Validity, reliability and feasibility of nutrition screening tools NRS-2002 and MST administered by trained medical doctors in routine practice

Although malnutrition is a common health and social care problem, there is no universal agreement about its definition, prevalence, or method of identification and report. Fifteen definitions of malnutrition were critically examined to assess their variability. They ranged from descriptions of undernutrition alone to under- and overnutrition, with intakes ranging from dietary protein and energy alone to dietary and nondietary sources of all nutrients and energy. Definitions also varied from non-outcome based to those based on functional, physiological, and/or clinical outcomes. Some definitions relied on the pathways by which malnutrition develops, with one apparently requiring loss of fat-free mass. Also examined were nutrition screening tools, diversely developed for detection of malnutrition, management of malnutrition, and prediction of clinical outcomes or health care usage. Their intended use also varied from specific care settings (hospital, community, care homes) to all settings and from specific age groups to all age groups. With all these definitions and tools, there is considerable scope for confusion and misunderstanding. Therefore, to clarify the burden and significance of malnutrition, guidelines for documenting it in routine practice and reporting it in scientific literature are provided.

Download Full-text

Studi komparasi beberapa metode skrining penilaian status gizi pada pasien dewasa rawat inap rumah sakit

Jurnal Gizi Klinik Indonesia ◽

10.22146/ijcn.22066 ◽

2017 ◽

Vol 14 (2) ◽

pp. 64 ◽

Cited By ~ 1

Author(s):

Rizki Andini ◽

Susetyowati Susetyowati ◽

Dian Caturini Sulistyoningrum

Keyword(s):

At Risk ◽

Screening Tool ◽

Risk Group ◽

Mean Difference ◽

Screening Tools ◽

Nutrition Screening ◽

Nrs 2002 ◽

The Mean ◽

Nutrition Screening Tool ◽

Not At Risk

Background: It is necessary to diagnose level of malnutrition in hospitalized patient to give optimal nutrition support. Many different nutrition screening assessment have been developed. In Indonesia, Simple Nutrition Screening Tool (SNST) that had been used in same hospital and the result was good enough in validity-realibility.Objective: To assessed that SNST were simple and practical nutrition screening tool for detecting level of malnutrition in different type of hospitalized patient.Method: Observational cross-sectional design with total of sampling two hundred and eighty seven adult patients from 2nd and 3rd class of surgical, internal, or neurology ward of RSUD Sleman. Independent variables are SNST, Nutritional Risk Screening (NRS) 2002, Malnutrition Screening Tool (MST), and Malnutrition Universal Screening Tool (MUST). Dependent variables are Subjective Global Assessment (SGA), body mass index (BMI), mid upper arm circumference (MUAC), and hemoglobin (Hb). Receive Operating Curve (ROC) were used for measuring validity of each screening tools. The proportion difference between at-risk group and not at-risk group was assessed by Chi-square test. The mean difference of BMI, MUAC, and Hb between both of group was assessed by independent sample t-test.Results: SNST has highest validity compared to NRS-2002, MST, and MUST with Sensitivity 99,0%, Specificity 84,5 and Area Under Curve (AUC) 0,917. Based on SNST, the proportion difference of at-risk group and not at-risk group between surgical patients and internal-neurology patients was statistically significant (p<0,05); the proportion difference of at-risk group and not at-risk group between young adult, adult, and elderly patients was statistically significant (p<0,05); the mean difference of BMI, MUAC, and Hb between at-risk group and not at-risk group was also statistically significant (p<0,05).Conclusion: All of the nutrition screening tools can be used as predictor of malnutrition in hospitalized patients but, the SNST has the best validity as a nutrition screening to predict malnutrition.

Download Full-text

Métodos de triagem nutricional em pacientes ginecológicas hospitalizadas

Abr-Jun - Braspen Journal ◽

10.37111/braspenj.2020354004 ◽

2021 ◽

Vol 4 (35) ◽

pp. 345-350

Author(s):

Amanda da Silva Paiva ◽

Larissa Gens Guilherme ◽

Maria Goretti Pessoa de Araújo Burgos

Keyword(s):

Public Health Problem ◽

The Elderly ◽

Screening Tools ◽

Nutritional Risk ◽

Cross Sectional ◽

Nutrition Screening ◽

Hospital Malnutrition ◽

Significant Public Health ◽

Nrs 2002 ◽

The Individual

Introduction: Hospital malnutrition is characterized as a significant public health problem, so nutrition screening stands out as a prior tool to identify the individual at nutritional risk or malnourished, enabling a more appropriate intervention. Methods: Cross-sectional descriptive study, where three nutritional screening tools were used: ASG, Nutritional Risk Screening-2002 (NRS-2002), Malnutrition Universal Screening Tool (MUST), applied in the first 48 hours of hospital admission by the same researcher. Results: 150 women aged 42,69 ±11,84 years (20 - 83 years) were evaluated, in adults the major diagnosis was myomatosis (70%) and elderly, gynecological malignancies (50%). Most adults did not have associated comorbidities (80%), while arterial hypertension was the most prevalent in the elderly (30%). MUST detected 41.3% nutritional risk, while NRS-2002 only 21.3%. Comparing the MUST and NRS-2002 with the ASG as gold standard, the greatest sensitivity occurred with the MUST (42.4%), Kappa 3,4%. Conclusion: MUST showed greater sensitivity to detect nutritional risk in this population and had significantly shorter application time.

