151 subjects with mean age of 45.2 ± 13.7 years participated in this study. Prevalence of malnutrition according to MUST, MST and SGA was 34.4%, 33.8% and 19.9%, respectively. As compared to SGA, MUST and MST had a sensitivity of 96.6% and 93.3% respectively, whereas the specificity was 80.9% for both tools. The sensitivity and specificity of MUST against the anthropometric parameters (BMI, CC and MUAC) were between 53.8% to 88.8% and 67.4% to 69.9%, respectively. The sensitivity values for MST were between 46.1% to 63.6% and specificity values were between 64.4% to 67.6%. The inter-rater reliability of MUST was higher (substantial, mean (κ) = 0.78) than for MST (moderate, mean (κ) = 0.52). Conclusions: In conclusion, MUST was found to have similar validity levels but higher reliability result than MST. Based on our result, MUST is recommended for use in identifying adult patients who are at high risk of malnutrition. It can be used as a malnutrition screening tool but there is a need to evaluate the cost effectiveness of its implementation.
Introduction: Feeding difficulty and functional disability are common problems among patients with dementia but their influence on caregivers' burden has not been addressed comprehensively. Thus, this study aimed to determine the association between feeding problems, functional status and caregiver burden among patients with dementia who receive outpatient treatment at Universiti Kebangsaan Malaysia Medical Centre (UKMMC) in Kuala Lumpur, Malaysia, as compared to their non-demented counterparts. Methods: A cross-sectional comparative study was conducted among 30 patients with dementia (12 men, 18 women, mean age 75 ± 7 years old) and 60 subjects without dementia (25 men, 35 women, mean age 69 ± 7 years), as well as their caregivers. Subjects' functional status, feeding problems and also caregiver burden were assessed using Activities of Daily Livings (ADLs) and Instrumental Activities of Daily Living (IADL) questionnaire, The Edinburgh Feeding Evaluation in Dementia Questionnaire (EdFED-Q) and Zarit Burden Interview (ZBI), respectively. Subjects were also measured for height and weight. Results: Patients with dementia needed supervision (50%) and physical help during mealtime (40%). The mean functional status score of these patients was higher than the patients without dementia (p<0.05). Caregiver burden score was positively correlated with the EdFED-Q score (r=0.405, p<0.05) but negatively correlated with functional status score (r=0.475, p<0.01). Further, multiple regression analysis showed that after adjustment for age, EdFED-Q score and functional status remained correlated with caregiver burden at R2 of 0.210. Conclusion: Caregiver burden is associated with feeding problems and functional disability among patients with dementia. There is a need to educate the caregivers in order to improve the quality of life of both carers and the demented patients.
Key words: Caregiver burden, dementia, feeding problems, functional status, outpatient
Study site: Psychiatric and medical clinics, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Loss of appetite, decrease in food intake and changes in body composition appear to be inter-related factors that can influence the well-being of older individuals. Therefore, a study was conducted to determine the level of appetite, food intake and its relation to body composition and functional status among noninstitutionalised elderly Malays in Cheras, Kuala Lumpur. The Council on Nutrition Appetite Questionnaire (CNAQ), Diet History Questionnaire (DHQ), Bio-impedance Analysis (BIA) and Instrumental Activity of Daily Living (IADL) questionnaire and handgrip dynamometer were used to measure appetite, food intake, body composition and functional status respectively. A total of 112 subjects (41.1% men and 58.9% women) participated with mean age being 66.0 ± 5.0 years for men and 66.3 ± 6.2 years for women. Prevalence of poor appetite was higher in elderly women (72.3%) than in men (52.3%) (p<0.05). Pearson's correlation test showed that CNAQ score correlated significantly with age (r=-0.255, p<0.01), energy intake (r=0.272, p<0.01), IADL score (r=0.408, p<0.01) and handgrip strength (r=0.263, p<0.05). Energy intake correlated significantly with fat free mass (r=0.424, p<0.05), muscle mass (r=0.456, p<0.05) and total body water (r=0.403, p<0.05). Multiple regression analysis showed that 27.0% of poor appetite could be explained by advanced age, low energy intake and decreased functional status. In conclusion, the study showed that poor appetite was prevalent among the subjects, especially women and this was influenced by aging, inadequate energy intake and decreased functional status.
