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Clinical nutrition, enteral and parenteral nutrition

Validity of nutritional screening with MUST and SNAQ in hospital outpatients

European Journal of Clinical Nutrition volume 67, pages 738–742 (2013)Cite this article

Subjects

Abstract

Background/Objectives:

The majority of hospital outpatients with undernutrition is unrecognized, and therefore untreated. There is a need for an easy and valid screening tool to detect undernutrition in this setting. The aim of this study was to determine the diagnostic accuracy of the MUST (Malnutrition Universal Screening Tool) and SNAQ (Short Nutritional Assessment Questionnaire) tools for undernutrition screening in hospital outpatients.

Methods:

In a large multicenter-hospital-outpatient population, patients were classified as: severely undernourished (body mass index (BMI) <18.5 (<65 years) or <20 (⩾65 years) and/or unintentional weight loss >5% in the last month or >10% in the last 6 months), moderately undernourished (BMI 18.5–20 (<65 years) or 20–22 (⩾65 years) and/or 5–10% unintentional weight loss in the last 6 months) or not undernourished. Diagnostic accuracy of the screening tools versus the reference method was expressed as sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV).

Results:

Out of the 2236 outpatients, 6% were severely and 7% were moderately undernourished according to the reference method. MUST and SNAQ identified 9% and 3% as severely undernourished, respectively. MUST had a low PPV (Se=75, Sp=95, PPV=43, NPV=98), whereas SNAQ had a low Se (Se=43, Sp=99, PPV=78, NPV=96).

Conclusions:

The validity of MUST and SNAQ is insufficient for hospital outpatients. While SNAQ identifies too few patients as undernourished, MUST identifies too many patients as undernourished. We advise to measure body weight, height and weight loss, in order to define undernutrition in hospital outpatients.

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Acknowledgements

We are grateful to Myriam van Zandvoort for her input in the study design. We also want to thank the dieticians, administrative personnel, research assistants and patients of the participating hospitals for their cooperation: Amphia Hospital (Breda/Oosterhout), Canisius Wilhelmina Hospital (Nijmegen), Catharina Hospital (Eindhoven), Gelderse Vallei Hospital (Ede), Haga Hospital (The Hague), Maasstad Hospital (Rotterdam), Martini Hospital (Groningen), Máxima Medical Center (Veldhoven), VU University Medical Center (Amsterdam).

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Authors and Affiliations

  1. Dutch Malnutrition Steering Group, Amsterdam, The Netherlands

    E Leistra, J A E Langius, A M Evers, M A E van Bokhorst-de van der Schueren, M Visser & H M Kruizenga

  2. Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands

    E Leistra, J A E Langius, M A E van Bokhorst-de van der Schueren & H M Kruizenga

  3. EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands

    E Leistra, M A E van Bokhorst-de van der Schueren, M Visser, H C W de Vet & H M Kruizenga

  4. Dutch Dietetic Association, Houten, The Netherlands

    A M Evers

  5. Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands

    M Visser & H M Kruizenga

  6. Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands

    M Visser & H C W de Vet

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  1. E Leistra
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  2. J A E Langius
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  3. A M Evers
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  4. M A E van Bokhorst-de van der Schueren
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  5. M Visser
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  6. H C W de Vet
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  7. H M Kruizenga
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Correspondence to E Leistra.

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The authors declare no conflict of interest.

Additional information

Contributors: EL, HK and AE designed the study. EL performed data collection, statistical analysis and drafted the manuscript. HK, JL, MB, MV and HV had significant advice concerning interpretation of the results and critical review of the manuscript. All authors have read and approved the final manuscript.

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Leistra, E., Langius, J., Evers, A. et al. Validity of nutritional screening with MUST and SNAQ in hospital outpatients. Eur J Clin Nutr 67, 738–742 (2013). https://doi.org/10.1038/ejcn.2013.85

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