Malnutrition in older patients with cancer: Appraisal of the Mini Nutritional Assessment, weight loss, and body mass index.

Malnutrition is common in older patients with cancer (age over 65 years old), with a prevalence ranging from 30% to 85% [1] and it is a big public health issue in the United States. However, older patients with cancer are one of the most underdiagnosed patient groups [2]. Cancer-associated malnutrition is multifactorial including local tumor effects, the host response to the tumor, and the effects of anticancer therapies [3]. Nutritional assessment and screening tools can be useful for identifying malnutrition status among older patients with cancer. However, there are currently no ideal methods for screening and diagnosing older patients with cancer with malnutrition. Several screening tools have been designed and are available for older patients with cancer, including Body Mass Index (BMI), Weight loss and Mini Nutritional Assessment (MNA). A BMI below 20 kg/m has been found to have high sensitivity in the diagnosis of severe malnutrition in the older patients with cancer [4]. Weight loss, an indicator ofmalnutrition, is strongly associatedwith poor outcomes, including increased mortality, across all stages and types of cancer [5]. MNA is a quick, non-invasive, inexpensive, and well validated scale, and it takes about 5 min to complete [6]. It is a seven-item tool, that can easily be performed by health professionals in hospitals and nursing homes or by general physicians for the early detection of malnutrition risk [6]. In hospital settings, a low MNA (0–7) score has been associated with an increase inmortality, prolonged length of stay, and greater likelihood of discharge to a nursing home. The MNA can detect a risk of malnutrition before a severe change in weight or serum proteins occurred [7]. Studies have demonstrated that it is internally consistent and has an inter-observer reliability of 0.51 to 0.89, sensitivity of 89%, specificity