Korean J Nutr.  2009 Apr;42(3):234-245. 10.4163/kjn.2009.42.3.234.

The Analysis of Geriatric Nutritional Risk Index (GNRI) for Nutritional Assessment and Health Care in Elderly Women

• Yang EJ

• KMID: 2264723
• DOI: http://doi.org/10.4163/kjn.2009.42.3.234

Abstract

Nutritional assessment for the elderly can identify health status and morbidity. However, development of Nutritional Risk Index (NRI) remains limited for elderly because of difficulties in understanding physiological mechanism of elderly. This study was performed to analyze and develop Nutritional Risk Index for Korean elderly Women (Geriatric Nutritional Risk Index, GNRI). Based on literature review, factors for NRI were identified and indices were assessed by a cross-sectional survey. The survey involved Korean elderly women (> or = 60, n = 94) in Gwangju area, and sociodemographics, lifestyle characteristics, health conditions, dietary intakes based on 24h- recall, anthropometric measures (wt, ht, BMI, waist, hip, WHR, body protein, body fat, abdominal fat, and triceps skinfold thickness), and clinical biochemistry parameters (systolic blood pressure, diastolic blood pressure, cholesterol, HDL-cholesterol, triglyceride, total protein, albumin, prealbumin, hemoglobin, hematocrit, fasting blood glucose, HbA1c, ferritin, Zn, Ca, Na, K, Vit E, Vit B12, folate, C-reactive protein) were examined relation to nutritional risk index. Based on literature review and data analyses, three NRIs were categorized (NRI I, NRI II, NRI III) and used for further analysis. NRI I was related to having metabolic syndrome, NRI II was related to serum albumin and body weight, and NRI III was related to food habit and health concerns. Abdominal fat (%) of elderly was correlated with each NRIs. NRI II was correlated with nutritional deficiency and higher tendency of inflammatory response, and NRI III was correlated with nutritional status which tend to be lower on aging (protein, folate, Vit B12). NRI can serve as a useful tools in assessing health risk and nutritional status. Some modification of items in NRI and validity study are need to apply to Korean elderly.

Keyword

Nutritional Risk Index (NRI); Nutritional Screening; Korean elderly Women; Nutritional Status; health risk; metabolic syndrome

MeSH Terms

Abdominal Fat
Adipose Tissue
Aged
Aging
Biochemistry
Blood Glucose
Blood Pressure
Body Weight
Cholesterol
Cross-Sectional Studies
Delivery of Health Care
Fasting
Female
Ferritins
Folic Acid
Food Habits
Hematocrit
Hemoglobins
Hip
Humans
Life Style
Malnutrition
Nutrition Assessment
Nutritional Status
Prealbumin
Serum Albumin
Statistics as Topic
Blood Glucose
Cholesterol
Ferritins
Folic Acid
Hemoglobins
Prealbumin
Serum Albumin

Reference

1. Dwyer J. Frankler RT, Owen AL, editors. The elderly. handbook of Nutrition in the community. 1993. Mosby-Year Book;230–235.

2. Kim SK, Kang HK, Kim JH. Socio-economic factors affecting the health and nutritional status of the aged. Korean J Nutr. 2000. 33(1):86–101.

3. Yang EJ, Kim WY. New paradigm for Dietary reference intakes: American/Canadian dietary reference intakes (DRIs): Elderly. Korean J Nutr. 2004. 37(7):603–605.

4. Krunbolz HM. Lack of association between cholesterol and coronary heart disease mortality and morbidity and all-cause mortality in persons older that 70 years. JAMA. 1994. 272:1335–1342.

5. Park MY, Lee KH, Youn HS. Nutrition status of the rural elderly living in Kyungnam. Korean J Community Nutrition. 2001. 6:3S. 527–541.

6. Pakr JK, Son SM. The dietary behaviors, depression rates and nutrient intakes of the elderly females living alone. Korean J Community Nutrition. 2003. 8(5):716–725.

