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Protein, malnutrition and wasting disorders

Validity of four nutritional screening tools against subjective global assessment for inpatient adults in a low-middle income country in Asia

European Journal of Clinical Nutrition volume 72, pages 979–985 (2018)Cite this article

Subjects

Abstract

Background/objectives

Hospital malnutrition is a common problem worldwide. This study aims to assess the validity of widely used nutritional screening tools for hospitalized adults in acute care settings in Ho Chi Minh City, Vietnam.

Subjects/methods

Participants in this study were 693 adult patients from six general public hospitals, in a multi-center survey undertaken in April and May, 2016. The criterion validity of the Malnutrition Screening Tool (MST), Malnutrition Universal Screening Tool (MUST), Nutrition Risk Screening (NRS-2002) and Mini Nutrition Assessment—Short Form (MNA-SF), modified MST (MST combined with low BMI), and BMI as independent tools were assessed using Subjective Global Assessment (SGA) or low BMI (<18.5 kg/m2) as the reference method. Area under curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using the ROC curve method to determine the validity of screening tools.

Results

NRS-2002, modified MST (MST + low BMI), MUST, and BMI at 21 kg/m2 showed moderate/fair validity compared to the reference method (SGA or BMI). MST alone and MNA-SF showed poor validity due to low sensitivity (41.8 and 35.0% for MST and MNA-SF, respectively).

Conclusions

Based on specificity and sensitivity, the first choice for the most appropriate screening tool for use in Vietnam is the NRS-2002, following by the MST + BMI, MUST, and BMI alone at the cut-off value of 21 kg/m2. Further investigation on the feasibility and acceptability are required to determine the most appropriate screening tools for use within the Vietnamese context.

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Acknowledgements

We would like to thank (1) Staff of Department of Nutrition and Dietetics from six participating hospitals, and staff from Nutrition Centre Ho Chi Minh City for their time and effort in helping collect data for this study; (2) statisticians Edward Gosden for his statistical advices; (3) Dr. Ekta Agarwal for her advices on the development of a protocol at an early stage. TQC was supported by an Australia Award PhD scholarship.

Author contribution

This study was done as part of PhD project of TQC and was supervised by DG, MHJ, MB, and DTND. The Project was planned and designed by TQC, DG, MB, MHJ, and DTND. Data was collected, analyzed by TQC. The original manuscript was written by TQC and then all authors participating in editing and revision. All authors have read and approved the final manuscript.

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Authors and Affiliations

  1. School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia

    Quoc Cuong Tran, Merrilyn Banks, Mary Hannan-Jones, Thi Ngoc Diep Do & Danielle Gallegos

  2. Department of Health, Nutrition Centre, Ho Chi Minh City, Vietnam

    Quoc Cuong Tran & Thi Ngoc Diep Do

  3. Department of Nutrition and Dietetics, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia

    Merrilyn Banks

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  1. Quoc Cuong Tran
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Correspondence to Quoc Cuong Tran.

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Tran, Q.C., Banks, M., Hannan-Jones, M. et al. Validity of four nutritional screening tools against subjective global assessment for inpatient adults in a low-middle income country in Asia. Eur J Clin Nutr 72, 979–985 (2018). https://doi.org/10.1038/s41430-018-0217-8

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