ONC: Malnutrition Screening and Nutrition Assessment of Adult Oncology Patients (2012)


Read JA, Crockett N, Volker DH, MacLennan P, Choy ST, Beale P, Clarke SJ.Nutritional assessment in cancer: comparing the Mini-Nutritional Assessment (MNA) with the scored Patient-Generated Subjective Global Assessment (PGSGA). Nutr Cancer. 2005; 53 (1): 51-56.

PubMed ID: 16351506
Study Design:
Diagnostic, Validity or Reliability Study
C - Click here for explanation of classification scheme.
Quality Rating:
Positive POSITIVE: See Quality Criteria Checklist below.
Research Purpose:

To compare two nutritional assessment tools in outpatients attending a cancer center. 

Inclusion Criteria:

Receiving either adjuvant or palliative treatment for malignancy.

Exclusion Criteria:

Not receiving adjuvant or palliative treatment for malignancy.

Description of Study Protocol:


All patients attending the medical oncology day centers of two Sydney, Australia teaching hospitals for initial consultation with diagnoses of colorectal, lung, esophageal, gastric, or pancreatice cancer. 


Comparison of two assessment tools. 

Statistical Analysis

  • Non-parametric Spearman P-test to assess the extent of correlation between the Mini-Nutritional Assessment (MNA) with the Scored Patient-Generated Subjective Global Assessment (PGSGA) scores at different time periods
  • The non-parametric Kruskal-Wallis tests was used in a one-way analysis of variance setting  to assess whether there were significant differences in nutritional status using the two methods at each time period
  • Two-sample T-tests, using Mann-Whitney and Kologorov-Smirnov tests were used to assess pairwise significance
  • The difference between the two methods was studied using an X2 goodness-of-fit test. 
Data Collection Summary:

Timing of Measurements

  • Baseline
  • Four to six weeks
  • Eight to 12 weeks.

Dependent Variables

  • MNA: Total score was used to classify patients as well-nourished (score of at least 23.5), at risk of malnutrition (score ranging from 17 to 23.5) or malnourished (score below 17)
  • PGSGA: Classified as well-nourished (A), moderately or suspected of being malnourished (B) or severely malnourished (C), as subjectively defined by the RD
  • A PGSGA was also calculated.     

Independent Variables

Treatment for the cancer.

Control Variables

Diagnosis of colorectal, lung, esophageal, gastric or pancreatic cancer.

Description of Actual Data Sample:
  • Initial N: 157 (99 males, 58 females)
  • Attrition (final N): 104
  • Age: 65 years (range, 32 to 81)
  • Ethnicity: Not described
  • Anthropometrics: Even distribution of elderly and non-elderly; half had colorectal cancer
  • Location: Sydney, Australia.
Summary of Results:

Key Findings


MNA Group




Baseline (N=157)


34% 35%
At risk for malnutrition 57% 55%
Malnourished 14% 10%
4-6 Weeks (N=126) Well-nourished 54%


At risk 41% 44%




8-12 Weeks (N=104)


61% 58%
At risk 31% 36%
Malnourished 8% 6%

Other Findings

  • Using the PGSGA as the accepted tool, the MNA at baseline correctly classified 33% as being well-nourished and 39% as being malnourished
  • 1% were misclassified as being well-nourished and 27% were misclassified as being malnourished, thus the sensitivity at baseline for NMA was 97% and the specificity 54%
  • The positive predictive value was 59%
  • At the four- to six-week follow-up, the sensitivity was 79%, the specificity was 69% and the positive predicative value was 54%
  • At the final follow-up, the sensitivity was 93%, the specificity was 82% and the positive predicative value was 66%
  • Using an X2 goodness-of-fit test, the MNA was compared to the validated PGSGA and it was confirmed that there is no significant (P=0.631) difference between the two methods.
Author Conclusion:

The Mini-Nutritional Assessment (MNA) is sensitive enough to diagnose patients with malnutrition, however it appears to be only moderately specific in identifying patients with malnutrition, when compared with the Scored Patient-Generated Subjective Global Assessment (PGSGA).

Funding Source:
University/Hospital: various hospitals in Sydney, Australia
Reviewer Comments:
Quality Criteria Checklist: Primary Research
Relevance Questions
  1. Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) Yes
  2. Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? Yes
  3. Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? Yes
  4. Is the intervention or procedure feasible? (NA for some epidemiological studies) Yes
Validity Questions
1. Was the research question clearly stated? Yes
  1.1. Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? Yes
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated? Yes
  1.3. Were the target population and setting specified? Yes
2. Was the selection of study subjects/patients free from bias? Yes
  2.1. Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? Yes
  2.2. Were criteria applied equally to all study groups? Yes
  2.3. Were health, demographics, and other characteristics of subjects described? Yes
  2.4. Were the subjects/patients a representative sample of the relevant population? Yes
3. Were study groups comparable? Yes
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) Yes
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? Yes
  3.3. Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) N/A
  3.4. If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? N/A
  3.5. If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) N/A
  3.6. If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? N/A
4. Was method of handling withdrawals described? No
  4.1. Were follow-up methods described and the same for all groups? No
  4.2. Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) No
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? No
  4.4. Were reasons for withdrawals similar across groups? N/A
  4.5. If diagnostic test, was decision to perform reference test not dependent on results of test under study? N/A
5. Was blinding used to prevent introduction of bias? No
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? N/A
  5.2. Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) N/A
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? N/A
  5.4. In case control study, was case definition explicit and case ascertainment not influenced by exposure status? N/A
  5.5. In diagnostic study, were test results blinded to patient history and other test results? No
6. Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? Yes
  6.1. In RCT or other intervention trial, were protocols described for all regimens studied? N/A
  6.2. In observational study, were interventions, study settings, and clinicians/provider described? Yes
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? N/A
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured? N/A
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described? Yes
  6.6. Were extra or unplanned treatments described? No
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? Yes
  6.8. In diagnostic study, were details of test administration and replication sufficient? Yes
7. Were outcomes clearly defined and the measurements valid and reliable? Yes
  7.1. Were primary and secondary endpoints described and relevant to the question? Yes
  7.2. Were nutrition measures appropriate to question and outcomes of concern? Yes
  7.3. Was the period of follow-up long enough for important outcome(s) to occur? Yes
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? Yes
  7.5. Was the measurement of effect at an appropriate level of precision? Yes
  7.6. Were other factors accounted for (measured) that could affect outcomes? No
  7.7. Were the measurements conducted consistently across groups? Yes
8. Was the statistical analysis appropriate for the study design and type of outcome indicators? Yes
  8.1. Were statistical analyses adequately described and the results reported appropriately? Yes
  8.2. Were correct statistical tests used and assumptions of test not violated? Yes
  8.3. Were statistics reported with levels of significance and/or confidence intervals? Yes
  8.4. Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? N/A
  8.5. Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? N/A
  8.6. Was clinical significance as well as statistical significance reported? Yes
  8.7. If negative findings, was a power calculation reported to address type 2 error? N/A
9. Are conclusions supported by results with biases and limitations taken into consideration? Yes
  9.1. Is there a discussion of findings? Yes
  9.2. Are biases and study limitations identified and discussed? Yes
10. Is bias due to study's funding or sponsorship unlikely? Yes
  10.1. Were sources of funding and investigators' affiliations described? No
  10.2. Was the study free from apparent conflict of interest? Yes