The two most popular malnutrition screening tools in the light of the new ESPEN consensus definition of the diagnostic criteria for malnutrition

Poulia, Kalliopi-Anna; Kłęk, Stanisław; Doundoulakis, Ioannis; Bouras, Emmanouil; Karayiannis, Dimitrios; Baschali, Aristea; Passakiotou, M.; Chourdakis, Michael

doi:10.1016/j.clnu.2016.07.014

Cited by 103 publications

(91 citation statements)

References 25 publications

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“…The ESPEN criteria for diagnosis of malnutrition gave a lower estimate of malnourished patients compared to the usual diagnostic criteria, and this is in accordance with other publications [5,6]. The main differences between our national and the ESPEN criteria for diagnosis of malnutrition are that data on food intake are included in the national definition and that the combination of weight loss and reduced fat free mass is an option in the ESPEN definition.…”

Section: Discussionsupporting

confidence: 69%

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A low proportion of malnourished patients receive nutrition treatment — results from nutritionDay

Henriksen

Gjelstad

Nilssen

et al. 2017

Food & Nutrition Research

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NutritionDay is a yearly point-prevalence study of malnutrition in hospitals from more than 50 countries. The aim of the present study was to quantify the frequency of malnutrition and the proportion of malnourished patients receiving nutritional treatment in two university hospitals in Norway using data from nutritionDay. All units at Oslo University Hospital (OUH) and University Hospital of Northern Norway (UNN) were invited to participate in nutritionDay 2014, and 28 out of 85 eligible units agreed to take part. Malnutrition was diagnosed based on body mass index (BMI), weight reduction and food intake in the previous week, according to national guidelines and ESPEN criteria. Data from 488 patients were available, representing 90.1% of occupied beds in participating units. Thirty percent of the patients were diagnosed malnourished when national criteria were used, and only 41% of these patients received nutritional treatment. The estimated malnutrition rate was 11% when the ESPEN consensus criteria were used. Data on weight or height were frequently missing in the patient records, and BMI could only be calculated in twothirds of the patients. The frequency of low BMI (<18.5 kg/m 2 ) was only 5%. Involuntary weight loss was present in 37% of the patients, and 60% had eaten less than normal in the previous week. Oncology units had the highest frequency of patients with low BMI, and the highest weight loss and overall malnutrition rate. Surgery and geriatric units had the highest rate of patients with low food intake. In this study, nearly 60% of the malnourished patients did not receive any nutritional treatment, and this indicates a potential for improved nutritional care and cost savings. Low food intake and weight loss were frequent at these two Norwegian hospitals, and in line with previous reports from nutritionDay in other countries. ARTICLE HISTORY

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Section: Discussionsupporting

confidence: 69%

“…Several screening tools and diagnostic criteria exist, but there is no general consensus on which are preferable. The prevalence of malnutrition in European hospitals ranges from 20 to 60% [3][4][5][6]. The wide range may be explained by regional variations and use of different tools and criteria.…”

Section: Introductionmentioning

confidence: 99%

A low proportion of malnourished patients receive nutrition treatment — results from nutritionDay

Henriksen

Gjelstad

Nilssen

et al. 2017

Food & Nutrition Research

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“…In their metaanalysis of 128 randomized clinical trials, Kondrup et al [7] validated the patient-and treatment-related risk factors for malnutrition and proposed the NRS scale as a tool for their assessment. Its effectiveness has been confirmed by a number of studies [5,7,[16][17][18][19]. Budzyński et al [17], for instance, analyzed annual admissions to a selected full-profile centre (more than 15,000 patients, 20,000 hospitalizations) and confirmed the utility of the NRS 2002 in the prognosis of both 14-and 30-day readmission (OR, respectively: 2.44, p < 0.0001 and 2.37 p < 0.001) and in-hospital mortality (OR 13.95, p < 0.001).…”

Section: Discussionmentioning

confidence: 64%

“…The lack of NRS 2002 scores for all patients (only 83% were studied) may undermine its validity, but a comparison with the Polish population [3] shows a similar distribution of malnutrition in the study group (51% NRS 2002 ≥ 3 points). Like many other studies, the current analysis suggests that the NRS 2002 scale may be very useful in the risk assessment of postoperative complications and conservative cancer treatment [16][17][18][19]. It is an extremely simple tool with a high predictive value.…”

Section: Discussionmentioning

confidence: 90%

Utility of nutritional evaluation for the clinical risk assessment of postoperative complications. Does oncology need the NRS 2002 scale?

