Nutritional form for the elderly is a reliable and valid instrument for the determination of undernutrition risk, and it is associated with health-related quality of life

Abstract

Undernutrition is a common problem associated with clinical complications such as impaired immune response, reduced muscle strength, impaired wound healing, and susceptibility to infections; therefore, it is an important treatment target to reduce morbidity and mortality associated with chronic diseases and aging. The aim of the present study was to apply a reliable and valid instrument for the determination of undernutrition risk in an in-hospital patient population and to describe possible associations between risk of undernutrition and some aspects of health-related quality of life in patients with chronic diseases. Fifty-six adult patients with different chronic diseases were interviewed with NUFFE questionnaire and the EQ-5D. Anthropometric measurements were performed. Reliability and validity of the NUFFE instrument was tested, and its correlation with EQ-5D was calculated. Euro-Qol scores correlated significantly with the total NUFFE scores and with the items constructing the most important factor of the instrument, explaining 53.74% of its variance. Nutritional form for the elderly was shown to be a reliable instrument in the study group because its internal consistency measured by Cronbach α was 0.62, and the item-total score correlations were significant for the half of the items. Criterion-related validity, concurrent validity, and construct validity of NUFFE were established. We have shown that impaired level of health-related quality of life is an important determinant of risk for undernutrition. Nutritional form for the elderly is an appropriate instrument to estimate undernutrition risk in a general, in-hospital patient population with various chronic diseases and to identify “at risk” patients who may benefit from professional dietary interventions to reduce undernutrition-related complications.

Introduction

Among nutritional disorders, obesity has received more attention recently; however, undernutrition has disadvantageous effects as well, although it is associated with increased morbidity and mortality [1]. Cachexia is a well-known complication of renal and hepatic insufficiency, malignant diseases, and chronic heart failure. The mortality of patients with undernutrition is much higher than that of patients without. Undernutrition may cause decrease in the protein synthesis leading to secondary immunodeficiency and to decrease in the level of lipoproteins, thus, increasing the susceptibility to infections. It is also associated with reduced muscle strength and impaired wound healing [2]. Malnutrition may be associated with impaired quality of life in older adults [3] or in patients with chronic kidney disease [4]. Early nutritional intervention may positively impact on quality of life and enhance clinical response in oncology patients [5] and in alcoholic liver disease [6].

In western societies the prevalence of undernutrition may reach high levels, 20% in elderly but even 37% in nursing homes and hospitals [7]. The assessment of the undernutrition risk of elderly people or of patients with chronic diseases is of great importance; therefore, it should be part of the admission procedure to hospitals. The recognition of the high-risk patients for undernutrition is the base of the appropriate dietary treatment.

Nutritional status can be estimated by several methods, for example, with objective anthropometric measurements or with laboratory tests, based on identification of major abnormalities of fluid, electrolytes, vitamins, minerals, and energy/protein supply [8]. Although these methods are accurate, they need special devices in some cases with high costs, experienced staff to perform the measurements, and they are not always easily available. Assessment instruments, such as the Mini Nutritional Assessment [9] and the nutritional form for the elderly (NUFFE) [10], are free of the mentioned difficulties. Nutritional form for the elderly is an instrument based on simple questions; it can be easily performed by the staff without special nutritional training and experience, and it has a high degree of reliability and validity determined in a home-living elderly population [11].

Because nutritional status can be viewed as a strong determinant of the prognosis and complications of chronic diseases and that impaired health-related quality of life is an important marker of the global health status in the affected individuals, it should be important to investigate possible associations between risk of undernutrition and decreased level of some aspects of health-related quality of life. Thus, the aim of this study was to test reliability and validity of the NUFFE instrument in an in-hospital population of patients with different chronic diseases. Furthermore, we investigated the associations between risk of undernutrition and some aspects of health-related quality of life in screened adult patients using NUFFE. Because there are no available Hungarian translations of the NUFFE instrument, we translated it into Hungarian (NUFFE-HU) and tested this version for reliability and validity.