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Nutrition Screening Adults

NSA: Validity and Reliability of Tools (2018)

Six tools for identifying adults at risk for malnutrition, defined as undernutrition (White et al, 2012) were evaluated for validity, reliability and agreement. An overall summary (expert opinion) of the tools is presented below, as well as a detailed analysis of the evidence for each of tool.

Reference: White JV, Guenter P, Jensen G, Malone A, Schofield M. 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(3): 275-283.

Assessment
ALL TOOLS: What nutrition screening tools have been found to be valid and reliable for identifying malnutrition risk in adults across care settings, acute and chronic medical conditions, and ages?
- Conclusion
  Based on the strength of the supporting evidence, the validity, reliability and agreement results, and the generalizability of the six screening tools, the work group ranked the tools from highest to lowest as follows:
  
  Grade I, Good/strong evidence:
  - Malnutrition Screening Tool (MST).
  Grade II, Fair evidence:
  - Malnutrition Universal Screening Tool (MUST)
  - Mini Nutrition Assessment-Short Form (MNA-SF)
  - Short Nutritional Assessment Questionnaire (SNAQ)
  - Mini Nutrition Assessment-Short Form-Body Mass Index (MNA-SF-BMI)
  - Nutrition Risk Screen-2002 (NRS-2002).
  Conclusion statements and evidence summaries for each tool can be found below.
- Grade: IV
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: ALL TOOLS: What nutrition screening tools have been found to be valid and reliable for identifying malnutrition risk in adults across care settings, acute and chronic medical conditions and ages?
  - Detail
- Search Plan and Results: NSCRA: Validity and Reliability of Nutrition Screening Tools (2017)
What is the validity and reliability of Mini Nutritional Assessment-Short Form (MNA-SF) for identifying malnutrition risk in adults across care settings, acute and chronic medical conditions, and ages?
What is the validity and reliability of the Mini Nutritional Assessment-Short Form-Body Mass Index (MNA-SF-BMI) for identifying malnutrition risk in adults across care settings, acute and chronic medical conditions, and ages?
- Conclusion
  The Mini Nutritional Assessment-Short Form-Body Mass Index (MNA-SF-BMI) exhibited a high degree of validity and a moderate degree of agreement in identifying malnutrition risk in adults across care settings, medical conditions and ages. Inter-rater reliability of the tool was not reported.
- Grade: II
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the validity and reliability of MNA-SF-BMI for identifying malnutrition risk in adults across care settings, acute and chronic medical conditions and ages?
- Search Plan and Results: NSCRA: Validity and Reliability of Nutrition Screening Tools (2017)
What is the validity and reliability of the Malnutrition Screening Tool (MST) for identifying malnutrition risk in adults across care settings, acute and chronic medical conditions, and ages?
What is the validity and reliability of the Malnutrition Universal Screening Tool (MUST) for identifying malnutrition risk in adults across care settings, acute and chronic medical conditions, and ages?
What is the validity and reliability of Nutrition Risk Screening-2002 (NRS-2002) for identifying malnutrition risk in adults across care settings, acute and chronic medical conditions and ages?
- Conclusion
  Nutrition Risk Screening-2002 (NRS-2002) exhibited a moderate degree of validity and a moderate degree of agreement in identifying malnutrition risk in adults across care settings, medical conditions and ages. Inter-rater reliability of the tool was not reported.
- Grade: II
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the validity and reliability of NRS-2002 for identifying malnutrition risk in adults across care settings, acute and chronic medical conditions and ages?
- Search Plan and Results: NSCRA: Validity and Reliability of Nutrition Screening Tools (2017)
What is the validity and reliability of Short Nutritional Assessment Questionnaire (SNAQ) for identifying malnutrition risk in adults across care settings, acute and chronic medical conditions and ages?
- Conclusion
  The Short Nutritional Assessment Questionnaire (SNAQ) exhibited a moderate degree of validity and a moderate degree of inter-rater reliability in identifying malnutrition risk in adults across care settings, medical conditions and ages. Agreement of the tool was not reported.
- Grade: II
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: What is the validity and reliability of SNAQ for identifying malnutrition risk in adults across care settings, acute and chronic medical conditions and ages?
- Search Plan and Results: NSCRA: Validity and Reliability of Nutrition Screening Tools (2017)