Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 14, Number 2, April 2023, pages 133-141

Nutritional Status in Patients Undergoing Phase II Cardiac Rehabilitation by Mini Nutritional Assessment

Figure 2. Correlation between MNA-SF and MNA total score and BMI. (a) Correlation between MNA-SF and BMI. (b) Correlation between MNA total score and BMI. MNA: Mini Nutritional Assessment; SF: short form; BMI: body mass index.

Figure 3. Screening accuracy of (a) MNA-SF and (b) MNA total score for malnutrition. AUC: area under the curve; MNA: mini nutritional assessment; ROC: receiver operator characteristic; SF: short form.

Figure 4. ROC curves of MNA-SF for MNA overall score < 24. AUC: area under the curve; MNA: Mini Nutritional Assessment; ROC: receiver operator characteristic; SF: short form.

**Table 1.** Patient Characteristics
	Total (N = 336)	MNA-SF < 12 (N = 157)	MNA-SF ≥ 12 (N = 179)	P
P: Wilcoxon rank sum test or χ² test. CR: cardiac rehabilitation; BMI: body mass index; CVD: cardiovascular disease; eGFR: estimated glomerular filtration rate; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; MNA: Mini Nutritional Assessment; SF: short form; TG: triglyceride; CRP: C-reactive protein; HbA1c: hemoglobin A1c; SD: standard deviation.
Age (years), mean ± SD	70.1 ± 11.4	70.3 ± 11.9	70.0 ± 11.0	0.44
Sex (male), n (%)	209 (62.2%)	97 (61.8%)	112 (62.6%)	0.88
CVD at the beginning for CR, n (%)
Open heart surgery	151 (44.9%)	67 (42.7%)	84 (46.9%)	0.06
Chronic heart failure	119 (35.4%)	65 (41.4%)	54 (30.2%)
Other	66 (19.6%)	25 (15.9%)	41 (22.9%)
Acute coronary syndrome, n (%)	33 (9.8%)	19 (12.1%)	14 (7.8%)	0.18
BMI, mean ± SD	23.1 ± 4.1	21.5 ± 3.9	24.4 ± 3.7	< 0.05
Hemoglobin (g/dL), mean ± SD	12.8 ± 1.9	12.3 ± 1.9	13.2 ± 1.8	< 0.05
Creatinine (mg/dL), mean ± SD	1.3 ± 1.8	1.4 ± 1.9	1.2 ± 1.6	0.07
eGFR (mL/min/1.73 m²), mean ± SD	60.8 ± 23.5	58.0 ± 24.8	63.2 ± 22.0	0.06
TG (mg/dL), mean ± SD	115.0 ± 56.5	116.2 ± 59.1	114 ± 54.7	0.88
LDL-C (mg/dL), mean ± SD	98.0 ± 28.7	97.9 ± 30.4	98.2 ± 27.3	0.65
HDL-C (mg/dL), mean ± SD	52.6 ± 15.8	50.8 ± 15.4	54.2 ± 16.1	0.07
HbA1c (%), mean ± SD	6.0 ± 0.8	6.0 ± 0.9	6.0 ± 0.6	0.19
CRP (mg/dL), mean ± SD	0.6 ± 1.6	0.6 ± 1.7	0.5 ± 1.4	0.75

Table 1. Patient Characteristics

Total (N = 336)

MNA-SF < 12 (N = 157)

MNA-SF ≥ 12 (N = 179)

P: Wilcoxon rank sum test or χ² test. CR: cardiac rehabilitation; BMI: body mass index; CVD: cardiovascular disease; eGFR: estimated glomerular filtration rate; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; MNA: Mini Nutritional Assessment; SF: short form; TG: triglyceride; CRP: C-reactive protein; HbA1c: hemoglobin A1c; SD: standard deviation.

Age (years), mean ± SD

70.1 ± 11.4

70.3 ± 11.9

70.0 ± 11.0

0.44

Sex (male), n (%)

209 (62.2%)

97 (61.8%)

112 (62.6%)

0.88

CVD at the beginning for CR, n (%)

Open heart surgery

151 (44.9%)

67 (42.7%)

84 (46.9%)

0.06

Chronic heart failure

119 (35.4%)

65 (41.4%)

54 (30.2%)

Other

66 (19.6%)

25 (15.9%)

41 (22.9%)

Acute coronary syndrome, n (%)

33 (9.8%)

19 (12.1%)

14 (7.8%)