A cross-sectional study was carried out to evaluate the nutritional status of 51 subjects with leukemia aged 4 to 12 years from the Haematology and Oncology Paediatric Ward, Universiti Kebangsaan Malaysia Medical Centre (PPUKM) and the Paediatric Institute of Kuala Lumpur. Nutritional status was assessed using anthropometric measurements, biochemical and haematological parameters. Subjects comprised 32 (62.7%) males and 19 (27.3%) females. Most of the subjects (41.2%) were in the age group of 4 to 6 years. More than half of the children were Malays (70.6%) followed by Indians (15.7%) and Chinese (13.7%). The subjects were diagnosed as acute lymphoblastic leukemia (ALL) (84.3%) followed by acute myelogenous leukemia (AML) (13.7%) and chronic myelogenous leukemia (CML) (2.0%) respectively. Most of the children were in remission status (54.9%). Underweight (s) of malnutrition (
A cross-sectional study was carried out to assess the physical activity levels among patients with type 2 diabetes mellitus (DM) at Cheras Health Clinic in Kuala Lumpur. A total of 132 subjects (62 men and 70 women) aged 30 years and above participated in this study. Data was collected using an interview based questionnaire to obtain socio-demographic and health profile information. Physical activity was assessed using a shortened version of the International Physical Activity Questionnaire (IPAQ). Anthropometric measurements and body fat were also taken. Glycaemic status, that is, HbA1c, fasting blood sugar (FBS) and 2 hours post-prandial (2-HPP) were obtained from medical records. Results showed that the mean age of the patients was 51.9 + 5.8 years. The majority of patients had poor glycaemic control based on HbA1c (70.7%), FBS (71.9%) and 2HPP (85.4%). Patients who were unmarried and aged(60 years and above had a lower physical activity level (p< 0.05). In the older age group, low physical activity was associated with poor glycaemic control (p< 0.05). Patients in the moderate and high physical activity level were motivated to perform physical activity so as to be healthy (68.1%). Low physical activity level among patients was due to lack of time (54.5%) and lack of energy (21.2%). In conclusion, physical activity levels of the patients were unsatisfactory and associated with poor glycaemic control, especially in the elderly. There is a need to encourage diabetic patients to undertake regular physical activity in order to achieve optimal glycaemic control.
Study site: Klinik Kesihatan Cheras, Kuala Lumpur, Malaysia
The incidence of falls among older adults can be caused by nutritional, health status, physical and environmental factors. The objective of this study was to develop and evaluate the contents in a booklet on nutrition and falls prevention among older adults as a nutritional education material for falls prevention. In Phase I, market survey in bookstore, website search and need assessment among 30 respondents using a questionnaire was conducted. Results from Phase I were used to form a 32-page A5 size booklet that includes information on nutrients related to bone health, recommendations of high protein and calcium menus, ideal exercise and tips to avoid falls in older adults. The content validity of the booklet was conducted among six health professionals to assess the suitability and understanding in Phase II. The content of the booklet (Phase III) was then evaluated among 24 respondents aged 60 years and above. From the need assessment in Phase I, majority of respondents chose 7 to 9 for the score of each questions which indicates the need for all information to be included in the booklet. For Phase II, criteria with highest average score were composition and typography with a score of 60%. For Phase III, most respondents chose “good” for all the criteria stated except for pictures (satisfactory), while 62.5% of respondents stated that they were satisfied with the information contents in the booklet. In conclusion, this booklet can be used as one of the strategies for nutrition education in the prevention of falls among older adults.
Body weight can be estimated using equations developed from the anthropometric measurements when body weight is difficult to measure for example among bedridden older adults. This study has developed the equation to estimate body weight among older adults resided in Klang Valley from several anthropometric measurements. A cross sectional study was carried out among community dwelling older adults aged 60 years old and above in Klang Valley area. Subjects were recruited through convenience sampling method. Weight, height, knee height (KH), demi span (DS), subscapular skinfold (SSF), calf circumference (CC), waist circumference (WC), hip circumference (HC), mid upper arm circumference (MUAC) and wrist circumference (WrC) were measured according to the standard protocol. Cross validation was performed. 61% from total subjects were selected randomly for the development of equation meanwhile, 39% subjects as control subjects. Equation was generated using stepwise multiple regression analysis. A total of 164 older adults involved in this study which consist of 39.0% men and 61.0% women. Mean age of the subjects was 68.32 ± 5.79 years meanwhile mean of measured body weight was 66.46 ± 11.98 kg. Predictive equation obtained was: estimated body weight = 5.149 (Sex) – 0.082 (Age) + 0.889 (Hip circumference) + 1.112 (Knee Height) – 72.778 (R2 = 0.848, p < 0.001). Correlation coefficient for 61% subjects were higher (r = 0.921) compared to the correlation coefficient for 39% subjects (r = 0.883) (p < 0.001). However, the differences between measured and estimated body weight was not significant (p = 0.798). This showed that the equation developed was able to estimate body weight among older adults, because the value of estimated body weight was closed to the value of measured body weight. The equation developed can be used to estimate body weight among Malaysian older adults. However, further study is warranted to explore this equation into the different settings such as clinical setting.
Obesity is an emerging public health threat in the elderly population in developing countries. Hence, the Third National Health and Morbidity Survey has assessed 4746 individuals aged 60 years and older recruited through a household survey to determine the prevalence of adiposity using body mass index and waist circumference. The national's prevalence of overweight and obesity in men was 29.2% (95% confidence interval [CI] = 27.2-31.3) and 7.4% (95% CI = 6.4-8.6), respectively. However, the prevalence decreased with age. The figures in women were 30.3% (95% CI = 28.5-32.1) and 13.8% (95% CI = 12.5-15.2), respectively. The prevalence of abdominal obesity was 21.4% (95%CI = 20.2-22.6), with 7.7% (95% CI = 6.7-9.0) in men and 33.4% (95% CI = 31.4-35.3) in women. Predictors of adiposity include the following: Malay and Indian ethnicity, higher education level, higher household income, from urban area, and being married. In conclusion, adiposity affects about one third of the Malaysian elderly population, especially those of the younger age group, women, and those with higher socioeconomic status.
Study name: National Health and Morbidity Survey (NHMS-2006)