脳卒中患者のMNA：台湾

少し古いですが、台湾での脳卒中患者のMNAに関する論文を紹介します。

Alan C Tsai et al: A population-specific Mini-Nutritional Assessment can effectively grade the nutritional status of stroke rehabilitation patients in Taiwan. Journal of Clinical Nursing, 18, 82–88, 2008

脳卒中患者80人にMNAで栄養状態を評価した結果、低栄養18人（24.3%）、低栄養のおそれあり42人（56.8%）、栄養状態良好14人（18.9%）でした。

この論文では従来のMNAに加え、台湾バージョンでのMNAでも栄養状態を調査しています。65歳以上の台湾人の身体計測で5パーセンタイル以下をカットオフ値としています。具体的には上腕周囲長で男性22.5cm、女性21cm、下腿周囲長で男性28cm、女性25cm、BMIで21～17kg/m2です。

これで判定すると、従来のMNAは上腕周囲長21cm、下腿周囲長31cm、BMI23～19kg/m2がカットオフ値ですので、低栄養と判定される割合がやや少なくなり、栄養状態良好と判定される割合がやや増加します。

この論文を参考にすると日本では、日本人の新身体計測基準値（JARD 2001）を利用して、その5パーセンタイル以下を低栄養やサルコペニアの診断基準とする方法もありだと感じます。特に下腿周囲長31cmは若年者の5パーセンタイル程度ですので、65～69歳の28cm程度が適切なカットオフ値かもしれません。

Abstract
Aims and objectives.
To determine whether a modified version of the Mini-Nutritional Assessment without body mass index could effectively assess the nutritional risk status of stroke rehabilitation patients in Taiwan.

Background.
The Mini-Nutritional Assessment was developed on the basis of clinical data of Western populations. Although widely used, its application to assess stroke rehabilitation patients has been limited. Further, to get best results, populationspecific modifications to address anthropometric and lifestyle differences have been suggested, especially for non-Caucasian populations.

Design.
The study assessed the nutritional status of stroke rehabilitation patients who enrolled in the Long-term Care Service of Taipei. Strokes who were >40 years old, in the program for >1 month and cognitively able to answer the questions were recruited to participate in the study.

Methods.
An on-site in-person interview with structured questionnaire elicited information on personal data, disease history and healthcare use and answers to the Mini-Mental State Examination, the Activities of Daily Living and the Mini-Nutritional Assessment. Patient’s nutritional status was assessed with the Mini-Nutritional Assessment in three versions: the original, population-specific (MNA-TI) and population-specific, without body mass index (MNA-TII).

Results.
The original Mini-Nutritional Assessment rated 24% of patients malnourished and 57% at risk of malnutrition. Similar results, 14 and 64%, respectively, for MNA-TI; and 19 and 57%, respectively, for MNA-TII were observed.

Conclusion.
Both the original and the modified versions of the Mini-Nutritional Assessment can effectively rate the nutritional risk status of stroke rehabilitation patients in Taiwan. Version MNA-TII that adopted population-specific anthropometric cut-values but without body mass index can effectively predict the nutritional status of stroke patients.

Relevance to clinical practice.
The modified scale (MNA-TII) can enhance the application of the tool and timely detection and intervention of undernutrition among stroke rehabilitation patients. It can also help to improve job efficiency of the primary care professionals.