Clinical nutrition

Comparison of the efficacy of Nutritional Risk Screening 2002 and Mini Nutritional Assessment Short Form in recognizing sarcopenia and predicting its mortality



This study aimed to examine the efficacy of Nutritional Risk Screening 2002 (NRS2002) and Mini Nutritional Assessment Short Form (MNA-SF) in recognizing sarcopenia and predicting its mortality in Chinese geriatric hospitalized patients.


A prospective analysis was performed in 430 hospitalized geriatric patients. Nutrition status was assessed using the NRS2002 and MNA-SF scales. Anthropometric measures and biochemical parameters were carried out for each patient. Sarcopenia was defined according to the revised consensus definition of the European Working Group on Sarcopenia in Older People (EWGSOP2). Patients were follow-up for up to 26 months.


The overall prevalence of sarcopenia was 35.3% in this population. In the sarcopenic patients, 53 (34.9%) were malnutrition/nutritional risk according to NRS2002 assessment and 101 (66.4%) patients were malnutrition/nutritional risk according to MNA-SF assessment. NRS2002 vs MNA-SF showed moderate agreement (κ = 0.460, P < 0.001). Receiver operating characteristic analysis showed that the area under the curve of MNA-SF was larger than NRS2002 in recognizing sarcopenia (0.763 vs 0.649, P = 0.001). During a median follow-up time of 20.22 months, 48 (31.6%) sarcopenic patients died. The Kaplan–Meier curve demonstrated that malnutrition/nutritional risk patients according to whether NRS2002 or MNA-SF assessment had a higher risk of death than the normal nutrition patients (χ2 = 15.728, P < 0.001; χ2 = 7.039, P = 0.008, respectively). Age, serum albumin levels, and NRS2002 score were independent factors influencing the mortality.


MNA-SF score may be better than the NRS2002 score to recognize sarcopenia in Chinese geriatric population. Both NRS2002 and MNA-SF scores could predict mortality, but NRS2002 score was the independent predict factor.

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Fig. 1: Comparison of CC levels in three groups.
Fig. 2: ROC curve analysis of NRS2002 and MNA-SF for sarcopenia.
Fig. 3: Kaplan–Meier analysis for sarcopenic patients’ mortality.


  1. 1.

    Cao L, Morley JE. Sarcopenia is recognized as an independent condition by an international classification of disease, tenth revision, Clinical Modification (ICD-10-CM) Code. J Am Med Dir Assoc. 2016;17:675–7.

  2. 2.

    Fávaro-Moreira NC, Krausch-Hofmann S, Matthys C, Vereecken C, Vanhauwaert E, Declercq A, et al. Risk factors for malnutrition in older adults: a systematic review of the literature based on longitudinal data. Adv Nutr. 2016;7:507–22.

  3. 3.

    Álvarez-Hernández J, Planas Vila M, León-Sanz M, García de Lorenzo A, Celaya-Pérez S, García-Lorda P, et al. Prevalence and costs of malnutrition in hospitalized patients; the PREDyCES Study. Nutr Hosp. 2012;27:1049–59.

  4. 4.

    Diekmann R, Winning K, Uter W, Kaiser MJ, Sieber CC, Volkert D, et al. Screening for malnutrition among nursing home residents—a comparative analysis of the mini nutritional assessment, the nutritional risk screening, and the malnutrition universal screening tool. J Nutr Health Aging. 2013;17:326–31.

  5. 5.

    Stratton RJ, Hackston A, Longmore D, Dixon R, Price S, Stroud M, et al. Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the ‘malnutrition universal screening tool’ (‘MUST’) for adults. Br J Nutr. 2004;92:799–808.

  6. 6.

    Correia MI, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr. 2003;22:235–9.

  7. 7.

    Beaudart C, Sanchez-Rodriguez D, Locquet M, Reginster JY, Lengelé L, Bruyère O. Malnutrition as a strong predictor of the onset of sarcopenia. Nutrients 2019;11:2883.

  8. 8.

    Eglseer D, Eminovic S, Lohrmann C. Association between sarcopenia and nutritional status in older adults: a systematic literature review. J Gerontol Nurs. 2016;42:33–41.

  9. 9.

    Vandewoude MF, Alish CJ, Sauer AC, Hegazi RA. Malnutrition-sarcopenia syndrome: is this the future of nutrition screening and assessment for older adults? J Aging Res. 2012;2012:651570.

  10. 10.

    Rubenstein LZ, Harker JO, Salvà A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: developing the Short-form Mini-Nutritional Assessment (MNA-SF). J Gerontol A Biol Sci Med Sci. 2001;56:M366–72.

  11. 11.

    Cederholm T, Bosaeus I, Barazzoni R, Bauer J, Van Gossum A, Klek S, et al. Diagnostic criteria for malnutrition—an ESPEN Consensus Statement. Clin Nutr. 2015;34:335–40.

  12. 12.

    Liguori I, Curcio F, Russo G, Cellurale M, Aran L, Bulli G, et al. Risk of malnutrition evaluated by mini nutritional assessment and sarcopenia in noninstitutionalized elderly people. Nutr Clin Pract. 2018;33:879–86.

  13. 13.

    Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48:16–31.

  14. 14.

