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Nutrition Screening Adults

Nutrition Screening Adults

Welcome to the Nutrition Screening Adults Systematic Review 

Nutrition screening is the process of identifying patients, clients, or groups who may have a nutrition diagnosis and benefit from nutrition assessment and intervention by a registered dietitian nutritionist (RDN). Nutrition screening is a supportive task, which relies on tools that are quick and easy-to-use (<10 minutes to complete) and that requires minimal training. Use of valid and reliable tools are important to avoid under referral of patients or clients with malnutrition or over referral of patients or clients without malnutrition.

The project goal was to update and expand an existing EAL systematic review examining the validity and reliability of adult malnutrition screening tools. Six tools for identifying risk for malnutrition (undernutrition) with sufficient evidence for evaluation were selected: Malnutrition Screening Tool (MST), 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), and Nutrition Risk Screening (NRS-2002). This review provides an analysis of validity, agreement and reliability of tools to screen adults for malnutrition regardless of their age, medical history, or setting/location. The costs of the malnutrition screening procedure was also reviewed.

Key Findings 

The workgroup concluded:
•    The MST exhibited moderate validity, reliability, and agreement. The conclusion statement was supported by Grade I (Good/Strong) evidence. 
•    The conclusion statements for the remaining five tools were supported by Grade II (Fair) evidence: 
o    The MUST exhibited high validity, and moderate reliability and agreement 
o    The MNA-SF exhibited moderate validity and reliability and low agreement
o    The SNAQ exhibited moderate validity and reliability; no agreement data were available
o    The MNA-SF-BMI high validity and moderate agreement; no reliability data were available
o    The NRS-2002 exhibited moderate validity and agreement; no reliability data were available
•    Costs of the malnutrition screening procedure ranged from €2 (~$2.27 US) (SNAQ) in 2003 to €3.27 (~$2.93 US) (MNA-SF) in 2001, per hospital patient in the Netherlands. The conclusion statement was supported by Grade III (Limited) evidence.

Use the links on the left to view tool components and descriptions; validity and reliability criteria, definitions; procedure costs; and the evidence analysis. Expand the section below titled Project Team and Disclosures for a listing of individuals who contributed to the development of the systematic review, disclosures and project funding information.
  • Project Team and Disclosures (2018)

    The following individuals contributed their valuable time and expertise to this project:

    Workgroup Members

    • Annalynn Skipper, PhD, RDN, CNSC, FADA, Chair
      Manager, Health and Sciences, American Medical Association, Chicago, IL, USA
    • Pamela Charney, PhD, MS, RDN
      Associate Professor, University of North Georgia, Dawsonville, GA, USA
    • Anne E. Coltman, MS, RD, CNSC
      Clinical Nutrition Coordinator, Loyola University Medical Center, Maywood, IL, USA
    • Judith M. Porcari,  MBA, MS, RDN
      Adjunct Instructor, Lehman College and Queens College of the City University of New York, Bronx, NY, USA
    • Jennifer A. Tomesko, DCN, RD, CNSC
      Assistant Professor/Program Director, Rutgers University, School of Health Professions, Newark, NJ, USA
    • Erin Pover, MS RDN (resigned 3/14/18)

    Project Leaders

    • Tami A. Piemonte, MS, RDN, LDN, Project Manager
      Independent Contractor, St. Petersburg, FL, USA
    • Mary Katherine Hoy, EdD, RD, Lead Analyst (through October 2017)
      Nutritionists, ARS-USDA, Beltsville, MD, USA
    • Feon Cheng, PhD, MPH, RDN, Lead Analyst
      Nutrition Researcher, Academy of Nutrition and Dietetics, Chicago, IL, USA
    • Margaret J. Foster, MS, MPH, AHIP, Medical Librarian
      Texas A&M University, TAMU-Libraries, College Station, TX, USA
    • Deepa Handu, PhD, RN, Methodologist
      Senior Scientist, Academy of Nutrition and Dietetics, Chicago, IL, USA

