Abstract
Background
Malnutrition screening relies on quick and easy-to-use tools that require minimal
training of users. Valid and reliable tools should avoid under-referral of adults
with a malnutrition diagnosis or over-referral of those without a malnutrition diagnosis
to dietitians.
Objective
Our aim was to conduct a systematic review of adult malnutrition screening tools for
validity, agreement, and reliability, and to determine the costs of the malnutrition
screening procedure.
Methods
Following a structured process, a comprehensive search using PubMed, MEDLINE, EMBASE,
and CINAHL was conducted for relevant research published between 1997 and 2017 that
examined the validity, agreement, reliability, and costs of nutrition screening tools.
Results
Sixty-nine studies met the inclusion criteria. The Malnutrition Screening Tool exhibited
moderate validity, agreement, and reliability based on Grade I (Good/Strong) evidence. The evidence supporting the conclusions for the remaining tools was Fair (Grade II). The Malnutrition Universal Screening Tool exhibited high validity and
moderate agreement and reliability. The Mini Nutritional Assessment–Short Form exhibited
moderate validity and reliability and low agreement. The Short Nutritional Assessment
Questionnaire and the Nutrition Risk Screening 2002 exhibited moderate validity and
reliability and the Mini Nutritional Assessment–Short Form Body Mass Index exhibited
high validity and moderate agreement. However, these last three tools were missing
reliability or agreement data. Limited data were available to evaluate malnutrition
screening costs.
Conclusions
This review provides an analysis of validity, agreement, and reliability of tools
to screen adults for malnutrition, regardless of their age, medical history, or location.
No tools were found with high validity, reliability, and strong supportive evidence.
Tools most often achieved moderate validity, agreement, and reliability, and had large
variations in individual results. The minimum validity and reliability of tools to
screen adults for malnutrition should be established to shape future research. Cost
data for the screening process should be obtained and examined.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the Academy of Nutrition and DieteticsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Nutrition screening tools: An analysis of the evidence.JPEN J Parenter Enteral Nutr. 2012; 36: 292-298
- Nutrition Care Process and Model update: Toward realizing people-centered care and outcomes management.J Acad Nutr Diet. 2017; 117: 2003-2014
- Fast Facts on US Hospitals, 2018.https://www.aha.org/system/files/2018-01/fast-facts-us-hospitals-2017_0.pdfDate accessed: April 4, 2019
- Academy of Nutrition and Dietetics nutrition screening adults systematic review.(Published 2018. Accessed April 10, 2019)
- Consensus statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: Characteristics recommended for the identification and documentation of adult malnutrition (undernutrition).JPEN J Parenter Enteral Nutr. 2012; 36: 275-283
- Academy of Nutrition and Dietetics methodology for conducting systematic reviews for the Evidence Analysis Library.J Acad Nutr Diet. 2016; 116: 311-318
- What nutrition screening tools have been found to be valid and reliable for identifying malnutrition risk in adults across: a.) Care settings, b.) acute and chronic medical conditions, c.) ages, or d.) other?.(Published 2018. Accessed December 18, 2018)
- Quick-and-easy nutritional screening tools to detect disease-related undernutrition in hospital in- and outpatient settings: A systematic review of sensitivity and specificity.E Spen Eur E J Clin Nutr Metab. 2007; 2: 21-37
- The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients.Nutrition. 1999; 15: 116-122
- What is subjective global assessment of nutritional status?.JPEN J Parenter Enteral Nutr. 1987; 11: 8-13
- Definition of standardized nutritional assessment and interventional pathways in oncology.Nutrition. 1996; 12: S15-S19
