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Comparison of four nutritional screening tools to detect nutritional risk in hospitalized patients: a multicentre study

European Journal of Clinical Nutrition volume 65, pages 269–274 (2011)Cite this article

Subjects

Abstract

Background/Objectives:

The prevalence of malnutrition in hospitals is high. No nutritional screening tool is considered the gold standard for identifying nutritional risk. The aims of this study were to evaluate nutritional risk in hospitalized patients using four nutritional screening tools.

Subjects/Methods:

Four nutritional screening tools were evaluated: nutritional risk screening (NRS-2002), the malnutrition universal screening tool (MUST), the subjective global assessment (SGA) and the mini nutritional assessment (MNA). Patients were assessed within the first 36 h after hospital admission. Date of admission, diagnosis, complications and date of discharge were collected. To compare the tools, the results were reorganized into: patients at risk and patients with a good nutritional status. The statistical analysis included the χ2-test to assess differences between the tests and the κ statistic to assess agreement between the tests.

Results:

The study sample comprised 400 patients (159 women, 241 men), mean age 67.3 (16.1) years. The prevalence of patients at nutritional risk with the NRS-2002, MUST, SGA and MNA was 34.5, 31.5, 35.3 and 58.5%, respectively. Statistically significant differences were observed between the four nutritional screening tools (P<0.001). The agreement between the tools was quite good except for the MNA (MNA–SGA κ=0.491, NRS-2002–SGA κ=0.620 and MUST–SGA κ=0.635). Patients at nutritional risk developed more complications during admission and had an increased length of stay.

Conclusions:

The prevalence of nutritional risk in hospitalized patients was high with all the tools used. The best agreement between the tools was for NRS-2002 with SGA and MUST with SGA. At admission, NRS-2002 and MUST should be used to screen for nutritional status.

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References

  • Anthony PS (2008). Nutrition screening tools for hospitalized patients. Nutr Clin Pract 23, 373–382.

    Article  PubMed  Google Scholar 

  • Bauer JM, Vogl T, Wicklein S, Trögner J, Mühlberg W, Sieber CC (2005). Comparison of the Mini Nutritional Assessment, Subjective Global Assessment, and Nutritional Risk Screening (NRS 2002) for nutritional screening and assessment in geriatric hospital patients. Z Gerontol Geriat 38, 322–327.

    Article  CAS  Google Scholar 

  • Bruun LI, Bosaeus I, Bergstad I, Nygaard K (1999). Prevalence of malnutrition in surgical patients: evaluation of nutritional support and documentation. Clin Nutr 18, 141–147.

    Article  CAS  PubMed  Google Scholar 

  • Buzby GP, Knox LS, Crosby LO, Eisenberg JM, Haakenson CM, McNeal GE et al. (1988). Study protocol: a randomized clinical trial of total parenteral nutrition in malnourished surgical patients. Am J Clin Nutr 47, 366–381.

    Article  CAS  PubMed  Google Scholar 

  • Cereceda C, González I, Antolín FM, García Figueiras P, Tarrazo Espiñeira R, Suárez Cuesta B et al. (2003). Detection of malnutrition on admission to hospital. Nutr Hosp 28, 95–100.

    Google Scholar 

  • Council of Europe. Committee of Ministers (2003). Resolution ResAP(2003)3 on food and nutritional care in hospitals. Available at https://wcd.coe.int/ViewDoc.jsp?id=85747.

  • de Luis D, Lopez Guzman A, Nutrition Group of Society of Castilla-Leon (Endocrinology, Diabetes and Nutrition) (2006). Nutritional status of adult patients admitted to internal medicine departments in public hospitals in Castilla Leon, Spain. A multi-center study. Eur J Intern Med 17, 556–560.

    Article  PubMed  Google Scholar 

  • Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whitwell J, Mendelson RA et al. (1987). What is subjective global assessment of nutritional status? JPEN 11, 8–13.

    Article  CAS  Google Scholar 

  • Dupertuis YM, Kossovsky MP, Kyle UG, Raguso CA, Genton L, Pichard C (2003). Food intake in 1707 hospitalised patients: a prospective comprehensive hospital survey. Clin Nutr 22, 115–123.

    Article  CAS  PubMed  Google Scholar 

  • Edington J, Boorman J, Durrant ER, Perkins A, Giffin CV, James R et al. (2000). Prevalence of malnutrition on admission to four hospitals in England. The malnutrition prevalence group. Clin Nutr 19, 191–195.

    Article  CAS  PubMed  Google Scholar 

  • Elia M, Zellipour L, Stratton RJ (2005). To screen or not to screen for adult malnutrition? Clin Nutr 24, 867–884.

    Article  CAS  PubMed  Google Scholar 

  • Gaynes RP, Horan TC (1999). Surveillance of nosocomial infections. In: Mayhall CG (ed). Hospital Epidemiology and Infection Control. Lippincott Williams & Wilkins: Philadelphia, pp 1285–1317.

    Google Scholar 

  • Green SM, Watson R (2005). Nutritional screening and assessment tools for use by nurses: literature review. J Adv Nurs 50, 69–83.

    Article  PubMed  Google Scholar 

  • Green SM, Watson R (2006). Nutritional screening and assessment tools for older adults: literature review. J Adv Nurs 54, 477–490.

    Article  PubMed  Google Scholar 

  • Kondrup J, Allison SP, Elia M, Vellas B, Plauth M (2003). ESPEN guidelines for nutrition screening 2002. Clin Nutr 22, 415–421.