Download Full-text

Nutrition screening tools and the prediction of postoperative infectious and wound complications: comparison of methods in presence of risk adjustment

Nutrition ◽

10.1016/j.nut.2004.10.015 ◽

2005 ◽

Vol 21 (6) ◽

pp. 691-697 ◽

Cited By ~ 39

Author(s):

Panwadee Putwatana ◽

Pinmanee Reodecha ◽

Yupapin Sirapo-ngam ◽

Panuwat Lertsithichai ◽

Kanit Sumboonnanonda

Keyword(s):

Risk Adjustment ◽

Screening Tools ◽

Wound Complications ◽

Comparison Of Methods ◽

Nutrition Screening

Download Full-text

Comparison of Malnutrition Screening Tools for Use in Hospitalized Older Adults (OR36-02-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz035.or36-02-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Cited By ~ 1

Author(s):

Rachel Deer ◽

Mackenzie McCall ◽

Elena Volpi

Keyword(s):

Older Adults ◽

Elderly Patients ◽

Screening Tool ◽

Screening Tools ◽

Good Sensitivity ◽

Predictive Values ◽

Hospitalized Elderly ◽

Nrs 2002 ◽

Hospitalized Elderly Patients ◽

Hospitalized Older Adults

Abstract Objectives Malnutrition is a common problem in geriatric patients that often goes unrecognized. Undernutrition is a primary health concern for older adults due to associations with increased mortality, complications, and length of hospital stay. Yet, there is no consensus on which malnutrition screening tool should be used for hospitalized older adults. Therefore, the objective of this study was to determine which screening tool is best to rapidly detect malnutrition in hospitalized older adults so that patient outcomes may be improved. Methods Older adult patients (n = 211; ≥65 yrs old) were enrolled during acute hospitalization. Testing occurring within 72 hours of admission and included the following screening tools included: Malnutrition Screening Tool (MST), Mini Nutritional Assessment Short Form (MNA-SF), Malnutrition Universal Screening Tool (MUST), Nutrition Risk Screening 2002 (NRS-2002), and Geriatric Nutritional Risk Index (GNRI). These screening tools were compared to a malnutrition diagnostic tool, the Subjective Global Assessment (SGA). Results According to SGA, 49% of patients were at risk of being malnourished. The other screening tools indicated a wide range of malnutrition prevalence, from 18% (MST) to 76% (MNA-SF). MST (93%) and MUST (92%) were highest in sensitivity. NRS-2002 had moderately good sensitivity (71%). MNA-SF and GNRI had poor sensitivity, eliminating them as good screening tools for hospitalized elderly patients. Of the remaining tools, NRS-2002 had the highest specificity (77%). MST and MUST had poor specificity (31%, 39%, respectively), eliminating them as good screening tools for hospitalized elderly patients. The remaining screening tool, NRS-2002, had moderately good positive and negative predictive values (76%, 72%, respectively). It also had the highest kappa (0.479). Overall, NRS-2002 had the best agreement to SGA and showed moderately good sensitivity, specificity and predictive values. Conclusions Our data suggests NRS-2002 is the best malnutrition screening tool for rapid detection of malnutrition in elderly hospitalized patients, when compared to the diagnostic tool, SGA. Future research is needed to determine which screening tool is most effective for use in different settings. Additional research can assist in standardizing malnutrition criteria and care processes. Funding Sources National Dairy Council, National Institutes of Health-National Center for Advancing Translational Sciences, and UTMB Claude D. Pepper OAIC. Supporting Tables, Images and/or Graphs

Download Full-text

Construct Validation of Three Nutrition Questions Using Health and Diet Ratings in Older Canadian Males Living in the Community

Canadian Journal of Dietetic Practice and Research ◽

10.3148/cjdpr-2015-025 ◽

2015 ◽

Vol 76 (4) ◽

pp. 194-199 ◽

Cited By ~ 4

Author(s):

Usman Akhtar ◽

Heather H. Keller ◽

Robert B. Tate ◽

Christina O. Lengyel

Keyword(s):

