How to detect non-institutionalized older patients at risk of malnutrition during their hospitalization? Comparison of 8 screening tools for malnutrition or nutritional risk

Background

The prevalence of malnutrition is high among the elderly population. Hospital admission is a window of opportunity for its detection.

Objective

To assess the concordance of different nutritional scales in hospitalized patients.

Methods

Prospective study in non-institutionalized patients over 65 years of age admitted to an internal medicine department. Five malnutrition screening surveys (MNA, MST, MUST, NRS-2000 and CONUT) and three nutritional risk screening surveys (SCREEN 3, 8 and 14) were compared. As gold standard we use the Global Malnutrition Leadership Initiative for Malnutrition (GLIM) definition of malnutrition.

Results

Eighty-five patients (37% female, median age 83 years) were included. Forty-eight percent (95% CI 38–59%) of patients were classified as malnourished according to GLIM criteria. The SCREEN 3 scale was the most sensitive (93%; 95% CI 87–98) and MUST the most specific (91%; CI 85–99). The most effective scale for excluding suspected malnutrition was SCREEN 3 (LR− 0.17; 95% CI 0.05−0.53) and the best for confirming it was MST (LR+ 7.08; 95% CI 3.06–16.39). Concordance between the different scales was low or very low with kappa indices between 0.082 and 0.465.

Conclusions

A comprehensive approach is needed to detect malnutrition in hospitalized patients. More sensitive scales are more useful in initial screening. Nutritional risk tools could be effective at this stage. In a second step, malnutrition should be confirmed according to established criteria such as GLIM.