Malnutrition screening tools: Comparison against two validated nutrition assessment methods in older medical inpatients

Adrienne M Young, Sarah Kidston, Merrilyn D Banks, Alison M Mudge, Elisabeth A Isenring

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Abstract

OBJECTIVE: Although several validated nutritional screening tools have been developed to "triage" inpatients for malnutrition diagnosis and intervention, there continues to be debate in the literature as to which tool/tools clinicians should use in practice. This study compared the accuracy of seven validated screening tools in older medical inpatients against two validated nutritional assessment methods.

METHODS: This was a prospective cohort study of medical inpatients at least 65 y old. Malnutrition screening was conducted using seven tools recommended in evidence-based guidelines. Nutritional status was assessed by an accredited practicing dietitian using the Subjective Global Assessment (SGA) and the Mini-Nutritional Assessment (MNA). Energy intake was observed on a single day during first week of hospitalization.

RESULTS: In this sample of 134 participants (80 ± 8 y old, 50% women), there was fair agreement between the SGA and MNA (κ = 0.53), with MNA identifying more "at-risk" patients and the SGA better identifying existing malnutrition. Most tools were accurate in identifying patients with malnutrition as determined by the SGA, in particular the Malnutrition Screening Tool and the Nutritional Risk Screening 2002. The MNA Short Form was most accurate at identifying nutritional risk according to the MNA. No tool accurately predicted patients with inadequate energy intake in the hospital.

CONCLUSION: Because all tools generally performed well, clinicians should consider choosing a screening tool that best aligns with their chosen nutritional assessment and is easiest to implement in practice. This study confirmed the importance of rescreening and monitoring food intake to allow the early identification and prevention of nutritional decline in patients with a poor intake during hospitalization.

Original languageEnglish
Pages (from-to)101-6
Number of pages6
JournalNutrition
Volume29
Issue number1
DOIs
Publication statusPublished - Jan 2013
Externally publishedYes

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Nutrition Assessment
Malnutrition
Inpatients
Energy Intake
Hospitalization
Nutritionists
Triage
Nutritional Status
Cohort Studies
Eating
Prospective Studies
Guidelines

Cite this

Young, Adrienne M ; Kidston, Sarah ; Banks, Merrilyn D ; Mudge, Alison M ; Isenring, Elisabeth A. / Malnutrition screening tools : Comparison against two validated nutrition assessment methods in older medical inpatients. In: Nutrition. 2013 ; Vol. 29, No. 1. pp. 101-6.
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Malnutrition screening tools : Comparison against two validated nutrition assessment methods in older medical inpatients. / Young, Adrienne M; Kidston, Sarah; Banks, Merrilyn D; Mudge, Alison M; Isenring, Elisabeth A.

In: Nutrition, Vol. 29, No. 1, 01.2013, p. 101-6.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Young, Adrienne M

AU - Kidston, Sarah

AU - Banks, Merrilyn D

AU - Mudge, Alison M

AU - Isenring, Elisabeth A

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N2 - OBJECTIVE: Although several validated nutritional screening tools have been developed to "triage" inpatients for malnutrition diagnosis and intervention, there continues to be debate in the literature as to which tool/tools clinicians should use in practice. This study compared the accuracy of seven validated screening tools in older medical inpatients against two validated nutritional assessment methods.METHODS: This was a prospective cohort study of medical inpatients at least 65 y old. Malnutrition screening was conducted using seven tools recommended in evidence-based guidelines. Nutritional status was assessed by an accredited practicing dietitian using the Subjective Global Assessment (SGA) and the Mini-Nutritional Assessment (MNA). Energy intake was observed on a single day during first week of hospitalization.RESULTS: In this sample of 134 participants (80 ± 8 y old, 50% women), there was fair agreement between the SGA and MNA (κ = 0.53), with MNA identifying more "at-risk" patients and the SGA better identifying existing malnutrition. Most tools were accurate in identifying patients with malnutrition as determined by the SGA, in particular the Malnutrition Screening Tool and the Nutritional Risk Screening 2002. The MNA Short Form was most accurate at identifying nutritional risk according to the MNA. No tool accurately predicted patients with inadequate energy intake in the hospital.CONCLUSION: Because all tools generally performed well, clinicians should consider choosing a screening tool that best aligns with their chosen nutritional assessment and is easiest to implement in practice. This study confirmed the importance of rescreening and monitoring food intake to allow the early identification and prevention of nutritional decline in patients with a poor intake during hospitalization.

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JF - Nutrition International

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