The ‘malnutrition universal screening tool’ (‘MUST’) for adults has been developed for all health care settings and patient groups, but ease of use and agreement with other published tools when screening to identify malnutrition requires investigation. The present study assessed the agreement and the prevalence of malnutrition risk between ‘MUST’ and a variety of other tools in the same patients and compared the ease of using these tools. Groups of patients were consecutively screened using ‘MUST’ and: (1) MEREC Bulletin (MEREC) and Hickson and Hill (HH) tools (fifty gastroenterology outpatients); (2) nutrition risk score (NRS) and malnutrition screening tool (MST; seventy-five medical inpatients); (3) short-form mini nutritional assessment (MNA-tool; eighty-six elderly and eighty-five surgical inpatients); (4) subjective global assessment (SGA; fifty medical inpatients); (5) Doyle undernutrition risk score (URS; fifty-two surgical inpatients). Using ‘MUST’, the prevalence of malnutrition risk ranged from 19–60% in inpatients and 30% in outpatients. ‘MUST’ had ‘excellent’ agreement (κ 0.775–0.893) with MEREC, NRS and SGA tools, ‘fair–good’ agreement (κ 0.551–0.711) with HH, MST and MNA-tool tools and ‘poor’ agreement with the URS tool (κ 0.255). When categorisation of malnutrition risk differed between tools, it did not do so systematically, except between ‘MUST’ and MNA-tool (P=0.0005) and URS (P=0.039). ‘MUST’ and MST were the easiest, quickest tools to complete (3–5 min). The present investigation suggested a high prevalence of malnutrition in hospital inpatients and outpatients (19–60% with ‘MUST’) and ‘fair–good’ to ‘excellent’ agreement beyond chance between ‘MUST’ and most other tools studied. ‘MUST’ was quick and easy to use in these patient groups.

This present paper reviews the reliability and validity of visual analogue scales (VAS) in terms of (1) their ability to predict feeding behaviour, (2) their sensitivity to experimental manipulations, and (3) their reproducibility. VAS correlate with, but do not reliably predict, energy intake to the extent that they could be used as a proxy of energy intake. They do predict meal initiation in subjects eating their normal diets in their normal environment. Under laboratory conditions, subjectively rated motivation to eat using VAS is sensitive to experimental manipulations and has been found to be reproducible in relation to those experimental regimens. Other work has found them not to be reproducible in relation to repeated protocols. On balance, it would appear, in as much as it is possible to quantify, that VAS exhibit a good degree of within-subject reliability and validity in that they predict with reasonable certainty, meal initiation and amount eaten, and are sensitive to experimental manipulations. This reliability and validity appears more pronounced under the controlled (but more arti®cial) conditions of the laboratory where the signal : noise ratio in experiments appears to be elevated relative to real life. It appears that VAS are best used in within-subject, repeated-measures designs where the effect of different treatments can be compared under similar circumstances. They are best used in conjunction with other measures (e.g. feeding behaviour, changes in plasma metabolites) rather than as proxies for these variables. New hand-held electronic appetite rating systems (EARS) have been developed to increase reliability of data capture and decrease investigator workload. Recent studies have compared these with traditional pen and paper (P&P) VAS. The EARS have been found to be sensitive to experimental manipulations and reproducible relative to P&P. However, subjects appear to exhibit a signi®cantly more constrained use of the scale when using the EARS relative to the P&P. For this reason it is recommended that the two techniques are not used interchangeably.Visual analogue scales: Electronic appetite rating systems: Appetite: Hunger A speci®c advantage of studying the behaviour of human subjects (relative to animals) is that human subjects can be asked a number of questions relating to their motivation, sensations and attitudes. Psychologists and clinicians have long used subjective feelings of bodily sensations or functions to help in research investigations and patient management. Such assessments have been carried out in diverse conditions to examine a variety of`functions': quality of life (Hunt et al. 1981), pain (Ohnhaus & Alder, 1975;Downie et al. 1978), sex, libido, depression, anxiety (Keys et al. 1950, nausea and appetite (Hill & Blundell, 1982). Freyd (1923) has pointed out that such ratings are the only practical equivalents of objective measurements for many types of psychological phenomena, especially introspective or verbally reported data.Attempting to understand the role of food and ...

