Hemodialysis Specific Nutrition Screening Tool (HD-NUT): validity and reliability assesment for Turkey.

Background: Subjective Global Assessment (SGA) had been recommended by the Renal Association (Wright & Jones 2010) as an appropriate nutritional screening tool for the detection of malnutrition in haemodialysis (HD) patients. However, it has been criticised for being time consuming (Kondrup et al. 2003) and lacking sensitivity (Kalantar-Zadeh et al.1999). The Patient Generated Subjective Global Assessment (PG-SGA) requires the patient to complete part of the screening tool; thus reducing the amount of time the dietitian spends completing it. A recent pilot project showed that, compared to SGA, PG-SGA was able to distinguish significant differences between several independent measurements of nutritional status (demonstrating construct validity) (Hyam et al., 2010). In contrast the Malnutrition Universal Screening Tool (MUST) did not identify risk of malnutrition in HD patients. The aim of the current project was to assess a greater number and range of patients (with respect to nutritional status) using the three tools, in order to confirm whether PG-SGA was the most appropriate nutritional screening tool for use in HD patients. Methods: The nutritional status of 65 HD patients (n = 43 male; n = 22 female) attending two renal units; St Georges and Canterbury, was assessed by one investigator at each unit (KF and RP respectively). There was no exclusion criteria, however investigators aimed to assess a greater proportion of patients with suspected malnutrition (identified by SN and SR) as this group was possibly under-represented in the previous study. Data included SGA, MUST, PG-SGA, grip strength, anthropometric and biochemical parameters. Construct validity was examined using ANOVA to compare differences between the nutritional values of those patients classified by the nutritional screening tools as being at no risk, moderate risk or high risk of malnutrition. Criterion validity was assessed using the kappa statistic to measure the level of agreement between SGA (as the gold standard), PG-SGA, and MUST. Results: SGA classifications of nutritional status were able to distinguish significant differences in: Albumin (P = 0.03); CRP (P = 0.023), hand grip strength (P = 0.001), average daily energy intake (P = 0.005), protein intake (P = 0.01) and haemoglobin (P = 0.0001). PG-SGA only identified significant differences in hand grip strength (P = 0.008) and mid arm circumference (P = 0.024). MUST identified differences in current BMI (P = 0.04), mid arm circumference (P = 0.005) and CRP (P = 0.03). A moderate kappa statistic (0.51) was recorded when comparing the level of agreement between PGSGA and SGA classifications of patients. Virtually no agreement was found between SGA and MUST (( = 0.07). The sensitivity of PG-SGA compared to SGA was 89% and the specificity was 50%. When MUST was compared to SGA the sensitivity was 31% and the specificity was 95%. The majority (63%) of patients were unable to complete the PG-SGA; which were then completed with the assistance of the investigators. Discussion: MUST poorly identify malnourished HD patients (as found previously by Hyam et al., 2010). However in contrast to the pilot study, this current study which included a larger more nutritionally diverse group of patients, indicated that SGA was more sensitive to changes within independent nutritional parameters than PG-SGA. Over half the patients were not able to complete the PGSGA so, contrary to expectations, there were no time savings. Conclusion: SGA appears to be more sensitive to the nutritional status of HD patients than PG-SGA and additionally a large proportion of HD patients find PG-SGA too difficult to complete. MUST is not a sensitive method for detecting malnutrition in this group of patients.

there is a need for a kidney-specific nutritional screening tool for patients with renal failure. It was planned to perform the validity and reliability of the Renal Inpatient Nutrition Screening Tool screening tool developed for renal patients in Turkey. the validity and reliability of the Renal Inpatient Nutrition Screening Tool were investigated by comparing it with the Malnutrition Universal Screening Tool and the Subjective Global Assessment for assessing malnutrition in 153 adult patients newly admitted to the nephrology unit. Nutritional status was assessed using anthropometric measurements and nurse opinion was assessed using a questionnaire. the Renal Inpatient Nutrition Screening Tool was found to be more sensitive than the Malnutrition Universal Screening Tool in identifying increased malnutrition risks and providing dietary guidance. Cramer V coefficient was 0.238 between the Malnutrition Universal Screening Tool and the Renal Inpatient Nutrition Screening Tool, and 0.137 between the Subjective Global Assessment and the Renal Inpatient Nutrition Screening Tool, indicating the compatibility of the Renal Inpatient Nutrition Screening Tool with the variables in the Malnutrition Universal Screening Tool screening tool. A significant positive moderate correlation was observed between the total number of red boxes in the Renal Inpatient Nutrition Screening Tool and the total score of Malnutrition Universal Screening Tool (p < 0.05; r = 0.404). the Renal Inpatient Nutrition Screening Tool is a valid and reliable tool for assessing malnutrition risks in renal patients in Turkey, particularly when used by experienced specialist nurses in nephrology units.

