Nutrition Screening Adults

NSCR: Quick and Easy Nutrition Screening Tools: Adult Patients in Acute and Ambulatory Care Settings (2009)

To view the overall evidence analysis of the eleven nutrition screening tools, see: Overview of Quick and Easy Nutrition Screening Tools for Adults.

Assessment
What is the validity and reliability of the Malnutrition Universal Screening Tool (MUST) in identifying nutrition problems in adult patients in acute care and hospital-based ambulatory care settings?
- Conclusion
  One prospective cohort study (quality rating positive; 995 patients, acute care setting) evaluated the sensitivity and specificity of the Malnutrition Universal Screening Tool (MUST), compared to Subjective Global Assessment (SGA) as the reference standard. The study found that sensitivity was 61% and specificity was 76%. The positive and negative predictive values of MUST were 65% and 76%, respectively. Fair agreement was found between the SGA and MUST (kappa 0.26, P<0.001). Another cross-sectional study (quality rating positive; 398 medical and surgical patients, acute care setting) examined the validity of MUST when compared with SGA. Malnourished vs. well-nourished agreement was 92% (kappa 0.783).
  
  No data were available in these studies to evaluate the reliability of MUST.
- 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: Validity and Reliability of the Malnutrition Universal Screening Tool (MUST) in Adult Patients in Acute Care and Hospital-based Ambulatory Care Settings
- Search Plan and Results: Nutrition Screening Quick and Easy Tools - 2007
What is the validity and reliability of the Mini Nutritional Assessment-Short Form (MNA-SF) tool in identifying nutrition problems in adult patients in acute care and hospital-based ambulatory care settings?
- Conclusion
  
  One cross-sectional study (quality rating positive; 904 older adult patients, acute care setting) found that the Mini Nutritional Assessment-Short Form (MNA-SF) had a sensitivity of 97.9%, a specificity of 100% and a diagnostic accuracy of 98.7% for detecting malnutrition, as well as significantly correlating (r=0.945) with the Mini Nutritional Assessment (MNA).
  
  Another study based on a retrospective review of patient data (quality rating neutral; 408 older adults, ambulatory setting) found that the MNA-SF had a sensitivity of 100% and a specificity of 69.5% compared to the full MNA in identifying the absence of overt malnutrition. Negative predictive value was 92.8% and positive predictive value was 78.5% in identifying the absence of overt malnutrition.
  
  No data were available in these studies to evaluate the reliability of the MNA-SF.
- 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: Validity and Reliability of the MNA-SF Tool in Adult Patients in Acute Care and Hospital-based Ambulatory Care Settings
- Search Plan and Results: Nutrition Screening Quick and Easy Tools - 2007
What is the validity and reliability of the Malnutrition Screening Tool (MST) in identifying nutrition problems in adult patients in acute care and hospital-based ambulatory care settings?
- Conclusion
  Four positive-quality, cross-sectional studies evaluated the sensitivity and specificity of the Malnutrition Screening Tool (MST) in screening the nutritional status of adults in acute care, as well as adults receiving radiotherapy and chemotherapy (total acute care patients: 2,619; total ambulatory oncology patients: 156). Three of the studies used the SGA as a reference standard; the fourth study used the PG-SGA as a reference standard.
  
  The studies found that sensitivity ranged from 74.4% to 100% (all scores: 74.4%; 93%; 100%; 100%) and that specificity ranged from 76.2% to 93% (all scores: 76.2%; 81%; 92%; 93%). Positive predictive values were 27.9%, 40% and 80%. Negative predictive values were 96%, 100% and 100%. Two of the studies found that inter-rater reliability was acceptable (Study #1: Kappa 0.83 to 0.88; P<0.001; Study #2: Three assessments of inter-rater reliability: Kappa 0.88, P<0.01; kappa 0.84, P<0.01; Kappa 0.93, P<0.01). One of the studies found predictive and convergent validity between the MST and biochemical and anthropometric parameters as well as LOS.
  
