Elsevier

Nutrition

Volume 21, Issue 6, June 2005, Pages 659-665
Nutrition

Applied nutritional investigation
Simple two-part tool for screening of malnutrition

https://doi.org/10.1016/j.nut.2004.10.016Get rights and content

Abstract

Objective

Malnutrition in hospitalized patients is a major problem that is underdiagnosed. Early recognition of malnutrition is important for nutritional support to be effective. Our aims were to determine the malnutrition rate at our center and to devise an effective screening tool for identifying patients at risk for malnutrition.

Methods

This prospective study included 2211 patients. Each subject was assessed for malnutrition by the Subjective Global Assessment (SGA), and combination criteria (CC), which included anthropometric measurements and laboratory testing. Findings based on these methods were compared with findings in a series of malnutrition screening tests (malnutrition screening tool, self-assessment portion of a mini-nutritional assessment, a question about unintentional weight loss, evaluation of loss of subcutaneous fat, and various combinations of these).

Results

The SGA and CC methods identified 242 (11.0%) and 345 (15.6%) patients as malnourished, respectively. Of the screening methods that were tested, the combination of unintentional weight loss and loss of subcutaneous fat proved to be the most valuable, with 93% accuracy for predicting malnutrition according to the SGA, and 82.9% accuracy for predicting malnutrition according to CC. The corresponding negative predictive values were 95.5% and 87.3%.

Conclusions

The results show that this simple two-part nutritional screening tool (unintentional weight loss and loss of subcutaneous fat) is valuable for identifying malnutrition according to the SGA and CC at our institution; however, its validity must be confirmed at other centers.

Introduction

Undernutrition in hospitalized patients is a major worldwide problem that is estimated to affect 20% to 60% of recently admitted inpatients [1], [2], [3]. This condition is frequently overlooked and is therefore under-reported. Fewer than 20% of malnourished patients have any information about nutritional status on their medical charts [2]. Further, the severity of malnutrition usually increases as hospital stay is prolonged [2]. Early recognition of malnutrition, preferably at admission, is the most important step toward instituting nutritional support in a timely manner and optimizing outcome.

Unfortunately, the nutritional assessment methods currently available are not ideal for detecting patients at risk. Moreover, they tend to be time consuming, expensive, and often require highly trained personnel, so assessment of every hospitalized patient is not feasible. The ability to screen for malnutrition with simple, reliable tools used by non-specialized personnel would decrease the workload of the nutritional support team without compromising patient safety. Patients identified as being at risk could then be assessed by conventional methods.

In this study, we used proven nutritional assessment methods to determine the prevalence of malnutrition in patients recently admitted to our hospital. We then tested the validity of five screening tests: a recently developed Malnutrition Screening Tool (MST) [4], the self-assessment portion of the Mini-Nutritional Assessment (MNA) [5], unintentional weight loss (UWL), loss of subcutaneous fat (LSF), and a combination of UWL and LSF.

Section snippets

Power analysis

Based on reports in the literature, the rate of hospital malnutrition is approximately 35% [1], [2], [3]. With a β-value of 0.90 and a P value of 0.05, the sample size required to identify a difference of 10% from this value (i.e., <3.5% or >3.5%) is 1911. We also factored in a dropout rate of 20%; therefore, our target sample size was approximately 2300. We predicted that a maximum of 10 patients per working day could be assessed for malnutrition with the Subjective Global Assessment (SGA) and

Descriptive data

A total of 2211 patients (48.8% male and 51.2% female) was assessed during the study period. Mean age ± standard deviation of patients was 54.3 ± 14.8 y. Of all admissions, 604 (27.3%) were emergency cases. Although 2032 patients (91.9%) were from urban areas, 1888 (85.4%) were from low-income households (<$360 U.S./mo). Three hundred forty-eight patients (15.7%) had one systemic disease, and 65 (2.9%) had at least two systemic diseases. One hundred three cases (4.7%) involved a malignancy. One

Discussion

The prevalence of hospital malnutrition is alarmingly high. Even in industrialized countries, reported rates are 20% to 60% [1], [2], [3]. Malnutrition increases hospital morbidity and mortality rates and places an immense burden on financial resources [9], [10]. The literature indicates that this problem accounts for 40% to 70% of total hospital days Although malnutrition is reported to exist in epidemic proportions and is regarded as the most common disability in hospitalized patients by some

References (15)

There are more references available in the full text version of this article.

Cited by (46)

  • Reprint of: Position of the Academy of Nutrition and Dietetics: Malnutrition (Undernutrition) Screening Tools for All Adults

    2022, Journal of the Academy of Nutrition and Dietetics
    Citation Excerpt :

    Ferguson and colleagues6 developed the MST to detect malnutrition or risk for malnutrition. Between 1999 and 2017, the MST was validated in acute, long-term, rehabilitation, and ambulatory care and oncology clinics in at least nine different countries.15-33 These studies revealed that the MST exhibited a moderate degree of validity, a moderate degree of agreement, and a moderate degree of inter-rater reliability in identifying malnutrition risk in adults (Figure 2).

  • Adult Malnutrition (Undernutrition) Screening: An Evidence Analysis Center Systematic Review

    2020, Journal of the Academy of Nutrition and Dietetics
    Citation Excerpt :

    Study participants with various medical conditions ranged in age from 45.2±13.733 to 84±9 years.30 Ten studies were conducted in the hospital,14,26,32,34-38,41,42 two in long-term care,30,31 and seven in ambulatory settings.24,25,27-29,39,40 One study33 was conducted in both hospital and ambulatory settings, but data were not separated by setting.

View all citing articles on Scopus

Başkent University and its official organ, the research committee, sponsored this study.

View full text