The aim of this study was to analyse the validity and reliability of the Turkish version of the renal inpatient nutrition screening tool (Renal iNUT) for haemodialysis patients. The Renal iNUT and the malnutrition universal screening tool (MUST) were used in adult haemodialysis patients at two different centres to identify malnutrition. The subjective global assessment (SGA), regarded as the gold standard for nutritional status assessment, was utilised for comparison. Structural validity was assessed using biochemical values and anthropometric measurements, while reliability was assessed using repeated the Renal iNUT assessment. Of the 260 patients admitted, 42·3 % were malnourished (SGA score was B or C). According to the Renal iNUT, 59·6 % of the patients were at increased risk for malnutrition (score ≥ 1) and 3·8 % required referral to a dietitian (score ≥ 2). According to the MUST, 13·1 % of the patients were at increased risk for malnutrition and 8·5 % required referral to a dietitian. The Renal iNUT was found to be more sensitive in detecting increased risk of malnutrition in haemodialysis patients compared with the MUST (59·6 % v. 13·1 %). According to the SGA, the sensitivity of the Renal iNUT is higher compared to the MUST (89 % and 45 %, respectively). Kappa-assessed reliability of the Renal iNUT was 0·48 (95 % CI, 0·58, 0·9) and a moderate concordance was observed. The Renal iNUT is a valid and reliable nutritional screening tool for evaluating haemodialysis patients to determine their nutritional status. The use of the Renal iNUT by dietitians will contribute to the identification of malnutrition and its treatment.

A new renal inpatient nutrition screening tool (Renal iNUT): a multicenter validation study

Comparison of tools for nutritional assessment and screening at hospital admission: A population study

The purpose of these guidelines is to provide dietitians in Australia with a user-friendly summary of the evidence to support the nutritional management of adult patients with cancer cachexia. This best available evidence is presented and used as a basis for providing recommendations about clinical practice. The clinical questions were as follows: How should patients be identified for referral to the dietitian in order to maximise nutritional intervention opportunities? How should nutritional status be assessed? What are the goals of nutrition intervention for patients with cancer cachexia? What is the nutrition prescription to achieve these goals? Should eicosapentaenoic acid be included in the prescription? What are effective methods of implementation to ensure positive outcomes? Does nutrition intervention improve outcomes in patients with cancer cachexia? This document is a general guide to appropriate practice to be followed only subject to the dietitian's judgement in each individual case. The guidelines are designed to provide information to assist decision-making and are based on the best information available at the date of compilation. The guidelines recommend intensive nutrition therapy. This has potential resource implications that may include additional staff, change to staff roles and increased use of high/protein energy supplements if they are considered. Therefore, in applying the guidelines these potential organisational and cost barriers need to be considered. These guidelines for practice are provided with the express understanding that they do not establish or specify particular standards of care, whether legal, medical or other.

Twenty years ago, ESPEN published its "Guidelines for nutritional screening 2002", with the note that these guidelines were based on the evidence available until 2002, and that they needed to be updated and adapted to current state of knowledge in the future. Twenty years have passed, and tremendous progress has been made in the field of malnutrition risk screening. Many screening tools have been developed and validated for different patient groups and different health care settings. Some countries even have introduced mandatory screening for malnutrition at admission to hospital. Yet, changes in society and healthcare require a reflection on current practice and policies regarding malnutrition risk screening. In this opinion paper, we share our perspectives on malnutrition risk screening in the twenty-twenties, addressing the changing and varying profile of the malnourished individual, the goals of screening and screening tools (i.e., preventive or reactive), the construct of malnutrition risk (i.e., screening for risk factors or screening for existing malnutrition), and screening alongside a patient's journey.

