Accuracy of three tools for malnutrition diagnosis in hospitalised patients: Comparison to subjective global assessment

Abstract

Background: Malnutrition is prevalent in hospital, and the Subjective Global Assessment (SGA) has been widely used for its identification. However, in the last decade, new tools were proposed by the Academy of Nutrition and Dietetics-American Society for Parenteral and Enteral Nutrition (AND-ASPEN), European Society for Clinical Nutrition and Metabolism (ESPEN) and Global Leadership Initiative on Malnutrition (GLIM). The diagnostic test accuracy of these tools has been scarcely investigated. Thus, we aimed to compare the accuracy of AND-ASPEN, ESPEN and GLIM for malnutrition diagnosis in hospitalised patients. Methods:A cross-sectional study was conducted with hospitalised patients aged ≥ 18 years from a five-unit complex hospital. Malnutrition was diagnosed within 48 h of admission using SGA, AND-ASPEN, ESPEN and GLIM. The accuracy of these tools was evaluated by the area under the receiver operating characteristic (AUROC) curve, considering SGA as reference, which was compared by the DeLong test.Results: Six hundred patients (55.7 ± 14.8 years, 51.3% male) were evaluated. AND-ASPEN [AUROC 0.846; 95% confidence interval (CI) = 0.810-0.883] and GLIM presented a satisfactory accuracy (AUROC 0.842; 95% CI, 0.807-0.877), whereas ESPEN had a substantially lower accuracy (AUROC, 0.572; 95% CI, 0.522-0.622). The AUROC of AND-ASPEN and GLIM were not different from each other (p = 0.785) and both had significantly higher accuracy than ESPEN (p < 0.001). AND-ASPEN and GLIM presented sensitivity, specificity and negative predictive value > 80%, whereas ESPEN sensitivity was < 20%.Conclusions: AND-ASPEN and GLIM were accurate methods for diagnosing malnutrition and could be applied in hospitalised patients. By contrast, the ESPEN criteria had unsatisfactory accuracy.

Nutritional Status Assessed with Objective Data Assessment Correlates with a High-Risk Foot in Patients with Type 2 Diabetes

“…Therefore, timely nutritional assessment is needed for patients with diabetes and high-risk foot. Although Mini Nutritional Assessment (MNA) and subjective global assessment (SGA) are well-known nutritional assessment screening tools [ 20 , 21 ], they are not always easy to perform routinely in clinical practice. SGA is a well-established tool for nutritional assessment [ 20 ]; however, it is subjective and requires an evaluator with some training and specialized knowledge for accurate assessment.…”

Criterios GLIM: análisis de su consistencia interna y una comparación con respecto a la valoración global subjetiva

“…La sensibilidad del GLIM en pacientes con riesgo nutricional (99,1 %) fue acorde a lo recomendado (≥ 80 %) y se especula que el GLIM detecta fácilmente al individuo desnutrido (34) . Lo mismo fue demostrado por Brito y colaboradores (86,6 %) y Burgel y colaboradores (86,8 %) (9,10) . En cambio, Allard y colaboradores encontraron una sensibilidad menor (61,30 %) (8) .…”

“…Las diferencias de sensibilidad y especificidad encontradas con otros estudios podrían deberse tanto a la disparidad en la metodología de los mismos como a la muestra de pacientes incluidos. A su vez, se debe considerar el desempeño de cada herramienta en las distintas poblaciones y las discrepancias en las técnicas de medición (8)(9)(10) .…”

“…El estudio concluyó que el GLIM, con respecto a la VGS, subestimó la DN, pero aumentó la probabilidad de que un individuo fuera categorizado como gravemente desnutrido (8) . Luego, en 2021, Burgel y colaboradores, y Brito y colaboradores describieron una sensibilidad y especificidad del GLIM mayor del 80 % con respecto a la VGS (9,10) . Ambos consideraron que el GLIM puede ser utilizado en pacientes hospitalizados.…”

Nutrition screening tools: Still no consensus 40 years on

“…17 Similarly, a comparison of ESPEN, the Global Leadership Initiative on Malnutrition (GLIM) and the American Society for Parenteral and Enteral Nutrition (ASPEN) tools with SGA found that ESPEN had low sensitivity, whereas ASPEN and GLIM had good agreement. 18 There are many other examples of tools being validated against each other in the literature 19 and, typically, these show only modest agreement and consistency and highlight the variation in sensitivity for predicting malnutrition risk. A systematic review of tools and their predictive validity in clinical practice found that MNA had good utility for assessing older adults but that no tool was able to both adequately screen nutritional status and predict poor nutritional outcomes.…”