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Protein, malnutrition and wasting diseases

Concurrent and predictive evaluation of malnutrition diagnostic measures in hip fracture inpatients: a diagnostic accuracy study

European Journal of Clinical Nutrition volume 68, pages 358–362 (2014)Cite this article

Subjects

Abstract

Background/Objectives:

Differences in malnutrition diagnostic measures impact malnutrition prevalence and outcomes data in hip fracture. This study investigated the concurrent and predictive validity of commonly reported malnutrition diagnostic measures in patients admitted to a metropolitan hospital acute hip fracture unit.

Subjects/Methods:

A prospective, consecutive level II diagnostic accuracy study (n=142; 8 exclusions) including the International Classification of Disease, 10th Revision, Australian Modification (ICD10-AM) protein-energy malnutrition criteria, a body mass index (BMI) <18.5 kg/m2, the Mini-Nutrition Assessment Short-Form (MNA-SF), pre-operative albumin and geriatrician individualised assessment.

Results:

Patients were predominantly elderly (median age 83.5, range 50–100 years), female (68%), multimorbid (median five comorbidities), with 15% 4-month mortality. Malnutrition prevalence was lowest when assessed by BMI (13%), followed by MNA-SF (27%), ICD10-AM (48%), albumin (53%) and geriatrician assessment (55%). Agreement between measures was highest between ICD10-AM and geriatrician assessment (κ=0.61) followed by ICD10-AM and MNA-SF measures (κ=0.34). ICD10-AM diagnosed malnutrition was the only measure associated with 48-h mobilisation (35.0 vs 55.3%; P=0.018). Reduced likelihood of home discharge was predicted by ICD-10-AM (20.6 vs 57.1%; P=0.001) and MNA-SF (18.8 vs 47.8%; P=0.035). Bivariate analysis demonstrated ICD10-AM (relative risk (RR)1.2; 1.05–1.42) and MNA-SF (RR1.2; 1.0–1.5) predicted 4-month mortality. When adjusted for age, usual place of residency, comorbidities and time to surgery only ICD-10AM criteria predicted mortality (odds ratio 3.59; 1.10–11.77). Albumin, BMI and geriatrician assessment demonstrated limited concurrent and predictive validity.

Conclusions:

Malnutrition prevalence in hip fracture varies substantially depending on the diagnostic measure applied. ICD-10AM criteria or the MNA-SF should be considered for the diagnosis of protein-energy malnutrition in frail, multi-morbid hip fracture inpatients.

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Acknowledgements

This project was funded in part by a novice researcher’s grant from The Prince Charles Hospital Foundation. We thank members of the NOFEAR (Neck of Femur Education and Research) collaborative and all members of the multidisciplinary team for your dedication to patient care.

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Authors and Affiliations

  1. Department of Nutrition and Dietetics, The Prince Charles Hospital, Queensland Health, Brisbane, Queensland, Australia

    J J Bell & R C Pulle

  2. Centre for Dietetic Research, School of Human Movement Studies, University of Queensland, Brisbane, Queensland, Australia

    J J Bell, J D Bauer & S Capra

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  1. J J Bell
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  2. J D Bauer
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  3. S Capra
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  4. R C Pulle
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Correspondence to J J Bell.

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Author contributions

JJB was the chief investigator primarily responsible for study conception and design, data analysis with the assistance of a statistician and drafting of the manuscript. JDB assisted with study design and data interpretation and assisted with manuscript revision. SC assisted in developing the study design and data interpretation. CP contributed to study design, data acquisition and interpretation. All authors reviewed and approved the final manuscript.

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Bell, J., Bauer, J., Capra, S. et al. Concurrent and predictive evaluation of malnutrition diagnostic measures in hip fracture inpatients: a diagnostic accuracy study. Eur J Clin Nutr 68, 358–362 (2014). https://doi.org/10.1038/ejcn.2013.276

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