    Aliberti MJR, Szlejf C, Covinsky KE, Lee SJ, Jacob-Filho W, Suemoto CK. Prognostic value of a rapid sarcopenia measure in acutely ill older adults. Clin Nutr. 2019;S0261-5614:33038–9.

  15. 15.

    Tresignie J, Scafoglieri A, Pieter Clarys J, Cattrysse E. Reliability of standard circumferences in domain-related constitutional applications. Am J Hum Biol. 2013;25:637–42.

  16. 16.

    Cereda E, Veronese N, Caccialanza R. The final word on nutritional screening and assessment in older persons. Curr Opin Clin Nutr Metab Care. 2018;21:24–9.

  17. 17.

    Berthon BS, Wood LG. Nutrition and respiratory health–feature review. Nutrients. 2015;7:1618–43.

  18. 18.

    Ravera A, Carubelli V, Sciatti E, Bonadei I, Gorga E, Cani D, et al. Nutrition and cardiovascular disease: finding the perfect recipe for cardiovascular health. Nutrients. 2016;8:363.

  19. 19.

    Sieber CC. Malnutrition and sarcopenia. Aging Clin Exp Res. 2019;31:793–8.

  20. 20.

    Baek M, Heo Y. Evaluation of the efficacy of nutritional screening tools to predict malnutrition in the elderly at a geriatric care hospital. Nutr Res Pract. 2015;9:637–43.

  21. 21.

    Bauer JM, Kaiser MJ, Sieber CC. Evaluation of nutritional status in older persons: nutritional screening and assessment. Curr Opin Clin Nutr Metab Care. 2010;13:8–13.

  22. 22.

    Abd-El-Gawad WM, Abou-Hashem RM, El Maraghy MO, Amin GE. The validity of Geriatric Nutrition Risk Index: simple tool for prediction of nutritional-related complication of hospitalized elderly patients. Comparison with Mini Nutritional Assessment. Clin Nutr. 2014;33:1108–16.

  23. 23.

    Drescher T, Singler K, Ulrich A, Koller M, Keller U, Christ-Crain M, et al. Comparison of two malnutrition risk screening methods (MNA and NRS 2002) and their association with markers of protein malnutrition in geriatric hospitalized patients. Eur J Clin Nutr. 2010;64:887–93.

  24. 24.

    Wu ML, Courtney MD, Shortridge-Baggett LM, Finlayson K, Isenring EA. Validity of the malnutrition screening tool for older adults at high risk of hospital readmission. J Gerontol Nurs. 2012;38:38–45.

  25. 25.

    Maeda K, Shamoto H, Wakabayashi H, Akagi J. Sarcopenia is highly prevalent in older medical patients with mobility limitation. Nutr Clin Pract. 2017;32:110–5.

  26. 26.

    Chang KV, Hsu TH, Wu WT, Huang KC, Han DS. Is sarcopenia associated with depression? A systematic review and meta-analysis of observational studies. Age Ageing. 2017;46:738–46.

  27. 27.

    Chang KV, Hsu TH, Wu WT, Huang KC, Han DS. Association between sarcopenia and cognitive impairment: a systematic review and meta-analysis. J Am Med Dir Assoc. 2016;17:1164.e7–1164.e15.

  28. 28.

    Hu X, Zhang L, Wang H, Hao Q, Dong B, Yang M. Malnutrition-sarcopenia syndrome predicts mortality in hospitalized older patients. Sci Rep. 2017;7:3171.

  29. 29.

    Koga Y, Fujita M, Yagi T, Todani M, Nakahara T, Kawamura Y, et al. Early enteral nutrition is associated with reduced in-hospital mortality from sepsis in patients with sarcopenia. J Crit Care. 2018;47:153–8.

  30. 30.

    Holst M, Yifter-Lindgren E, Surowiak M, Nielsen K, Mowe M, Carlsson M, et al. Nutritional screening and risk factors in elderly hospitalized patients: association to clinical outcome? Scand J Caring Sci. 2013;27:953–61.

  31. 31.

    Donini LM, Poggiogalle E, Molfino A, Rosano A, Lenzi A, Rossi Fanelli F, et al. Mini-nutritional assessment, malnutrition universal screening tool, and nutrition risk screening tool for the nutritional evaluation of older nursing home residents. J Am Med Dir Assoc. 2016;17:959.e11–e18.

  32. 32.

    Raslan M, Gonzalez MC, Dias MC, Nascimento M, Castro M, Marques P, et al. Comparison of nutritional risk screening tools for predicting clinical outcomes in hospitalized patients. Nutrition. 2010;26:721–6.

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We thank all the team involved in the development and implementation of the study: Jin Wang, Caihua Zhang, Xuelian Chen, Xiaokang Sun, and Ji Li.

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The paper was conceived by author XLZ. XLZ, ZZ, YXZ, YYW, YYK, CXR and JX contributed to the implementation of the program and acquisition of the data. YXZ and JT performed the statistical analysis. XLZ and ZZ wrote the paper. XLZ finalized the paper. All authors contributed to the interpretation of data analysis, drafted or reviewed the paper and approved this version for publication.

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Correspondence to Xiao-yan Zhang.

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Zhang, X., Zhang, Z., Zhu, Y. et al. Comparison of the efficacy of Nutritional Risk Screening 2002 and Mini Nutritional Assessment Short Form in recognizing sarcopenia and predicting its mortality. Eur J Clin Nutr (2020).

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