0.18

BMI, mean ± SD

23.1 ± 4.1

21.5 ± 3.9

24.4 ± 3.7

< 0.05

Hemoglobin (g/dL), mean ± SD

12.8 ± 1.9

12.3 ± 1.9

13.2 ± 1.8

< 0.05

Creatinine (mg/dL), mean ± SD

1.3 ± 1.8

1.4 ± 1.9

1.2 ± 1.6

0.07

eGFR (mL/min/1.73 m²), mean ± SD

60.8 ± 23.5

58.0 ± 24.8

63.2 ± 22.0

0.06

TG (mg/dL), mean ± SD

115.0 ± 56.5

116.2 ± 59.1

114 ± 54.7

0.88

LDL-C (mg/dL), mean ± SD

98.0 ± 28.7

97.9 ± 30.4

98.2 ± 27.3

0.65

HDL-C (mg/dL), mean ± SD

52.6 ± 15.8

50.8 ± 15.4

54.2 ± 16.1

0.07

HbA1c (%), mean ± SD

6.0 ± 0.8

6.0 ± 0.9

6.0 ± 0.6

0.19

CRP (mg/dL), mean ± SD

0.6 ± 1.6

0.6 ± 1.7

0.5 ± 1.4

0.75

**Table 2.** MNA Results
Number	Total (N = 336)	MNA-SF < 12 (N = 157)	MNA-SF ≥ 12 (N = 179)	P
P: Wilcoxon rank sum test or χ² test. MNA: mini nutritional assessment; SF: short form.
MNA
Screening items: MNA-SF
A. Has food intake declined over the past 3 months due to loss of appetite, digestive problems, chewing or swallowing difficulties?	1.8 ± 0.5	1.7 ± 0.6	1.9 ± 0.3	< 0.05
B. Weight loss during the last 3 months?	2.1 ± 1.1	1.5 ± 1.2	2.7 ± 0.6	< 0.05
C. Mobility	1.9 ± 0.3	1.9 ± 0.3	2.0 ± 0.2	< 0.05
D. Has suffered psychological stress or acute disease in the past 3 months?	1.4 ± 0.9	0.9 ± 1.0	1.8 ± 0.6	< 0.05
E. Neuropsychological problems	2.0 ± 0.2	1.9 ± 0.3	2.0 ± 0.0	< 0.05
F. BMI	2.1 ± 1.1	1.5 ± 1.1	2.6 ± 0.7	< 0.05
MNA-SF category
Normal nutritional status: 12 - 14 points	179 (53.3%)	0 (0%)	179 (100%)	< 0.05
At risk of malnutrition: 8 - 11 points	136 (40.5%)	136 (86.6%)	0 (0%)
Malnourished: 0 - 7 points	21 (6.3%)	21 (13.4%)	0 (0%)
MNA assessment items
G. Lives independently	0.9 ± 0.4	0.9 ± 0.4	0.8 ± 0.4	0.93
H. Takes more than four prescription drugs per day	0.2 ± 0.4	0.1 ± 0.4	0.2 ± 0.4	0.11
I. Pressure sores or skin ulcers	0.7 ± 0.5	0.6 ± 0.5	0.7 ± 0.5	0.24
J. How many full meals does the patient eat daily?	1.9 ± 0.3	2.0 ± 0.2	1.9 ± 0.3	< 0.05
K. Selected consumption markers for protein intake	0.8 ± 0.3	0.7 ± 0.3	0.8 ± 0.3	< 0.05
L. Consumes two or more servings of fruit or vegetables	0.8 ± 0.4	0.8 ± 0.4	0.9 ± 0.4	0.4
M. How much fluid is consumed per day?	0.7 ± 0.3	0.7 ± 0.3	0.8 ± 0.3	< 0.05
N. Mode of feeding	1.9 ± 0.3	1.9 ± 0.3	2.0 ± 0.3	0.59
O. Self-assessment of nutritional status	1.7 ± 0.5	1.6 ± 0.6	1.8 ± 0.4	< 0.05
P. In comparison with other people of the same age, how does the patient consider his/her health status?	0.9 ± 0.7	0.8 ± 0.7	0.9 ± 0.7	< 0.05
Q. Mid-arm circumference in cm	0.9 ± 0.3	0.8 ± 0.4	1.0 ± 0.1	< 0.05
R. Calf circumference in cm	0.8 ± 0.4	0.7 ± 0.5	0.9 ± 0.3	< 0.05
MNA total score categories
Normal nutritional status: 24 - 30 points	168 (50.0%)	21 (13.4%)	147 (82.1%)	< 0.05
At risk of malnutrition: 17 - 23.5 points	159 (47.3%)	127 (80.9%)	32 (17.9%)
Malnourished: < 17 points	9 (2.7%)	9 (5.7%)	0 (0%)

Table 2. MNA Results

Number

Total (N = 336)

MNA-SF < 12 (N = 157)

MNA-SF ≥ 12 (N = 179)

P: Wilcoxon rank sum test or χ² test. MNA: mini nutritional assessment; SF: short form.