  No data were available to evaluate agreement of the MST.
- 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: Validity and Reliability of the Malnutrition Screening Tool (MST) in Adult Patients in Acute Care and Hospital-based Ambulatory Care Settings
- Search Plan and Results: Nutrition Screening Quick and Easy Tools - 2007
What is the validity and reliability of the Simple Two-part Screening Tool in identifying nutrition problems in adult patients in acute care and hospital-based ambulatory care settings?
- Conclusion
  One cross-sectional study of 2,211 patients admitted to acute care (quality rating positive) evaluated the sensitivity and specificity of the Simple Two-part Tool, compared to the Subjective Global Assessment (SGA). Sensitivity was 63.2% and specificity was 96.7%. Positive predictive value was 70.2%. Negative predictive value was 95.5%.
  
  No data were available to evaluate the agreement or reliability of the Simple Two-part Tool.
- 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: Validity and Reliability of the Simple Two-Part Tool in Adult Patients in Acute Care and Hospital-based Ambulatory Care Settings
  - Detail
  - Quality Rating Summary
    For a summary of the Quality Rating results, click here.
  - Worksheets
    
    Nursal TZ, Noyan T, Atalay BG, Köz N, Karakayali H. Simple two-part tool for screening of malnutrition. Nutrition. 2005 Jun; 21(6): 659-665.
- Search Plan and Results: Nutrition Screening Quick and Easy Tools - 2007
What is the validity and reliability of the Nutritional Risk Screening 2002 (NRS-2002) Tool in identifying nutrition problems in adult patients in acute care and hospital-based ambulatory care settings?
- Conclusion
  One prospective cohort study of 995 adults admitted to acute care (quality rating positive) and one cross-sectional study of 121 geriatric patients admitted to acute care (quality rating neutral) evaluated the Nutrition Risk Screening 2002 tool (NRS-2002). The cohort and cross-sectional studies found that sensitivity of the NRS-2002 was 62% and 70%,* respectively when using SGA as a reference standard. Specificity was 93% and 85%,* respectively when using SGA as a reference standard.
  
  The cohort study found that positive (PPV) and negative predictive values (NPV) of the NRS-2002 were 85% and 79%, respectively and found moderate agreement between NRS-2002 and SGA (kappa 0.48, P<0.001).
  
  The cross-sectional study found that sensitivity of the NRS-2002 was 39% and specificity was 83%, when compared with the MNA as a reference standard. Agreement of the NRS-2002 and the MNA in classification of high-risk patients was 84.6%. Agreement of the NRS-2002 and the MNA in classifying normal patients was 63%. The PPV and NPV of the NRS-2002 compared to the MNA was 85% and 37%, respectively. The PPV and NPV of the NRS-2002 compared to the SGA was 79% and 78%, respectively. Agreement of NRS-2002 and SGA in classifying high-risk/malnourished patients was 79.2%. Agreement of NRS-2002 and SGA in classifying normal patients was 32.5%.
  
  Information on the reliability of the NRS-2002 was not available.
  
  *Values were calculated (see Definitions and Criteria) by the Nutrition Screening workgroup using data included in the article.
- Grade: I
  - 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: Validity and Reliability of the Nutritional Risk Screening 2002 (NRS-2002) in Adult Patients in Acute Care and Hospital-based Ambulatory Care Settings
- Search Plan and Results: Nutrition Screening Quick and Easy Tools - 2007
What is the validity and reliability of the Short Nutritional Assessment Questionnaire (SNAQ) in identifying nutrition problems in adult patients in acute care and hospital-based ambulatory care settings?
- Conclusion
  There were no data available using an acceptable reference standard to determine the validity or reliability of the SNAQ tool in adult patients in acute care and hospital-based ambulatory care settings.
- Grade: V
  - 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.
- Search Plan and Results: Nutrition Screening Quick and Easy Tools - 2007
What is the validity and reliability of the Nutritional Risk Score (NRS) in identifying nutrition problems in adult patients in acute care and hospital-based ambulatory care settings?
- Conclusion
  One cross-sectional study of patients admitted to acute care (quality rating positive) validated the Nutritional Risk Score (NRS) using dietitian evaluation as a reference standard. The study had two parts. In the validation phase of the study (N=20), agreement of patients' nutrition risk category between the NRS and dietitian assessment was 93%, with a correlation coefficient of 0.83 (P<0.001). Agreement of patient nutrition risk category between two dietitians using the tool was 100% with a correlation coefficient of 0.91 for actual scores (P<0.001). In the reliability phase of the study (N=153), inter-observer reliability between nurses and dietitians using the tool was 74%, with a correlation coefficient of 0.80 (P<0.001).
  
