Malnutrition is associated with poor muscle mass and physical performance in community-dwelling older adults: COINS study baseline data

Malnutrition is prevalent in older adults and frequently coexists with sarcopenia (1) , a condition characterised by low muscle mass and physical performance (2) . Malnutrition and sarcopenia are associated with adverse outcomes in older adults including mortality (3) , and thus require early detection. The Mini Nutrition Assessment (MNA) is a validated nutrition screening and assessment tool in older adults (4) , but its ability to predict poor muscle mass and physical performance is unclear. This study aimed to determine the association between MNA-determined (risk of) malnutrition and muscle mass and physical performance in community-dwelling older adults. This is a cross-sectional analysis of baseline data from the Capacity of Older Individuals after Nut Supplementation (COINS) study, a randomised controlled trial investigating the effect of peanut butter on functional capacity in older adults. Participants were generally healthy and at risk for falls (simplified fall risk screening score ≥ 2). Participants were screened for malnutrition risk (MNA-Screening score range 0–14; at-risk or malnourished if < 11), followed by assessment (MNA-Assessment score range 0–16) to obtain MNA-Total score (range 0–30; at-risk or malnourished if score < 23.5). Skeletal muscle mass index (SMMI) was derived from bio-impedance analysis. Physical performance including muscle strength, gait speed, balance and power, was objectively measured using multiple standard tests. Linear regression analyses were performed and adjusted for age and sex. A total of 120 participants were included (70% females, age 74.8 ± 4.5 years). MNA-Screening, MNA-Assessment and MNA-Total scores were (median [IQR]) 14 [12–14], 14 [13.5–15] and 27.5 [26.0–28.4] respectively. Malnutrition (or risk) was found in 18 (15.0%) and 8 (6.7%) participants according to MNA-Screening and MNA-Total, respectively. A higher MNA-Screening score was associated with higher knee extension strength [β = 1.36 (Standard Error, SE 0.65) kg, p = 0.039]. A higher MNA-Assessment score was associated with higher gait speed [β = 0.04 (0.01) kg/m 2 , p = 0.007] and shorter timed up-and-go test time [β = −0.19 (0.09) seconds, p = 0.035]. MNA-Total score was not significantly associated with muscle mass or physical performance. Malnutrition status as determined by MNA-Screening score (but not MNA-Total score) was associated with lower muscle mass (SMMI [β = −0.52 (0.26) kg/m 2 , p = 0.043]), but not strength and physical performance. In summary, the MNA-Screening score was predictive of muscle mass and strength, whereas the MNA-Assessment score predicted physical performance, particularly gait speed, in community-dwelling older adults at risk of falls. Periodic malnutrition screening by MNA may help early detection of poor muscle mass and function in generally healthy older adults.