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Open AccessArticle

The Simplified Nutritional Appetite Questionnaire (SNAQ) as a Screening Tool for Risk of Malnutrition: Optimal Cutoff, Factor Structure, and Validation in Healthy Community-Dwelling Older Adults

1
Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore
2
Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore 308433, Singapore
3
Department of Continuing and Community Care, Tan Tock Seng Hospital, Singapore 308433, Singapore
4
Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
5
Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, 20122 Milan, Italy
*
Author to whom correspondence should be addressed.
Nutrients 2020, 12(9), 2885; https://doi.org/10.3390/nu12092885
Received: 29 August 2020 / Revised: 17 September 2020 / Accepted: 18 September 2020 / Published: 21 September 2020
(This article belongs to the Special Issue Nutrients Requirements and Muscle Mass in Older Persons)
Malnutrition is an independent marker of adverse outcomes in older adults. While the Simplified Nutritional Appetite Questionnaire (SNAQ) for anorexia has been validated as a nutritional screening tool, its optimal cutoff and validity in healthy older adults is unclear. This study aims to determine the optimal cutoff for SNAQ in healthy community-dwelling older adults, and to examine its factor structure and validity. We studied 230 community-dwelling older adults (mean age 67.2 years) who were nonfrail (defined by Fatigue, Resistance, Ambulation, Illnesses & Loss (FRAIL) criteria). When compared against the risk of malnutrition using the Mini Nutritional Assessment (MNA), the optimal cutoff for SNAQ was ≤15 (area under receiver operating characteristic (ROC) curve: 0.706, sensitivity: 69.2%, specificity: 61.3%). Using exploratory factor analysis, we found a two-factor structure (Factor 1: Appetite Perception; Factor 2: Satiety and Intake) which accounted for 61.5% variance. SNAQ showed good convergent, discriminant and concurrent validity. In logistic regression adjusted for age, gender, education and MNA, SNAQ ≤15 was significantly associated with social frailty, unlike SNAQ ≤4 (odds ratio (OR) 1.99, p = 0.025 vs. OR 1.05, p = 0.890). Our study validates a higher cutoff of ≤15 to increase sensitivity of SNAQ for anorexia detection as a marker of malnutrition risk in healthy community-dwelling older adults, and explicates a novel two-factor structure which warrants further research. View Full-Text
Keywords: malnutrition; anorexia; older adults; cutoff; factor structure; validity malnutrition; anorexia; older adults; cutoff; factor structure; validity
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MDPI and ACS Style

Lau, S.; Pek, K.; Chew, J.; Lim, J.P.; Ismail, N.H.; Ding, Y.Y.; Cesari, M.; Lim, W.S. The Simplified Nutritional Appetite Questionnaire (SNAQ) as a Screening Tool for Risk of Malnutrition: Optimal Cutoff, Factor Structure, and Validation in Healthy Community-Dwelling Older Adults. Nutrients 2020, 12, 2885.

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