- Incidence and recognition of malnutrition in hospital.BMJ. 1994; 308: 945-948
- A malnutrition-inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients.Am J Kidney Dis. 2001; 38: 1251-1263
- Development of a valid and reliable malnutrition screening tool for adult acute hospital patients.Nutrition. 1999; 15: 458-464
- Screening and Malnutrition Universal Screening Tool (MUST).(Updated April 25, 2016. Accessed May 23, 2018)
- The Mini Nutritional Assessment-Short Form for preoperative nutritional evaluation of elderly patients.Aging (Milano). 2001; 13: 293-297
- Screening for undernutrition in geriatric practice: Developing the short-form mini-Nutritional Assessment (MNA-SF).J Gerontology. 2001; 56 (M366-372)
- Development and validation of a hospital screening tool for malnutrition: The Short Nutritional Assessment Questionnaire (SNAQ).Clin Nutr. 2005; 24: 75-82
- Validation of the Mini Nutritional Assessment short-form (MNA-SF): A practical tool for identification of nutritional status.J Nutr Health Aging. 2009; 13: 782-788
- ESPEN guidelines for nutrition screening 2002.Clin Nutr. 2003; 22: 415-421
- Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement.PLoS Med. 2009; 6: e1000097
- Evaluation of Mini-Nutritional Assessment for Japanese frail elderly.Nutrition. 2005; 21: 498-503
- Interrater reliability: The kappa statistic.Biochem Med (Zagreb). 2012; 22: 276-282
- A novel, automated nutrition screening system as a predictor of nutritional risk in an oncology day treatment unit (ODTU).Support Care Cancer. 2014; 22: 2107-2112
- NUTRISCORE: A new nutritional screening tool for oncological outpatients.Nutrition. 2017; 33: 297-303
- The malnutrition screening tool versus objective measures to detect malnutrition in hip fracture.J Hum Nutr Diet. 2013; 26: 519-526
- Validation of a malnutrition screening tool for patients receiving radiotherapy.Australas Radiol. 1999; 43: 325-327
- Use of an abridged scored Patient-Generated Subjective Global Assessment (abPG-SGA) as a nutritional screening tool for cancer patients in an outpatient setting.Nutr Cancer. 2013; 65: 234-239
- Validity of the malnutrition screening tool as an effective predictor of nutritional risk in oncology outpatients receiving chemotherapy.Support Care Cancer. 2006; 14: 1152-1156
- The Malnutrition Screening Tool is a useful tool for identifying malnutrition risk in residential aged care.J Hum Nutr Diet. 2009; 22: 545-550
- Beyond malnutrition screening: Appropriate methods to guide nutrition care for aged care residents.J Acad Nutr Diet. 2012; 112: 376-381
- Assessing the validity and reliability of the MUST and MST nutrition screening tools in renal inpatients.J Ren Nutr. 2012; 22: 499-506
- Sensitivity, specificity, predictive value and inter-rater reliability of malnutrition screening tools in hospitalised adult patients.Malays J Nutr. 2014; 20: 209-219
- Simple two-part tool for screening of malnutrition.Nutrition. 2005; 21: 659-665
- Comparison of a novel, simple nutrition screening tool for adult oncology inpatients and the Malnutrition Screening Tool (MST) against the Patient-Generated Subjective Global Assessment (PG-SGA).Support Care Cancer. 2015; 23: 47-54
- Malnutrition prevalence in a medical assessment and planning unit and its association with hospital readmission.Aust Health Rev. 2013; 37: 636-641
- Validity of the malnutrition screening tool for older adults at high risk of hospital readmission.J Gerontol Nurs. 2012; 38: 38-45
- Malnutrition screening tools: Comparison against two validated nutrition assessment methods in older medical inpatients.Nutrition. 2013; 29: 101-106
- What are the most effective methods for assessment of nutritional status in outpatients with gastric and colorectal cancer?.Nutr Hosp. 2013; 28: 585-591
- Nutritional status of Vietnamese outpatients with chronic obstructive pulmonary disease.J Hum Nutr Diet. 2017; 30: 83-89
- Nutrition Screening in Geriatric Rehabilitation: Criterion (Concurrent and Predictive) Validity of the Malnutrition Screening Tool and the Mini Nutritional Assessment-Short Form.J Acad Nutr Diet. 2016; 116: 795-801