Health Status ◽

Construct Validity ◽

Successful Aging ◽

Perceived Health ◽

Community Dwelling ◽

Screening Tools ◽

Perceived Health Status ◽

Nutrition Survey ◽

Nutrition Screening ◽

Screen Ii

Brief nutrition screening tools are desired for research and practice. Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN-II, 14 items) and the abbreviated version SCREEN-II-AB (8 items) are valid and reliable nutrition screening tools for older adults. This exploratory study used a retrospective cross-sectional design to determine the construct validity of a subset of 3 items (weight loss, appetite, and swallowing difficulty) currently on the SCREEN-II and SCREEN-II-AB tools. Secondary data on community-dwelling senior males (n = 522, mean ± SD age = 86.7 ± 3.0 years) in the Manitoba Follow-up Study (MFUS) study were available for analysis. Participants completed the mailed MFUS Nutrition Survey that included SCREEN-II items and questions pertaining to self-rated health, diet healthiness, and rating of the importance of nutrition towards successful aging as the constructs for comparison. Self-perceived health status (F = 14.7, P < 0.001), diet healthiness (ρ = 0.17, P = 0.002) and the rating of nutrition's importance to aging (ρ = 0.10, P = 0.03) were correlated with the 3-item score. Inferences were consistent with associations between these construct variables and the full SCREEN-II. Three items from SCREEN-II and SCREEN-II-AB demonstrate initial construct validity with self-perceived health status and diet healthiness ratings by older males; further exploration for criterion and predictive validity in more diverse samples is needed.

Download Full-text

NUTRITION ASSESSMENT IN HIGH-RISK PATIENTS: NRS-2002, PG-SGA, AND NFPE IN OLDER ADULTS PREPARING FOR ELECTIVE SURGERY

Innovation in Aging ◽

10.1093/geroni/igz038.1442 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S392-S392

Author(s):

Kathryn N Porter Starr ◽

Kenlyn Young ◽

Shelley R McDonald ◽

Nancy Loyack ◽

Sandhya Sandhya Lagoo-Deenadayalan ◽

...

Keyword(s):

Older Adults ◽

High Risk ◽

Surgical Complications ◽

Elective Surgery ◽

Convincing Evidence ◽

Assessment Tools ◽

Nutrition Intervention ◽

High Risk Population ◽

Nutrition Screening ◽

Nrs 2002

Abstract Post-surgical complications are most common in older adults. While a number of factors contribute, one key determinant is malnutrition. Malnutrition is seen in up to 86% of older adults at hospital admission. Malnutrition and post-surgical complications are linked through two critical observations: 1) malnutrition dramatically reduces the ability of older adults to overcome postsurgical health stressors, and 2) nutritional status is likely to deteriorate further during hospitalization and after discharge. Despite convincing evidence that perioperative nutrition intervention can improve surgical outcomes, nutrition screening and assessment in the preoperative period is not required or standardized. We will review issues surrounding screening and assessment of malnutrition in older adults preparing for elective surgery and present data on screening (NRS-2002) and assessment tools (Nutrition Focused Physical Exam and PG-SGA) used in this high-risk population. Finally, we will discuss best practices for identifying and intervening with malnourished older adults in the preoperative setting.

Download Full-text

Nutritional Screening and Clinical Outcome in Hospitalized Patients with Crohn’s Disease

Annals of Nutrition and Metabolism ◽

10.1159/000485637 ◽

2017 ◽

Vol 71 (3-4) ◽

pp. 266-272 ◽

Cited By ~ 12

Author(s):

Azusa Takaoka ◽

Masaya Sasaki ◽

Naoko Nakanishi ◽

Mika Kurihara ◽

Akiko Ohi ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Nutritional Status ◽

Serum Albumin ◽

Intestinal Resection ◽

Hospitalized Patients ◽

Screening Tools ◽

Characteristic Analysis ◽

Nutritional Screening ◽

Nrs 2002

Background/Aims: Hospitalized patients with Crohn’s disease (CD) can develop severe nutritional deficits. However, the nutritional screening tools with the most utility for such patients are still unknown. Methods: Nutritional status of 40 CD patients was assessed on admission using several screening tools and laboratory tests. Their validity was evaluated in relation to length of hospital stay (LOS) and intestinal resection. Receiver operating characteristic analysis was performed to predict prolonged LOS (≥28 days). Results: Prolonged LOS was correlated with each of the following screening parameters: Subjective Global Assessment, Nutrition Risk Screening 2002 (NRS 2002), Onodera’s Prognostic Nutritional Index (O-PNI), Controlling Nutritional Status, serum albumin level, and weight loss. These parameters were not correlated with intestinal resection. Evaluation of prognostic yield showed cutoff values of serum albumin 3.3 g/dL (AUC 0.797, sensitivity 57.1%, specificity 89.5%) and O-PNI 36.5 (0.749, 71.4%, 73.7%). By combining the serum albumin cutoff value and NRS 2002 score, patients were divided into 4 groups, with a prolonged LOS rate of 68.2% in the group with the worst prognosis. Conclusions: A combination of serum albumin (given the simplicity of testing) and NRS 2002 as nutritional screening tools may be useful for hospitalized CD patients.

Download Full-text