A systematic review and meta-analysis of the criterion validity of nutrition assessment tools for diagnosing protein-energy malnutrition in the older community setting

Background: Accurate diagnosis is a key step in managing protein-energy malnutrition. This review seeks to determine the criterion (concurrent and predictive) validity and reliability of nutrition assessment tools in making a diagnosis of proteinenergy malnutrition in community-living older adults. Methods: A systematic literature review was undertaken using six electronic databases in September 2016. Studies in any language were included which measured malnutrition via a nutrition assessment tool in adults ≥65 years living in their own homes. Data relating to the predictive validity of tools were analysed via meta-analyses. GRADE was used to evaluate the body of evidence. Results: There were 6,412 records identified, of which eight papers were included. Two studies evaluated the concurrent validity of the Mini Nutritional Assessment (MNA) and Subjective Global Assessment (SGA) and six evaluated the predictive validity of the MNA. The quality of the body of evidence for the concurrent validity of both the MNA and SGA was very low. The quality of the body of evidence for the predictive validity of the MNA in detecting risk of death was moderate (RR: 1.92 [95%CI: 1.55-2.39]; P<0.00001; n=2,013 participants; n=4 studies; I2: 0%). The quality of the body of evidence for the predictive validity of the MNA in detecting risk of poor physical function was very low (SMD: 1.02 [95%CI: 0.24-1.80]; P=0.01; n=4,046 participants; n=3 studies; I2:89%). Conclusions: Due to the small number of studies identified and no evaluation of the predictive validity of tools other than the MNA, there is insufficient evidence to recommend a particular nutrition assessment tool for diagnosing protein-energy malnutrition in older adults in the community setting. High quality diagnostic accuracy studies are needed for all nutrition assessment tools used in older community samples, including measuring of health outcomes subsequent to nutrition assessment by the SGA and PG-SGA.