Nutritional Risk Screening Tools for Older Adults with COVID-19: A Systematic Review

Abstract

Coronavirus disease 2019 (COVID-19) is associated with high risk of malnutrition, primarily in older people; assessing nutritional risk using appropriate screening tools is critical. This systematic review identified applicable tools and assessed their measurement properties. Literature was searched in the MEDLINE, Embase, and LILACS databases. Four studies conducted in China met the eligibility criteria. Sample sizes ranged from six to 182, and participants’ ages from 65 to 87 years. Seven nutritional screening and assessment tools were used: the Nutritional Risk Screening 2002 (NRS-2002), the Mini Nutritional Assessment (MNA), the MNA-short form (MNA-sf), the Malnutrition Universal Screening Tool (MUST), the Nutritional Risk Index (NRI), the Geriatric NRI (GNRI), and modified Nutrition Risk in the Critically ill (mNUTRIC) score. Nutritional risk was identified in 27.5% to 100% of participants. The NRS-2002, MNA, MNA-sf, NRI, and MUST demonstrated high sensitivity; the MUST had better specificity. The MNA and MUST demonstrated better criterion validity. The MNA-sf demonstrated better predictive validity for poor appetite and weight loss; the NRS-2002 demonstrated better predictive validity for prolonged hospitalization. mNUTRIC score demonstrated good predictive validity for hospital mortality. Most instruments demonstrate high sensitivity for identifying nutritional risk, but none are acknowledged as the best for nutritional screening in older adults with COVID-19.

Nutritional Risk Screening and Body Composition in COVID‐19 Patients Hospitalized in an Internal Medicine Ward

“…1 Nutritional status was found to be associated with the novel Coronavirus disease 2019 (COVID-19) severity, and malnutrition might play a role in this regard, but this aspect was investigated in a limited number of studies. [2][3][4] Previous studies have shown that malnutrition represents an independent risk factor for the prognosis of various infectious diseases including pneumonia. 5 Nutritional risk screening tools are useful in the everyday clinical practice to promptly detect potential or evident malnutrition.…”

“…A previous study conducted in a Chinese cohort of 140 elderly patients (over 65 years) hospitalized for COVID-19 and later a systematic review, analyzed the usefulness of the different NRS scales, including the NRS-2002, confirming their usefulness in screening patients needing additional nutritional interventions. 4,9 Currently, several studies are striving to define the risk factors for the development of severe pneumonia in COVID-19 patients and to identify the factors that can have an impact on patient outcome. 10,11 To date, there are also no studies that have evaluated the nutritional status of patients affected by COVID-19 with bioelectrical impedance analysis (BIA).…”

“…A previous study conducted in a Chinese cohort of 140 elderly patients (over 65 years) hospitalized for COVID-19 and later a systematic review, analyzed the usefulness of the different NRS scales, including the NRS-2002, confirming their usefulness in screening patients needing additional nutritional interventions. 4 , 9 …”

Comparison of Nutrition Risk Screening 2002 and Subjective Global Assessment Form as Short Nutrition Assessment Tools in Older Hospitalized Adults

“…This potential disparity should be corroborated in future prospective studies. Especially, given recently demonstrated high sensitivity of NRS-2002 for identifying nutritional risk and predictive validity for prolonged hospitalization in older adults with COVID-19 [ 45 ]. Adding those physical, cognitive and frailty data to phenotypic and etiologic criteria of malnutrition proposed by the Global Leadership Initiative on Malnutrition (GLIM) might also have enriched diagnosis and severity grading of malnutrition [ 13 ].…”

Editorial: COVID-19 in older persons: the role of nutrition

“…The authors concluded that NRS 2002, MNA-SF and NRI are suitable instrument for nutritional screening in older patients with COVID-19 infection [ 12 ]. In a recently published systematic review on the screening tools for malnutrition in COVID-19 patients Silva et al [ 13 ] provided an overview on the current literature, but were not able to identify a superior tool for this purpose, but they stated that all tested tools – MNA, MNA-SF, NRS, MUST and Nutritional Risk Index – demonstrated high sensitivity.…”