    Article  CAS  PubMed  Google Scholar 

  • Kondrup J, Johansen N, Plum LM, Bak L, Larsen IH, Martinsen A et al. (2002). Incidence of nutritional risk and causes of inadequate nutritional care in hospitals. Clin Nutr 21, 461–468.

    Article  CAS  PubMed  Google Scholar 

  • Kruizenga HM, Van Tulder MW, Seidell JC, Thijs A, Ader HJ, Van Bokhorst-de van der Schueren MA (2005). Effectiveness and cost-effectiveness of early screening and treatment of malnourished patients. Am J Clin Nutr 82, 1082–1089.

    Article  CAS  PubMed  Google Scholar 

  • Kyle UG, Kossovsky MP, Karsegard VL, Pichard C (2006). Comparison of tools for nutritional assessment and screening at hospital admission: a population study. Clin Nutr 25, 409–417.

    Article  PubMed  Google Scholar 

  • Lobo G, Ruíz MD, Pérez de la Cruz AJ (2009). Hospital malnutrition: relation between the hospital length of stay and the rate of early readmissions. Med Clin (Barc) 132, 377–384.

    Article  Google Scholar 

  • Malnutrition Advisory Group (MAG) (2000). MAG—Guidelines for Detection and Management of Malnutrition. British Association for Parenteral and Enteral Nutrition: Redditch, UK.

  • Norman K, Pichard C, Lochs H, Pirlich M (2008). Prognostic impact of disease-related malnutrition. Clin Nutr 27, 5–15.

    Article  PubMed  Google Scholar 

  • Odelli C, Burgess D, Bateman L, Hughes A, Ackland S, Gillies J et al. (2005). Nutrition support improves patient outcomes, treatment tolerance and admission characteristics in oesophageal cancer. Clin Oncol (R Coll Radiol) 17, 639–645.

    Article  CAS  Google Scholar 

  • O'Flynn J, Peake H, Hickson M, Foster D, Frost G (2005). The prevalence of malnutrition in hospitals can be reduced: results from three consecutive cross-sectional studies. Clin Nutr 24, 1078–1088.

    Article  PubMed  Google Scholar 

  • Ozkalkanli MY, Ozkalkanli DT, Katircioglu K, Savaci S (2009). Comparison of tools for nutrition assessment and screening for predicting the development of complications in orthopaedic surgery. Nutr Clin Pract 24, 274–280.

    Article  PubMed  Google Scholar 

  • Shrout PE (1998). Measurement reliability and agreement in psychiatry. Stat Methods Med Res 33, 159.

    Google Scholar 

  • Sorensen J, Kondrup J, Prokopowicz J, Schiesser M, Krähenbühl L, Meier R et al. (2008). EuroOOPS: an international, multicentre study to implement nutritional risk screening and evaluate clinical outcome. Clin Nutr 27, 340–349.

    Article  PubMed  Google Scholar 

  • Stanga Z, Field J, Iff S, Stucki A, Lobo DN, Allison SP (2007). The effect of nutritional management on the mood of malnourished patients. Clin Nutr 26, 379–382.

    Article  PubMed  Google Scholar 

  • STAT 509. Design and Analysis of Clinical Trials. http://www.stat.psu.edu/online/courses/stat509/18_agree/08_agree_cohen.htm.

  • Valero MA, Díez L, El Kadaoui N, Jiménez AE, Rodríguez H, León M (2005). Are the tools recommended by ASPEN and ESPEN comparable for assessing the nutritional status? Nutr Hosp 20, 259–267.

    PubMed  Google Scholar 

  • van Bokhorst-de van der Schueren MA, Klinkenberg M, Thije A (2004). Profile of the malnourished patient. Eur J Clin Nutr 59, 1129–1135.

    Article  Google Scholar 

  • Vellas B, Guigoz Y, Garry PJ, Nourhashemi F, Bennahum D, Lauque S et al. (1999). The mini nutritional assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition 15, 116–122.

    Article  CAS  PubMed  Google Scholar 

  • Vidal A, Iglesias MJ, Pertega S, Ayúcar A, Vidal O (2008). Prevalence of malnutrition in medical and surgical wards of a university hospital. Nutr Hosp 23, 263–267.

    CAS  PubMed  Google Scholar 

  • Waitzberg DL, Caiaffa WT, Correia MI (2001). Hospital malnutrition: the Brazilian national survey (IBRANUTRI): a study of 4000 patients. Nutrition 17, 573–580.

    Article  CAS  PubMed  Google Scholar 

  • World Health Organization. Screening and Early Detection of Cancer. http://www.who.int/cancer/detection/en

Download references

Acknowledgements

The authors are grateful to Thomas O'Boyle for editorial assistance. The study was performed without funding.

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Authors and Affiliations

  1. Nutrition Unit, HGU Gregorio Marañon, Madrid, Spain

    C Velasco, L Frias & P García-Peris

  2. Nutrition Unit, HGU Doce de Octubre, Madrid, Spain

    E García & M León

  3. Endocrinology and Nutrition Department, HGU Principe de Asturias, Alcalá de Henares, Spain

    V Rodríguez, R Garriga & J Álvarez

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  1. C Velasco
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  2. E García
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  3. V Rodríguez
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  4. L Frias
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  6. J Álvarez
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  7. P García-Peris
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  8. M León
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Correspondence to C Velasco.

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Velasco, C., García, E., Rodríguez, V. et al. Comparison of four nutritional screening tools to detect nutritional risk in hospitalized patients: a multicentre study. Eur J Clin Nutr 65, 269–274 (2011). https://doi.org/10.1038/ejcn.2010.243

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