  Information on the sensitivity, specificity, positive predictive value and negative predictive value of the NRS was not available.
- Grade: III
  - 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: Validity and Reliability of the Nutrition Risk Score (NRS) in Adult Patients in Acute Care and Hospital-based Ambulatory Care Settings
  - Detail
  - Quality Rating Summary
    For a summary of the Quality Rating results, click here.
  - Worksheets
    
    Reilly HM, Martineau JK, Moran A, Kennedy H. Nutritional screening: Evaluation and implementation of a simple Nutrition Risk Score. Clinical Nutrition. 1995; 14: 269-273.
- Search Plan and Results: Nutrition Screening Quick and Easy Tools - 2007
What is the validity and reliability of the Seniors in the Community: Risk Evaluation for Eating and Nutrition, Version II Abbreviated (SCREEN II-AB) Tool in identifying nutrition problems in adult patients in acute care and hospital-based ambulatory care settings?
- Conclusion
  One cross-sectional study (quality rating neutral) studied 439 senior adults in a community geriatric clinic setting to develop and validate the sensitivity, specificity and reliability of the SCREEN II-AB nutrition screening tool, compared to dieititian assessment as a reference standard. For the SCREEN II-AB with a score less than 43, sensitivity was 84%, specificity was 58%, positive predictive value was 83% and negative predictive value was 59% (N=193).
  
  Test-retest reliability (N=149) using the SCREEN II-AB was 0.84; 95% CI: 0.79, 0.89.
  
  For the SCREEN II-AB, inter-rater reliability (N=97) as measured by intra-class correlation was 0.79; intra-rater reliability was 0.85.
- Grade: III
  - 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 the Nutritional Risk Score (NRS) in identifying nutrition problems in adult patients in acute care and hospital-based ambulatory care settings?
  - Detail
  - Quality Rating Summary
    For a summary of the Quality Rating results, click here.
  - Worksheets
    
    Keller HH, Goy R, Kane SL. Validity and reliability of SCREEN II (Seniors in the community: risk evaluation for eating and nutrition, Version II). Eur J Clin Nutr. 2005 Oct; 59(10): 1149-1157.
- Search Plan and Results: Nutrition Screening Quick and Easy Tools - 2007
What is the validity and reliability of the Tool #1 (Laporte et al, 2001) screening tool in identifying nutrition problems in adult patients in acute care and hospital-based ambulatory care settings?
- Conclusion
  One cross-sectional study (quality rating neutral) of 142 older adults (greater than 65 years) in acute care (N=72) and long-term care (N=70), evaluated the validity of Tool #1 (BMI and percent weight loss) using nutrition assessment by a registered dietitian as a reference standard.
  
  In acute care, sensitivity and specificity were both 75%. Overall predictive value was 75%. Inter-rater reliability was 84.7% Test-retest reliability was 78.4%.
  
  In long-term care, sensitivity and specificity were 78.1% and 63.2%, respectively. Overall predictive value was 70.0%. Inter-rater reliability was 80.1%. Test-retest reliability was 81.6%.
  