Potyrała

Ogonowska²,

Toboła³

et al. 2017

Nowotwory. Journal of Oncology

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Introduction. Malnutrition accompanies many cancers, especially those of the gastrointestinal tract, and significantly raises the risk of postoperative complications in cancer surgery. In Poland, hospitals are legally obliged to evaluate the nutritional status of their patients; one of the assessment tools used for this purpose is the NRS 2002 scale. Aim. The primary objective of the study is to analyze the utility of the NRS 2002 scale in the risk assessment of postoperative complications in gastrointestinal cancers. In addition, the authors propose to determine whether the legal requirement to conduct nutritional assessments among hospitalized patients is complied with in clinical practice and to evaluate the risk of malnutrition in the study group. Materials and methods. A detailed assessment was conducted on 226 patients who underwent surgery for upper (95 patients) and lower (131 patients) GI tract cancers in 2015. The risk of complications was analyzed based on the nutritional risk score (NRS 2002) and the levels of albumin and total proteins in the serum before surgery. Compliance with the obligation to carry out nutritional assessments was evaluated on breast and GI cancer patients treated with surgery at the Institute of Oncology in Warsaw in two successive years.Results. An NRS 2002 score of ≥ 3 was shown to predict postoperative complications for both upper GI tract (p < 0.001) and colorectal cancers (p < 0.001). In upper GI cancers, complications were also more frequently observed at lower albumin (p = 0.018) and total protein (p = 0.025) levels in the serum. Conclusion. The analysis shows that the NRS 2002 scale is useful in predicting the risk of postoperative complications in the treatment of upper and lower GI tract cancers. NOWOTWORY J Oncol 2017; 67, 3: 174-179

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“…Of the three evaluated tools, the Liver Disease Undernutrition Screening Tool was able to predict malnutrition with a positive predictive value of 93% as compared to an RD led assessment, but requires external validation and correlation with outcomes. The NRS‐2002 predicted post‐transplant outcomes, but as has been identified from the use of this tool in other populations, it is inpatient‐focused, with limited evidence for generalisability to the outpatient setting. Recommended by a recent review and by the European Association for the Study of the Liver nutrition in chronic liver disease guidelines as a reasonable screening tool in cirrhosis, the RFH‐NPT has several advantages, including rapidity of the tool and a separate evaluation in patients who have volume overload.…”

Section: Discussionmentioning

confidence: 99%

Systematic review with meta‐analysis: Nutritional screening and assessment tools in cirrhosis

Ney

Vandermeer

et al. 2019

Liver International

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Background & Aims Disease‐related malnutrition is common in cirrhosis. Multiple studies have evaluated nutritional screening tools (NSTs, rapid bedside tests targeting who needs assessment) and nutritional assessment tools (NATs, used in diagnosing malnutrition) as predictors of clinical outcome in this population. We performed a systematic review and meta‐analysis of this literature with the aim of summarising the varying definitions of malnutrition across studies, the available evidence for NSTs and the ability of NSTs and NATs to predict clinical outcomes in cirrhosis. Methods The primary outcome measures were pre‐ and post‐transplant mortality with a range of secondary outcomes. Inclusion: cirrhosis over age 16. Exclusion: >25% with hepatocellular carcinoma, primarily laboratory test‐based NATs or lack of screening, assessment or outcome criteria. Results Eight thousand eight hundred fifty patients were included across 47 studies. Only 3 studies assessed NSTs. Thirty‐two definitions for malnutrition were utilised across studies. NATs predicted pre‐transplant mortality in 69% of cases that were assessed with a risk ratio (RR) of 2.38 (95% CI 1.96‐2.89). NATs were prognostic for post‐transplant mortality only 28% of the times they were assessed, with a RR of 3.04 (95% CI 1.51‐6.12). Conclusions The cirrhosis literature includes limited data on nutrition screening and multiple definitions for what constitutes malnutrition using NATs. Despite this discordance, it is clear that malnutrition is a valuable predictor of pre‐transplant mortality almost regardless of how it is defined. We require clinical and research consensus around the definition of malnutrition and the accepted processes and cut‐points for nutrition screening and assessment in cirrhosis.

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The two most popular malnutrition screening tools in the light of the new ESPEN consensus definition of the diagnostic criteria for malnutrition

Cited by 103 publications

References 25 publications

A low proportion of malnourished patients receive nutrition treatment — results from nutritionDay

A low proportion of malnourished patients receive nutrition treatment — results from nutritionDay

Utility of nutritional evaluation for the clinical risk assessment of postoperative complications. Does oncology need the NRS 2002 scale?

Systematic review with meta‐analysis: Nutritional screening and assessment tools in cirrhosis

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