Validation of the Malnutrition Universal Screening Tool (MUST) in cancer

Abstract

In the present study, we aimed to validate the Malnutrition Universal Screening Tool (MUST) for routine nutritional screening in the radiation oncology setting, thus enabling timely and adequate referrals of patients at risk for individualised or advanced intervention. Towards this objective, we conducted a prospective cross-sectional study in 450 non-selected cancer patients (18-95 years) referred for radiotherapy. The following were the nutritional parameters: BMI (categorised by WHO's age/sex criteria), weight loss >5 % in the previous 3-6 months, Patient-Generated Subjective Global Assessment (PG-SGA - validated/specific for oncology) and nutritional risk by MUST. Sensitivity, specificity, predictive values and concordance were calculated to validate MUST v. PG-SGA and compare single parameters v. PG-SGA/MUST. BMI v. PG-SGA showed a negligible capacity to detect undernutrition: 0.27 sensitivity, 0.23 specificity, 0.35 positive predictive value and 0.31 negative predictive value. Conversely, percentage weight loss v. PG-SGA was highly effective: 0.76 sensitivity, 0.85 specificity, 0.79 positive predictive value and 0.85 negative predictive value. MUST v. PG-SGA successfully detected patients at risk: 0.80 sensitivity, 0.89 specificity, 0.87 positive predictive value and 1.0 negative predictive value; percentage weight loss v. MUST proved able to identify patients likely to be at risk: 0.85 sensitivity, 0.91 specificity, 0.90 positive predictive value and 1.0 negative predictive value. This is the first study in the radiation oncology setting to validate MUST: a simple and quick method applicable by any health professional, with a high validity for early screening, ideally to antedate a comprehensive nutritional assessment and guide for intervention. In this study, percentage weight loss in the previous 3-6 months does seem valid to predict nutritional risk, and may be the minimum in a busy routine.

Assessment of nutritional status of gynecological cancer cases in India and comparison of subjective and objective nutrition assessment parameters

“…Percentage weight loss has the ability to detect mild to extreme nutritional changes and its high sensitivity and specificity in cancer has been recently confirmed and has been suggested to be used alone if not using any other tool of comprehensive nutrition assessment. [27] The hemoglobin, serum albumin, and BMI were negatively correlated and approximate percentage weight lost in last 1 month was positively correlated with PG-SGA score as evident from Table 3. According to a Malaysian study, PG-SGA score is significantly correlated with anthropometric measurements.…”

The Efficacy of Oral Nutritional Intervention in Malnourished Cancer Patients: a Systemic Review

“…Although PG-SGA scores are determined based on changes in body weight, dietary intake, and physical symptoms, the assessment itself requires highly trained medical staff and well-established guidelines. Therefore, patient PG-SGA scores often differ when measured by different medical staff; in addition, not enough personnel are available in clinical settings [47]. Other nutritional assessment tools include the Malnutrition Universal Screening Tool (MUST), Prognostic Nutritional Index, NRI, Nutritional Screening Tool, Maastricht Index, Instant Nutrition Assessment, and Mini Nutritional Assessment.…”

Association of nutritional status-related indices and chemotherapy-induced adverse events in gastric cancer patients

“…The Malnutrition Universal Screening Tool (MUST) scores are often used for surgical patients and have been validated for cancer patients [8]. However, the applicability and accuracy of MUST in assessing nutritional status of gastric cancer patients has not been well evidenced.…”