MNA

Screening items: MNA-SF

A. Has food intake declined over the past 3 months due to loss of appetite, digestive problems, chewing or swallowing difficulties?

1.8 ± 0.5

1.7 ± 0.6

1.9 ± 0.3

< 0.05

B. Weight loss during the last 3 months?

2.1 ± 1.1

1.5 ± 1.2

2.7 ± 0.6

< 0.05

C. Mobility

1.9 ± 0.3

2.0 ± 0.2

< 0.05

D. Has suffered psychological stress or acute disease in the past 3 months?

1.4 ± 0.9

0.9 ± 1.0

1.8 ± 0.6

< 0.05

E. Neuropsychological problems

2.0 ± 0.2

1.9 ± 0.3

2.0 ± 0.0

< 0.05

F. BMI

2.1 ± 1.1

1.5 ± 1.1

2.6 ± 0.7

< 0.05

MNA-SF category

Normal nutritional status: 12 - 14 points

179 (53.3%)

0 (0%)

179 (100%)

< 0.05

At risk of malnutrition: 8 - 11 points

136 (40.5%)

136 (86.6%)

0 (0%)

Malnourished: 0 - 7 points

21 (6.3%)

21 (13.4%)

0 (0%)

MNA assessment items

G. Lives independently

0.9 ± 0.4

0.8 ± 0.4

0.93

H. Takes more than four prescription drugs per day

0.2 ± 0.4

0.1 ± 0.4

0.2 ± 0.4

0.11

I. Pressure sores or skin ulcers

0.7 ± 0.5

0.6 ± 0.5

0.7 ± 0.5

0.24

J. How many full meals does the patient eat daily?

1.9 ± 0.3

2.0 ± 0.2

1.9 ± 0.3

< 0.05

K. Selected consumption markers for protein intake

0.8 ± 0.3

0.7 ± 0.3

0.8 ± 0.3

< 0.05

L. Consumes two or more servings of fruit or vegetables

0.8 ± 0.4

0.9 ± 0.4

0.4

M. How much fluid is consumed per day?

0.7 ± 0.3

0.8 ± 0.3

< 0.05

N. Mode of feeding

1.9 ± 0.3

2.0 ± 0.3

0.59

O. Self-assessment of nutritional status

1.7 ± 0.5

1.6 ± 0.6

1.8 ± 0.4

< 0.05

P. In comparison with other people of the same age, how does the patient consider his/her health status?

0.9 ± 0.7

0.8 ± 0.7

0.9 ± 0.7

< 0.05

Q. Mid-arm circumference in cm

0.9 ± 0.3

0.8 ± 0.4

1.0 ± 0.1

< 0.05

R. Calf circumference in cm

0.8 ± 0.4

0.7 ± 0.5

0.9 ± 0.3

< 0.05

MNA total score categories

Normal nutritional status: 24 - 30 points

168 (50.0%)

21 (13.4%)

147 (82.1%)

< 0.05

At risk of malnutrition: 17 - 23.5 points

159 (47.3%)

127 (80.9%)

32 (17.9%)

Malnourished: < 17 points

9 (2.7%)

9 (5.7%)

0 (0%)