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Malnutrition and its impact on clinical outcome may be underestimated in hospitalised elderly as many screening procedures require measurements of weight and height that cannot often be undertaken in sick elderly patients. The ‘Malnutrition Universal Screening Tool’ (‘MUST’)has been developed to screen all adults, even if weight and/or height cannot be measured, enabling more complete information on malnutrition prevalence and its impact on clinical outcome to be obtained. In the present study, 150 consecutively admitted elderly patients (age 85 (sd 5·5) years) were recruited prospectively, screened with ‘MUST’ and clinical outcome recorded. Although only 56% of patients could be weighed, all (n 150) could be screened with ‘MUST’; 58% were at malnutrition risk and these individuals had greater mortality (in-hospital and post-discharge, P<0·01) and longer hospital stays (P=0·02) than those at low risk. Both ‘MUST’ categorisation and component scores (BMI, weight loss, acute disease) were significantly related to mortality (P<0·03). Those patients with no measured or recalled weight (‘MUST’ subjective criteria used) had a greater risk of malnutrition (P<0·002) than those who could be weighed and, within both groups, clinical outcome was worse in those at risk of malnutrition. The present study suggests that ‘MUST’ predicts clinical outcome in hospitalised elderly, in whom malnutrition is common (58%). In those who cannot be weighed, a higher prevalence of malnutrition and associated poorer clinical outcome supports the importance of routine screening with a tool, like ‘MUST’, that can be used to screen all patients.

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OBJECTIVE -The aim of this systematic review was to determine the benefits of nutritional support in patients with type 1 or type 2 diabetes.RESEARCH DESIGN AND METHODS -Studies utilizing an enteral nutritional support intervention (oral supplements or tube feeding) were identified using electronic databases and bibliography searches. Comparisons of interest were nutritional support versus routine care and standard versus diabetes-specific formulas (containing high proportions of monounsaturated fatty acids, fructose, and fiber). Outcomes of interest were measures of glycemia and lipid status, medication requirements, nutritional status, quality of life, complications, and mortality. Meta-analyses were performed where possible.RESULTS -A total of 23 studies (comprising 784 patients) of oral supplements (16 studies) and tube feeding (7 studies) were included in the review, and the majority compared diabetesspecific with standard formulas. Compared with standard formulas, diabetes-specific formulas significantly reduced postprandial rise in blood glucose (by 1.03 mmol/l [95% CI 0.58 -1.47]; six randomized controlled trials [RCTs]), peak blood glucose concentration (by 1.59 mmol/l [86 -2.32]; two RCTs), and glucose area under curve (by 7.96 mmol ⅐ l Ϫ1 ⅐ min Ϫ1 [2.25-13.66]; four RCTs, i.e., by 35%) with no significant effect on HDL, total cholesterol, or triglyceride concentrations. In addition, individual studies reported a reduced requirement for insulin (26 -71% lower) and fewer complications with diabetes-specific compared with standard nutritional formulas.CONCLUSIONS -This systematic review shows that short-and long-term use of diabetesspecific formulas as oral supplements and tube feeds are associated with improved glycemic control compared with standard formulas. If such nutritional support is given long term, this may have implications for reducing chronic complications of diabetes, such as cardiovascular events. Diabetes Care 28:2267-2279, 2005T he impact of better glycemic control on long-term clinical outcome is well recognized in both type 1 (1) and type 2 (2) diabetes, where hyperglycemia may result in life-threatening complications and numerous comorbidities. In addition, many conditions, including accidental injury, stroke, and critical illness, show a worse outcome in the presence of hyperglycemia (3).In the U.K., the costs associated with major hyperglycemic complications range from £872 (€1,256 or $1,607 for blindness in one eye) to £8,459 (€12,178 or $15,591 for amputation) per patient (4), and the U.S. has reported annual diabetes health care costs of $11,157 (€8,710) per patient (5). This large economic burden is unsurprising given that patients with diabetes are known to be admitted to the hospital more often than other patient groups, accounting for up to 25% of intensive care admissions (3,6). Many of these hospitalized patients will require nutritional support. In addition, an increasing number of patients receive long-term home enteral tube feeding (ETF), including those with diabetes (7...