- Comparison of five malnutrition screening tools in one hospital inpatient sample.J Clin Nurs. 2011; 20: 2144-2152
- Nutritional risk screening in surgery; Valid, feasible, easy.Clin Nutr. 2012; 31: 206-211
- Validation of the Malnutrition Universal Screening Tool (MUST) in cancer.Br J Nutr. 2012; 108: 343-348
- 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.e911-e958)
- Nutritional risk and status of surgical patients; The relevance of nutrition training of medical students.Nutr Hosp. 2012; 27: 1086-1091
- Rehabilitation patients: Undernourished and obese?.J Rehabil Med. 2012; 44: 696-701
- Comparison of tools for nutritional assessment and screening at hospital admission: A population study.Clin Nutr. 2006; 25: 409-417
- Validity of nutritional screening with MUST and SNAQ in hospital outpatients.Eur J Clin Nutr. 2013; 67: 738-742
- Assessment of risk factors and test performance on malnutrition prevalence at admission using four different screening tools.Nutr Hosp. 2014; 29: 674-680
- Assessing nutrition in the critically ill elderly patient: A comparison of two screening tools.Indian J Crit Care Med. 2015; 19: 518-522
- Comparison of four nutritional screening tools to detect nutritional risk in hospitalized patients: A multicentre study.Eur J Clin Nutr. 2011; 65: 269-274
- Evaluation of nutritional screening tools for patients scheduled for cardiac surgery.Nutrition. 2013; 29: 436-442
- A longitudinal study of hospital undernutrition in the elderly: Comparison of four validated methods.J Nutr Health Aging. 2009; 13: 159-164
- Identifying malnutrition risk in acute medical patients: Validity and utility of Malnutrition Universal Screening Tool and Modified Malnutrition Screening Tool.Nutr Diet. 2012; 69: 309-314
- Comparison of the nutritional diagnosis, obtained through different methods and indicators, in patients with cancer.Nutr Hosp. 2009; 24: 51-55
- 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
- Validity and user-friendliness of the minimal eating observation and nutrition form-version II (MEONF-II) for undernutrition risk screening.Food Nutr Res. 2011; 55
- Nutritional assessment interpretation on 22,007 Spanish community-dwelling elders through the Mini Nutritional Assessment test.Public Health Nutr. 2009; 12: 82-90
- Suitability of the short-form Mini Nutritional Assessment in free-living elderly people in the northwest of Spain.J Nutr Health Aging. 2011; 15: 187-191
- Clinical study of mini-nutritional assessment for older Chinese inpatients.J Nutr Health Aging. 2009; 13: 871-875
- Validation of the Mini Nutritional Assessment-Short Form in a population of frail elders without disability. Analysis of the Toulouse Frailty Platform Population in 2013.J Nutr Health Aging. 2015; 19: 570-574
- Concurrent and predictive validity of composite methods to assess nutritional status in older adults on hemodialysis.J Ren Nutr. 2016; 26: 18-25
- Nutritional status of geriatric outpatients with systolic heart failure and its prognostic value regarding death or hospitalization, biomarkers and quality of life.J Nutr Health Aging. 2013; 17: 300-304
- Nutrition screening and assessment in Parkinson's disease: A comparison of methods.e-SPEN J. 2013; 8: e187-e192
- A comparison of the full Mini Nutritional Assessment, short-form Mini Nutritional Assessment, and Subjective Global Assessment to predict the risk of protein-energy malnutrition in patients on peritoneal dialysis: A cross-sectional study.Int J Nurs Stud. 2013; 50: 83-89
- The two-step Mini Nutritional Assessment procedure in community resident homes.J Clin Nutr. 2008; 17: 1211-1218
- Concurrent and predictive evaluation of malnutrition diagnostic measures in hip fracture inpatients: A diagnostic accuracy study.Eur J Clin Nutr. 2014; 68: 358-362
- Usefulness of short (MNA-SF) and full version of the Mini Nutritional Assessment (MNA) in examining the nutritional state of older persons.New Med. 2003; 6: 125-129
