Position of the Academy of Nutrition and Dietetics: Malnutrition (Undernutrition) Screening Tools for All Adults

Skipper, Annalynn; Coltman, A.; Tomesko, Jennifer; Charney, Pamela; Porcari, Judith; Piemonte, Tami A.; Handu, Deepa; Cheng, Feon W.

doi:10.1016/j.jand.2019.09.011

Cited by 63 publications

(43 citation statements)

References 30 publications

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“…The sensitivity and specificity, as well as positive and negative predictive values, were obtained and interpreted with the following cut-off points: 90%-100% as high, 80% to ≤ 89% as moderate and ≤ 79% as low. 27 The positive and negative likelihood ratios were also calculated. A cut-off point for clinically satisfactory AUROC was set at ≥ 0.750.…”

Section: Discussionmentioning

confidence: 99%

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

Burgel¹,

Eckert

Brito

et al. 2021

J Human Nutrition Diet

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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.

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Section: Discussionmentioning

confidence: 99%

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

Burgel¹,

Eckert

Brito

et al. 2021

J Human Nutrition Diet

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“…The MST is a two‐item screening tool that assesses unintentional weight loss and decreased appetite. It is used to identify adults at risk of malnutrition (MST score of <2, not at risk; ≥2, at risk) ( 18 , 19 ).…”

Section: Methodsmentioning

confidence: 99%

Nutrition Information Resources Used by People With Systemic Sclerosis and Perceived Advantages and Disadvantages: A Nominal Group Technique Study

Østbø

Jimenez

Harb

et al. 2021

ACR Open Rheumatology

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Objective Where people with systemic sclerosis (SSc) (or scleroderma) obtain diet and nutrition information to manage their disease is not known. Objectives were to identify 1) resources used by people with SSc for nutrition and diet information and 2) perceived advantages and disadvantages of resources. Methods We conducted nominal group technique (NGT) sessions in which people with SSc reported nutrition and diet information resources they have used and perceived advantages and disadvantages of accessing and using resources. Participants indicated whether they had tried each resource. They rated helpfulness and importance of possible advantages and disadvantages. Items elicited across sessions were merged to eliminate overlap. Results We conducted four NGT sessions (three English language, one French language; 15 total participants) and identified 33 unique information resources, 147 resource‐specific advantages, and 118 resource‐specific disadvantages. Resource categories included health care providers, alternative and complementary practitioners, websites and other media platforms, events, and print materials. The most common themes for advantages and disadvantages included quality and individualization of information and accessibility of resources in terms of cost, location, and comprehensibility. Information provided by medical professionals was regarded as most credible and can be obtained through books, articles, and websites if individual consultation is not easily accessible. Web‐based information was considered highly accessible, although of variable credibility. In‐person events may be an important source of health information for people with SSc. Conclusion People with SSc obtain nutrition and diet information from multiple resources. They seek credible and accessible resources that provide SSc‐specific and individualized information.

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“…The area under the ROC curve (95% CI) was constructed. Sensitivity, specificity, and positive and negative predictive values were calculated and classified according to the following cutoffs: 90%–100% as high, 80% to ≤89% as moderate, ≤79% as low 38 . The positive and negative likelihood ratios were also calculated.…”

Section: Methodsmentioning

confidence: 99%

Concurrent and Predictive Validity of AND‐ASPEN Malnutrition Consensus Is Satisfactory in Hospitalized Patients: A Longitudinal Study

Burgel¹,

Teixeira²,

Leites³

et al. 2020

J Parenter Enteral Nutr

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Background Subjective Global Assessment (SGA) is the reference method to identify hospital malnutrition. The Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition (AND‐ASPEN) proposed a more objective consensus, but studies regarding its validity are still scarce. This study aimed to evaluate the concurrent and predictive validity of the AND‐ASPEN Consensus. Methods Prospective cohort conducted with hospitalized adult and elderly patients. At admission, general data were collected and patients were evaluated by SGA and AND‐ASPEN with and without handgrip strength (HGS) for nutrition diagnoses. Patients were followed up for collection of outcomes—length of hospital stay (LOS), in‐hospital death, readmission, and mortality within 6 months after being discharged. Concurrent and predictive validity were tested. Results Six hundred patients (55.7 ± 14.8 years, 51.3% males) were evaluated. The median of LOS was 10.0 (5.018.0) days and in‐hospital mortality was 2.7%. SGA identified 34.0% and AND‐ASPEN 34.6% of patients as malnourished. AND‐ASPEN had substantial agreement with SGA (κ = 0.690) and satisfactory accuracy (AUC = 0.85; 95% CI, 0.810.88). Malnutrition defined by AND‐ASPEN predicted about 1.4 times higher risk of prolonged LOS (95% CI, 1.2–1.6) and hospital readmission (95% CI, 1.2–1.8), besides 5.0 times higher risk of hospital death (95% CI, 1.3–18.8) and 6 months' death (95% CI, 2.6–9.9), in an adjusted analysis. The validity of AND‐ASPEN without HGS was also satisfactory. Conclusion AND‐ASPEN can be used for malnutrition diagnoses, even without HGS because it has satisfactory concurrent and predictive validity.

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Position of the Academy of Nutrition and Dietetics: Malnutrition (Undernutrition) Screening Tools for All Adults

Cited by 63 publications

References 30 publications

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

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

Nutrition Information Resources Used by People With Systemic Sclerosis and Perceived Advantages and Disadvantages: A Nominal Group Technique Study

Concurrent and Predictive Validity of AND‐ASPEN Malnutrition Consensus Is Satisfactory in Hospitalized Patients: A Longitudinal Study

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