The association between the ‘at risk of developing undernutrition’ category of the Short Nutritional Assessment Questionnaire 65+ and incident undernutrition in community-dwelling older adults

Background & aims: Screening tools like the Short Nutritional Assessment Questionnaire 65+ (SNAQ⁶⁵⁺) have been developed for the early recognition of undernutrition in older adults. The SNAQ⁶⁵⁺ screens for being undernourished (red), being ‘at risk of developing undernutrition’ (i.e. ‘at risk’, orange), or ‘not at risk’ (green). This study investigated whether community-dwelling older adults ‘at risk’ (orange) are more likely to develop undernutrition during a 3-year follow-up compared to those ‘not at risk’ (green). Methods: Prospective data from a Longitudinal Aging Study were used. A total of 5461 observations, using multiple 3-year waves of participants aged ≥65 years with an orange or green baseline score were included. Logistic mixed models were used to assess the association with four indicators of incident undernutrition at 3-year follow-up: (1) red SNAQ⁶⁵⁺ score (mid upper arm circumference (MUAC) < 25 cm and/or ≥4 kg self-reported unintended weight loss in 6 months); (2) MUAC <25 cm; (3) ≥4 kg self-reported unintended weight loss in 6 months; and (4) ≥10% objectively measured weight loss in 3 years. Results: There were 53.1% female participants across waves, with a mean age of 74.2 (SD 6.1) years. Overall, 6.2% were ‘at risk of developing undernutrition’ (orange) at baseline. The incidence rates of undernutrition based on a red SNAQ⁶⁵⁺ score, MUAC <25 cm, ≥4 kg self-reported unintended weight loss, and ≥10% measured weight loss were 10.4%, 2.9%, 6.4%, and 5.4%, respectively. Those ‘at risk’ (orange) had a higher odds ratio of incident undernutrition based on these four indicators than those ‘not at risk’ (green) (respective odds ratio's: 2.51 (95%CI 1.74–3.62); 2.16 (95%CI 1.11–4.20); 2.43 (95%CI 1.61–3.65); and 2.08 (95%CI 1.28–3.37)). Conclusion: Community-dwelling older adults screened to be ‘at risk of developing undernutrition’ (orange) with the SNAQ⁶⁵⁺ have a more than two-fold higher odds ratio of developing undernutrition during a 3-year follow-up compared to those ‘not at risk’ (green).