**Table 3.** Background Characteristics of Patients With Discrepancies Between MNA-SF and MNA Total Score
	MNA-SF < 12	P	MNA-SF ≥ 12	P
CR: cardiac rehabilitation; CVD: cardiovascular disease; eGFR: estimated glomerular filtration rate; MNA: Mini Nutritional Assessment; SF: short form; BMI: body mass index; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; TG: triglyceride; CRP: C-reactive protein; HbA1c: hemoglobin A1c; SD: standard deviation.
Number	136	21		32	147
Age (years), mean ± SD	70.1 ± 11.9	71.5 ± 11.8	0.48	69.3 ± 9.4	70.1 ± 11.4	0.30
Sex (male), n (%)	80 (58.8%)	17 (81.0%)	< 0.05	17 (53.1%)	95 (64.6%)	0.22
CVD at beginning of CR, n (%)
Open heart surgery	57 (41.9%)	10 (47.6%)	0.36	16 (50.0%)	68 (46.3%)	0.81
Chronic heart failure	59 (43.4%)	6 (28.6%)		10 (31.3%)	44 (29.9%)
Other	20 (14.7%)	5 (23.8%)		6 (18.8%)	35 (23.8%)
BMI, mean ± SD	21.4 ± 4.1	22.0 ± 2.2	0.14	24.2 ± 6.0	24.5 ± 3.0	< 0.05
Hemoglobin (g/dL), mean ± SD	12.1 ± 2.0	13.4 ± 1.3	< 0.05	13.0 ± 1.9	13.2 ± 1.7	0.52
Creatinine (mg/dL), mean ± SD	1.45 ± 2.07	1.00 ± 0.66	0.61	1.47 ± 1.93	1.12 ± 1.51	0.36
eGFR (mL/min/1.73 m²), mean ± SD	57.3 ± 25.8	62.7 ± 16.3	0.35	57.7 ± 26.8	64.4 ± 20.8	0.17
TG (mg/dL), mean ± SD	120.5 ± 60.4	86.4 ± 40.7	0.10	129.3 ± 56.3	112.0 ± 54.6	0.32
LDL-C (mg/dL), mean ± SD	97.5 ± 31.0	100.2 ± 27.5	0.54	95.3 ± 25.4	98.7 ± 27.7	0.77
HDL-C (mg/dL), mean ± SD	49.9 ± 15.0	56.3 ± 16.7	0.14	55.3 ± 18.4	54.0 ± 15.7	0.88
HbA1c (%), mean ± SD	6.1 ± 1.0	5.8 ± 0.5	0.14	6.0 ± 0.7	6.0 ± 0.6	0.86
CRP (mg/dL), mean ± SD	0.72 ± 1.85	0.19 ± 0.32	< 0.05	0.23 ± 0.41	0.59 ± 1.56	0.52
MNA-assessment
G. Lives independently	0.8 ± 0.4	0.9 ± 0.3	0.46	0.7 ± 0.5	0.9 ± 0.3	< 0.05
H. Takes more than four prescription drugs per day	0.1 ± 0.3	0.3 ± 0.5	0.05	0.1 ± 0.3	0.2 ± 0.4	0.07
I. Pressure sores or skin ulcers	0.6 ± 0.5	0.8 ± 0.4	0.10	0.5 ± 0.5	0.8 ± 0.4	< 0.05
J. How many full meals does the patient eat daily?	2.0 ± 0.2	2.0 ± 0.0	0.42	1.8 ± 0.4	1.9 ± 0.3	0.38
K. Selected consumption markers for protein intake	0.7 ± 0.4	0.9 ± 0.2	< 0.05	0.5 ± 0.4	0.9 ± 0.3	< 0.05
L. Consumes two or more servings of fruit or vegetables	0.8 ± 0.4	1.0 ± 0.0	< 0.05	0.6 ± 0.5	0.9 ± 0.3	< 0.05
M. How much fluid is consumed per day?	0.6 ± 0.3	0.9 ± 0.2	< 0.05	0.6 ± 0.4	0.8 ± 0.3	< 0.05
N. Mode of feeding	1.9 ± 0.4	2.0 ± 0.0	0.32	1.8 ± 0.6	2.0 ± 0.1	< 0.05
O. Self-assessment of nutritional status	1.6 ± 0.6	2.0 ± 0.2	< 0.05	1.4 ± 0.6	1.9 ± 0.3	< 0.05
P. In comparison with other people of the same age, how does the patient consider his/her health status?	1.6 ± 0.6	2.0 ± 0.2	< 0.05	0.4 ± 0.4	1.1 ± 0.7	< 0.05
Q. Mid-arm circumference in cm	0.8 ± 0.4	0.9 ± 0.2	0.06	0.9 ± 0.3	1.0 ± 0.1	0.38
R. Calf circumference in cm	0.7 ± 0.5	0.9 ± 0.4	0.11	0.8 ± 0.4	0.9 ± 0.2	< 0.05

Table 3. Background Characteristics of Patients With Discrepancies Between MNA-SF and MNA Total Score

MNA-SF < 12

MNA-SF ≥ 12

MNA-total score < 24

MNA-total score ≥ 24

MNA-total score < 24

MNA-total score ≥ 24

CR: cardiac rehabilitation; CVD: cardiovascular disease; eGFR: estimated glomerular filtration rate; MNA: Mini Nutritional Assessment; SF: short form; BMI: body mass index; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; TG: triglyceride; CRP: C-reactive protein; HbA1c: hemoglobin A1c; SD: standard deviation.