7. Kim YK, Lee HO, Chang L, Choue RW. A study on the food habits, nutrient intake and the disease distribution in the elderly (aged over 65 years)(I). Korean J Community Nutrition. 2002. 7(4):516–526.

8. Posner BM, Jette AM, Smith KW, Miller DR. Nutrition and health risk in the elderly: the Nutrition Screening Initiative. Am J Public Health. 1993. 83:972–978.

9. Vellas B, Guigoz Y, Garry PJ, Albarede JL. The mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition. 1999. 15:116–122.

10. Bouillanne O, Morieneau G, Dupont C, Aussel C. Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr. 2005. 82:777–783.

11. Bonnefoy M, Ayzac L, Ingenbleek Y, Bienvenu J. Usefulness of the prognostic inflammatory and nutritional index (PINI) in hospitalized elderly patients. Intern J Vitamin and Nutrition Research. 1998. 68(3):189–195.

12. Naber T, Bree A, Schermer T, Bakkeren J, Bar Brigit, Wild G, Katan MB. Specificity of indexes of malnutrition when applied to apparently healthy people: the effect of age. Am J Clin Nutr. 1997. 65:1721–1725.

13. Pablo R, Izaga A, Alday A. Assessment of nutritional status on hospital admission: Nutritional scores. Eur J Clin Nutr. 2003. 57(7):824–831.

14. Kondrup J, Allison SP, Elia M, Vella B, Plauth M. ESPEN guidelines for Nutrition Scerrning 2002. Clin Nutr. 2003. 22(4):415–421.

15. Han KH, Choi M, Park J. Nutritional risk and its related factors evaluated by the mini nutritional assessment for the elderly who are meal service participants. Korean J Nutr. 2004. 37(8):675–687.

16. Yoon JS, Lee JH. Nutrient intake, zinc status and health risk factors in elderly Korean women as evaluated by the nutrient screening initiative (NSI) checklist. Korean J Community Nutrition. 2002. 7(4):539–547.

17. Lee KW, Lee YM, Kim JH. The health and nutritional status of low-income, alone living elderly. Korean J Community Nutrition. 2000. 5(1):3–12.

18. Lee JW, Kim KE, Kim KN, Hyun TS, Park YS. Evaluation of the validity of a simple screening test developed for identifying Korean elderly at risk of undernutrition. Korean J Nutr. 2000. 33(8):864–872.

19. Omran ML, Morley JE. Assessment of protein energy malnutrition in older persons, part I: History, Examination, body composition, and screening tools. Nutrition. 2000. 16:50–63.

20. Omran ML, Morley JE. Assessment of protein energy malnutrition in older persons, part II: Laboratory evaluation. Nutrition. 2000. 16:131–140.

21. The Korean Nutrition Society. Dietary reference intakes for Koreans. 2005.

22. Green Cross Research Lab. Clinical Research Service. 2007.

23. Caterina R, Zampolli A, Turco SD, Madonna R, Massaro M. Nutritional mechanism that influence cardiovascular disease. Am J Clin Nutr. 2006. 83:suppl. 421S–426S.

24. Yang EJ, Bang HM. Nutritional status and health risks of low income elderly women in Gwangju area. Korean J Nutr. 2008. 413(4):65–76.

25. Ministry of Health and Welfare. 2005 National Health and Nutrition Survey: Overview. 2007.

26. Yang EJ, Kim WY. Nutritional Status of Korean Elderly. Korean J Gerontol. 2005. 15(1):1–10.

27. Park JK, Son SM. Anthropometric and biochemical indicators and related factors for the community dwelling elderly living alone. Korean J Community Nutrition. 2003. 8(5):726–735.

28. Kagansky N, Berner Y, Koren-Morag N, Perelman L, Knobler H, Levy S. Poor nutritional habits are predictors of poor outcome in very old hospitalize patients. Am J Clin Nutr. 2005. 82:784–791.