  When the samples were combined (N=160), Tool #1 results were as follows: Sensitivity and specificity were 76.8% and 69.8%, respectively, overall predictive value was 72.5%, kappa for inter-rater reliability was 0.06±0.07 and kappa for test-retest reliability was 0.59±0.07.
- Grade: III
  - 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: Validity and Reliability of Tool #1 (Laporte et al, 2001) Screening Tool in Adult Patients in Acute Care and Hospital-based Ambulatory Care Settings
  - Detail
  - Quality Rating Summary
    For a summary of the Quality Rating results, click here.
  - Worksheets
    
    Laporte M, Villalon L, Thibodeau J, Payette H. Validity and reliability of simple nutrition screening tools adapted to the elderly population in healthcare facilities. J Nutr Health Aging. 2001; 5 (4): 292-294.
- Search Plan and Results: Nutrition Screening Quick and Easy Tools - 2007
What is the validity and reliability of the Rapid Screen tool (Visvanathan et al, 2004), in identifying nutrition problems in adult patients in acute care and hospital-based ambulatory care settings?
- Conclusion
  One prospective cohort study (quality rating neutral) of 65 patients (greater than 70 years of age) in sub-acute medical, orthopedic and geriatric care settings evaluated the validity of the Rapid Screen tool (BMI less than 22.5kg per m² or reported weight loss greater than 7.5% in the past three months) using the Standardized Nutritional Assessment (SNA) as a reference standard.
  
  The researchers found that, when compared to the SNA, sensitivity and specificity of the Rapid Screen were 78.6% and 97.3%, respectively. The positive predictive value and negative predictive value was 95.7%* and 85.7%,* respectively.
  
  No data were available to evaluate the reliability or agreement of the Rapid Screen tool.
  
  *Values were calculated (see Definitions and Criteria) by the Nutrition Screening workgroup using data included in the article.
- Grade: III
  - 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: Validity and Reliability of the Rapid Screen Tool (Visvanathan et al, 2004) in Adult Patients in Acute Care and Hospital-based Ambulatory Care Settings
  - Detail
  - Quality Rating Summary
    For a summary of the Quality Rating results, click here.
  - Worksheets
    
    Visvanathan R, Penhall R, Chapman I. Nutritional screening of older people in a sub-acute care facility in Australia and its relation to discharge outcomes. Age Ageing. 2004 May; 33 (3): 260-265. Erratum in: Age Ageing. 2004 Jul; 33 (4): 427.
- Search Plan and Results: Nutrition Screening Quick and Easy Tools - 2007
What is the validity and reliability of the Nutrition Screening Tool (NST)/BAPEN4 in identifying nutrition problems in adult patients in acute care and hospital-based ambulatory care settings?
- Conclusion
  One prospective cohort study (quality rating positive) studied 326 patients admitted to acute and elderly care wards in three cohorts (cohort 1, development phase: N=127; cohort 2, pilot phase: N=166; cohort 3, evaluation phase: N=33) to design, pilot and evaluate a nutrition screening tool (NST) based on British Association for Parenteral and Enteral Nutrition (BAPEN) criteria. Nutrition assessment by a registered dietitian was used as a reference standard. Only the pilot and evaluation phases evaluated the validity of the tool.
  
  The researchers found that in the pilot phase, agreement between the NST/BAPEN4 and dietitian assessment resulted in a kappa value of 0.72 (CI 0.59 - 0.84). Sensitivity and specificity were 86%* and 95%,* respectively. Positive predictive value was 80%* and negative predictive value was 96%.*
  
  In the evaluation phase (N=33), reliability resulted in a mean kappa value of 0.66.
  
  *Values were calculated (see Definitions and Criteria) by the Nutrition Screening workgroup using data included in the article.
- Grade: III
  - 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: Validity and Reliability of the Nutrition Screening Tool (NST)/BAPEN4 in Adult Patients in Acute Care and Hospital-based Ambulatory Care Settings
- Search Plan and Results: Nutrition Screening Quick and Easy Tools - 2007