Number

136

147

Age (years), mean ± SD

70.1 ± 11.9

71.5 ± 11.8

0.48

69.3 ± 9.4

70.1 ± 11.4

0.30

Sex (male), n (%)

80 (58.8%)

17 (81.0%)

< 0.05

17 (53.1%)

95 (64.6%)

0.22

CVD at beginning of CR, n (%)

Open heart surgery

57 (41.9%)

10 (47.6%)

0.36

16 (50.0%)

68 (46.3%)

0.81

Chronic heart failure

59 (43.4%)

6 (28.6%)

10 (31.3%)

44 (29.9%)

Other

20 (14.7%)

5 (23.8%)

6 (18.8%)

35 (23.8%)

BMI, mean ± SD

21.4 ± 4.1

22.0 ± 2.2

0.14

24.2 ± 6.0

24.5 ± 3.0

< 0.05

Hemoglobin (g/dL), mean ± SD

12.1 ± 2.0

13.4 ± 1.3

< 0.05

13.0 ± 1.9

13.2 ± 1.7

0.52

Creatinine (mg/dL), mean ± SD

1.45 ± 2.07

1.00 ± 0.66

0.61

1.47 ± 1.93

1.12 ± 1.51

0.36

eGFR (mL/min/1.73 m²), mean ± SD

57.3 ± 25.8

62.7 ± 16.3

0.35

57.7 ± 26.8

64.4 ± 20.8

0.17

TG (mg/dL), mean ± SD

120.5 ± 60.4

86.4 ± 40.7

0.10

129.3 ± 56.3

112.0 ± 54.6

0.32

LDL-C (mg/dL), mean ± SD

97.5 ± 31.0

100.2 ± 27.5

0.54

95.3 ± 25.4

98.7 ± 27.7

0.77

HDL-C (mg/dL), mean ± SD

49.9 ± 15.0

56.3 ± 16.7

0.14

55.3 ± 18.4

54.0 ± 15.7

0.88

HbA1c (%), mean ± SD

6.1 ± 1.0

5.8 ± 0.5

0.14

6.0 ± 0.7

6.0 ± 0.6

0.86

CRP (mg/dL), mean ± SD

0.72 ± 1.85

0.19 ± 0.32

< 0.05

0.23 ± 0.41

0.59 ± 1.56

0.52

MNA-assessment

G. Lives independently

0.8 ± 0.4

0.9 ± 0.3

0.46

0.7 ± 0.5

0.9 ± 0.3

< 0.05

H. Takes more than four prescription drugs per day

0.1 ± 0.3

0.3 ± 0.5

0.05

0.1 ± 0.3

0.2 ± 0.4

0.07

I. Pressure sores or skin ulcers

0.6 ± 0.5

0.8 ± 0.4

0.10

0.5 ± 0.5

0.8 ± 0.4

< 0.05

J. How many full meals does the patient eat daily?

2.0 ± 0.2

2.0 ± 0.0

0.42

1.8 ± 0.4

1.9 ± 0.3

0.38

K. Selected consumption markers for protein intake

0.7 ± 0.4

0.9 ± 0.2

< 0.05

0.5 ± 0.4

0.9 ± 0.3

< 0.05

L. Consumes two or more servings of fruit or vegetables

0.8 ± 0.4

1.0 ± 0.0

< 0.05

0.6 ± 0.5

0.9 ± 0.3

< 0.05

M. How much fluid is consumed per day?

0.6 ± 0.3

0.9 ± 0.2

< 0.05

0.6 ± 0.4

0.8 ± 0.3

< 0.05

N. Mode of feeding

1.9 ± 0.4

2.0 ± 0.0

0.32

1.8 ± 0.6

2.0 ± 0.1

< 0.05

O. Self-assessment of nutritional status

1.6 ± 0.6

2.0 ± 0.2

< 0.05

1.4 ± 0.6

1.9 ± 0.3

< 0.05

P. In comparison with other people of the same age, how does the patient consider his/her health status?

1.6 ± 0.6

2.0 ± 0.2

< 0.05

0.4 ± 0.4

1.1 ± 0.7

< 0.05

Q. Mid-arm circumference in cm

0.8 ± 0.4

0.9 ± 0.2

0.06

0.9 ± 0.3

1.0 ± 0.1

0.38

R. Calf circumference in cm

0.7 ± 0.5

0.9 ± 0.4

0.11

0.8 ± 0.4

0.9 ± 0.2

< 0.05