Nutritional status and the incidence of pneumonia in nursing home residents: results from the INCUR study

Objectives: To examine the predictive value of the Mini Nutritional Assessment-short form (MNA-SF) and its individual items on the incidence of pneumonia.

Design: Prospective observational cohort study over 1-year of follow-up.

Participants: A total of 773 older persons (74.4% women) living in 13 French nursing homes from the Incidence of pNeumonia and related ConseqUences in nursing home Residents (INCUR) study.

Measurements: Nutritional status was assessed using the MNA-SF questionnaire at baseline. Diagnosis of pneumonia was based on clinical conditions retrieved from a medical chart. Cox proportional hazard models were applied to test whether the MNA-SF score and its single components predict pneumonia events over 1 year of follow-up.

Results: After 1 year of follow-up, 160 (21%) incident cases of pneumonia were recorded. Mean age of participants was 86.2 (SD 7.5) years. Mean MNA-SF score was 9.8 (SD 2.4), with more than half of the participants (58.7%) being at risk of malnutrition (8-11 points). The total MNA-SF score and its categories did not predict the studied outcome. However, a single component of the MNA-SF score, specifically decreased mobility, was a significant risk factor for pneumonia (hazard ratio 2.289; 95% confidence interval 1.357-3.860; P = .002), independently of potential confounders.

Conclusions: The total MNA-SF score did not predict the incidence of pneumonia. However, decreased mobility was a significant risk factor, implying that individual components of the MNA-SF should be more carefully explored to verify whether they might be used for detecting specific declines of the health status in nursing home residents, thus potentially improving the risk profile estimation of such a complex population.