Clinical measurement properties of malnutrition assessment tools for use with patients in hospitals: a systematic review

Abstract

Background The use of malnutrition outcome measures (OM) by registered dietitians (RD) with inpatients in hospitals has increased promoting the achievement of nutritional care goals and supporting decision-making for the allocation of nutritional care resources in hospitals. There are 3 commonly used OMs: Subjective Global Assessment (SGA), Patient Generated-Subjective Global Assessment (PG-SGA) and Mini Nutritional Assessment (MNA). The purpose of this current study was to systematically review the evidence of the clinical measurement properties of malnutrition assessment tools for use with patients admitted in hospitals. Methods MEDLINE, Cinahl, EMBASE, and PubMed were searched for articles published between 2000 and 2019. Research articles were selected if they established reliability, validity, and responsiveness to change properties of the SGA, PG-SGA and MNA tools, were written in English, and used any of these OMs as an outcome measure. Abstracts were not considered. The risk of bias within studies was assessed using the Quality Appraisal for Clinical Measurement Study (QA-CMS). Results Five hundred five studies were identified, of which 34 articles were included in the final review: SGA (n = 8), PG-SGA (n = 13), and MNA (n = 13). Of the 34 studies, 8 had a quality score greater than 75%; 23 had a quality score of 40–75% and 3 studies had a quality score of less than 40%. PG-SGA was found to have excellentdiagnostic accuracy (ROC: 0.92–0.975; Sensitivity: 88.6–98%; Specificity: 82–100%), sufficient internal consistency (Cronbach’s alpha: 0.722–0.73), and strong test-retest reliability (r = 0.866). There was insufficient evidence to suggest adequate diagnostic accuracy and good inter-rater reliability for SGA. Only one study examined the minimum detectable change of MNA (MDC = 2.1). Conclusions The evidence of validity for the existing malnutrition assessment tools supports the use of these tools, but more studies with sound methodological quality are needed to assess the responsiveness of these OMs to detect the change in nutritional status.

Effect of malnutrition on the postoperative outcomes of patients undergoing pancreatectomy for pancreatic cancer: Propensity score–matched analysis of 2011–2017 US hospitals

“…12 This type of device for nutrition screening and assessment can be helpful to critically evaluate the severity of malnutrition prior to surgery. Other assessment tools include the Subjective Global Assessment (SGA), Patient-Generated SGA (PG-SGA), and Mini Nutritional Assessment (MNA), 50 which can provide a stratified measure of malnutrition severity and potential need for preoperative nutrition interventions. Pancreatic exocrine insufficiency should be screened for by measuring fecal elastase, 5 and pancreatic enzyme replacement therapy should be considered.…”

Nutritional screening through patient-generated subjective global assessment (PG-SGA) in gynecological cancer

“…Esses resultados demonstram a necessidade da avaliação do estado nutricional através de utilização de métodos rápidos, de fácil aplicabilidade e de baixo custo, na busca de identificar o risco nutricional ou a desnutrição e assim, intervir precocemente com a terapêutica nutricional adequada 11,12 .…”

The association between MNA and PG-SGA malnutrition assessment and the quality of life among hemodialysis patients

“…12,13 The nutritional assessment tools might include Instant Nutritional Assessment (INA), Nutrition Risk Score (NRI), Mini Nutritional Assessment (MNA), and Patient Generated Subjective Global Assessment (PG -SGA). 14 Most of those tools have complexity in measurement and may involve laboratory examination and professional skills. To provide the frequent and comprehensive monitoring; the simple, reliable, easy to use, and non -invasive tool is required.…”

“…Since MNA and PG-SGA have multifunctional property and simple to test, we speculated that MNA and PG-SGA might be able to evaluate the functional status and quality of life among hemodialysis patients. 14 However, to date, no study assessed the role of MNA and PG -SGA in predicting the QOL of hemodialysis patients. Therefore, we aimed to evaluate the association between the nutritional status, assessed by MNA and PG -SGA, and the QOL of hemodialysis patients.…”