- MNA® Mini Nutritional Assessment as a nutritional screening tool for hospitalized older adults; Rationales and feasibility.Nutr Hosp. 2012; 27: 1619-1625
- Validation of the revised mini nutritional assessment short-forms in nursing homes in Spain.J Nutr Health Aging. 2013; 17: 26-29
- Mini Nutritional Assessment Short-Form: Validation in Five Latin American Cities. SABE Study.J Nutr Health Aging. 2016; 20: 797-805
- Accuracy of Different Mini Nutritional Assessment Reduced Forms to Evaluate the Nutritional Status of Elderly Hospitalised Diabetic Patients.J Nutr Health Aging. 2016; 20: 370-375
- Long-form but not short-form Mini-Nutritional Assessment is appropriate for grading nutritional risk of patients on hemodialysis—A cross-sectional study.Int J Nurs Stud. 2011; 48: 1429-1435
- Prospective validation of the modified Mini Nutritional Assessment Short-Forms in the community, nursing home and reabilitation setting.J Am Geriatr Soc. 2011; 59: 2124-2128
- Validation of the modified Mini Nutritional Assessment Short-Forms in different populations of older people in Poland.J Nutr Health Aging. 2014; 18: 366-371
- Screening malnutrition in hospital outpatients. Can the SNAQ malnutrition screening tool also be applied to this population?.Clin Nutr. 2008; 27: 439-446
- Nutritional assessment in surgical oncology patients: A comparative analysis between methods.Nutr Hosp. 2015; 31: 916-921
- Malnutrition in geriatric trauma patients: Screening methods in comparison.Technol Health Care. 2016; 24: 225-239
- Nutritional risk and status assessment in surgical patients: A challenge amidst plenty.Nutr Hosp. 2004; 19: 83-88
- NRS-2002 for pre-treatment nutritional risk screening and nutritional status assessment in head and neck cancer patients.Support Care Cancer. 2015; 23: 1495-1502
- Comparison of tools for nutrition assessment and screening for predicting the development of complications in orthopedic surgery.Nutr Clin Pract. 2009; 24: 274-280
- Evaluation of nutritional risk screening-2002 and subjective global assessment for general surgery patients: A prospective study.J Pak Med Assoc. 2013; 63: 1405-1408
- 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 Geriatr. 2005; 38: 322-327
- Analysis of outcomes of the NRS 2002 in patients hospitalized in nephrology wards.Nutrients. 2017; 9
- Diagnostic performance of the Minimal Eating Observation and Nutrition Form-Version II (MEONF-II) and Nutritional Risk Screening 2002 (NRS 2002) among hospital inpatients—A cross-sectional study.BMC Nurs. 2011; 10
- Cost-effectiveness of an interdisciplinary intervention in geriatric inpatients to prevent malnutrition.J Nutr Health Aging. 2004; 8: 122-127
- The modified Norton scale and the nutritional state.Scand J Caring Sci. 1989; 3: 183-187
Biography
A. Skipper is a health and science manager, American Medical Association, Chicago, IL.
Biography
A. Coltman is a patient services manager, Trinity Health, Melrose Park, IL.
Biography
J. Tomesko is an assistant professor and program director, Rutgers University, School of Health Professions, Newark, NJ.
Biography
P. Charney is an associate professor, University of North Georgia, Dahlonega, GA.
Biography
J. Porcari is an adjunct instructor, Lehman College, Bronx, NY.
Biography
T. A. Piemonte is a project manager/consultant, Evidence Analysis Center, D. Handu is director and F. W. Cheng is a nutrition researcher, Evidence Analysis Center, Academy of Nutrition and Dietetics, Chicago, IL
Article info
Publication history
Published online: December 19, 2019
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors. Dr Skipper is an employee of the American Medical Association (AMA), but the views expressed in this document are her own and cannot be interpreted as AMA policy.
FUNDING/SUPPORT The Academy of Nutrition and Dietetics and the Commission on Dietetic Registration provided funding for the development of the systematic review. This includes funding for the project manager, medical librarian, analysts, and copy editors.
Identification
Copyright
© 2020 by the Academy of Nutrition and Dietetics.