    Evidence Analysts

    • Megan Baumler, PhD, RDN
       Professor, Mount Mary University, Milwaukee, WI, USA
    • Lisa A. Davis, MS, RD
      Dietitian/Nutritionist, University of Wisconsin Hospital & Clinics, Madison, WI, USA
    • Keiy C. Murofushi, MS, RDN
      Executive Director, Cedars-Sinai Medical Center, Beverly Hills, CA, USA
    • Jessica G. Redmond, PhD, RDN, FAND
      Assistant Professor, Syracuse University, Syracuse, NY, USA
    • Maja Redzic, PhD
      Research Associate, Huron Consulting Group, Chicago, IL, USA
    • Heather Valentine, MS, RD
      Research Administrative Assistant, University of Kansas Medical Center, Kansas City, KS, USA
    • Jessica West Schueler, MS, RDN
      Clinical Dietitian, St. Charles Health System, Bend, OR, USA
    • Jinyu Xu, PhD, MPH, RD
      Research Scientist, Nationwide Children’s Hospital, Columbus, OH, USA

    Financial Contributors

    • Commission on Dietetic Registration
    • Academy of Nutrition and Dietetics


    Disclosures of Potential Conflicts of Interest: In the interest of full disclosure, the Academy has adopted the policy of revealing relationships workgroup members have with companies that sell products or services that are relevant to this topic. Workgroup members are required to disclose potential conflicts of interest by completing the Academy Conflict of Interest Form. It should not be assumed that these financial interests will have an adverse impact on the content, but they are noted here to fully inform readers.

    • Annalynn Skipper: receives royalties for work on The Dietitian's Handbook of Enteral and Parenteral Nutrition
    • Pamela Charney: receives royalties for work on Pocket Guide to Nutrition Screening and Assessment
  • Resources and Articles (2018)

    The following resources from this project are available:

    • Position of the Academy of Nutrition and Dietetics: Malnutrition (Undernutrition) Screening Tools for All Adults. It is the position of the Academy of Nutrition and Dietetics that, based upon current evidence, the Malnutrition Screening Tool should be used to screen adults for malnutrition (undernutrition) regardless of their age, medical history, or setting. Malnutrition (undernutrition) screening is a simple process intended to quickly recognize individuals who may have a malnutrition diagnosis. While numerous malnutrition screening tools are in use, their levels of validity, agreement, reliability, and generalizability vary. The Academy of Nutrition and Dietetics reviewed the body of evidence supporting malnutrition screening tools and determined a single tool for identifying adults in all settings who may have malnutrition, regardless of their age or medical history. The Nutrition Screening for Adults Workgroup conducted a systematic review of the most robust evidence to promote using the highest-quality malnutrition screening tool available. J Acad Nutr Diet. 2020;120(4):709-713.
       
    • Adult Malnutrition (Undernutrition) Screening: An Evidence Analysis Center Systematic Review. 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. J Acad Nutr Diet. 2020;120(4):669-708.
  • Project Team and Disclosures (2010)

    The following individuals contributed their valuable time and expertise to the 2010 project:

    Workgroup Members

    • Maree Ferguson, MBA, PhD, RD, Chair
    • Victoria H. Castellanos, PhD, RD
    • Cinda Chima, MS, RD, LD
    • Judy Porcari, MBA, MS, RD
    • Nancy Nevin-Folino, MEd, RD, CSP, LD, FADA
    • Annalynn Skipper, PhD, RD, FADA
    • Pam Charney, PhD, RD  (resigned)

    Project Manager

    • Tami A. Piemonte, MS, RD, LDN

    Lead Analyst

    • Kyle Thompson, MS, RD, CSG, CD, CNSD

    Evidence Analysts

    • Julieanne Dzik Andereson, MPH, RD, LD
    • Kimberly Sasser Bandalier, MPH, RD, LD
    • Kathleen Burzynski, MS, RD, LD, CDE, CNSC
    • Alison Dvorak, MS, RD
    • Andrea Hutchins, PhD, RD
    • Karma Marino, PhD, MPH, RD
    • Patricia Mendoza, MS, RD, LD
    • Jen Nicholson, PhD, RD
    • Maureen K. Olson, MA, RD, LD
    • Julie Shertzer, MS, RD, LD

    Academy Staff

    • Deborah Cummins, PhD
    • Kay Howarter, MS, RD
    • Kari Kren, MPH, RD
    • Esther Myers, PhD, RD, FADA

    Financial Contributor

    • Academy of Nutrition and Dietetics

    Disclosures of Potential Conflicts of Interest: In the interest of full disclosure, the Academy has adopted the policy of revealing relationships workgroup members have with companies that sell products or services that are relevant to this topic. All workgroup members are required to disclose potential conflicts of interest by completing the Academy Conflict of Interest Form. It should not be assumed that these financial interests will have an adverse impact on the content, but they are noted here to fully inform readers.

    • None of the workgroup members listed above disclosed potential conflicts.