The prevalence of malnutrition in hospitals is high. No nutritional screening tool is considered the gold standard for identifying nutritional risk. The aims of this study were to evaluate nutritional risk in hospitalized patients using four nutritional screening tools. Four nutritional screening tools were evaluated: nutritional risk screening (NRS-2002), the malnutrition universal screening tool (MUST), the subjective global assessment (SGA) and the mini nutritional assessment (MNA). Patients were assessed within the first 36 h after hospital admission. Date of admission, diagnosis, complications and date of discharge were collected. To compare the tools, the results were reorganized into: patients at risk and patients with a good nutritional status. The statistical analysis included the χ(2)-test to assess differences between the tests and the κ statistic to assess agreement between the tests. The study sample comprised 400 patients (159 women, 241 men), mean age 67.3 (16.1) years. The prevalence of patients at nutritional risk with the NRS-2002, MUST, SGA and MNA was 34.5, 31.5, 35.3 and 58.5%, respectively. Statistically significant differences were observed between the four nutritional screening tools (P<0.001). The agreement between the tools was quite good except for the MNA (MNA-SGA κ=0.491, NRS-2002-SGA κ=0.620 and MUST-SGA κ=0.635). Patients at nutritional risk developed more complications during admission and had an increased length of stay. The prevalence of nutritional risk in hospitalized patients was high with all the tools used. The best agreement between the tools was for NRS-2002 with SGA and MUST with SGA. At admission, NRS-2002 and MUST should be used to screen for nutritional status.

Evaluation of nutritional screening tools for patients scheduled for cardiac surgery

The integrated assessment of nutritional status and presence of sarcopenia would help improve clinical outcomes of in-hospital aged patients. We compared three common nutritional screening tools with the new Global Leadership Initiative on Malnutrition (GLIM) diagnostic criteria among hospitalized older patients. To this, 152 older patients were assessed consecutively at hospital admission by the Malnutrition Universal Screening Tool (MUST), the Subjective Global Assessment (SGA), and the Nutritional Risk Screening 2002 (NRS-2002). A 46% prevalence of malnutrition was reported according to GLIM. Sensitivity was 64%, 96% and 47%, and specificity was 82%, 15% and 76% with the MUST, SGA, and NRS-2002, respectively. The concordance with GLIM criteria was 89%, 53% and 62% for the MUST, SGA, and NRS-2002, respectively. All the screening tools had a moderate value to diagnose malnutrition. Moreover, patients at high nutritional risk by MUST were more likely to present with sarcopenia than those at low risk (OR 2.5, CI 1.3-3.6). To conclude, MUST is better than SGA and NRS-2002 at detecting malnutrition in hospitalized older patients diagnosed by the new GLIM criteria. Furthermore, hospitalized older patients at high risk of malnutrition according to MUST are at high risk of presenting with sarcopenia. Nutritional status should be determined by MUST in older patients at hospital admission, followed by both GLIM and the European Working Group on Sarcopenia in Older People (EWGSOP2) assessment.

Chronic kidney disease (CKD) is characterized by its high prevalence of malnutrition, difficult to detect as it is underestimated by the usual tools. There is no valid or hospital-level nutritional screening tool in Spanish to identify patients with CKD at risk of malnutrition. to translate and accomplish the transcultural adaptation of Jackson's questionnaire (Renal Inpatient Nutrition Screening Tool [Renal iNUT]) to Spanish, which detects the risk of malnutrition in CKD inpatients and compares it with other nutritional tools. phase 1: translation, back-translation and transcultural adaptation of the questionnaire from the English to the Spanish version. A pilot test was carried out by nursing staff together with a satisfaction questionnaire. Phase 2: comparison of Renal iNUT with Malnutrition Universal Screening Tool (MUST) and Subjective Global Assessment (SGA). phase 1: the nursing staff's perception was highly favorable. They found it easy or very easy to use and 90 % of them did it in a maximum of ten minutes. Phase 2: from 48 patients included, Renal iNUT detected 44 % at low risk of malnutrition, 28 % at intermediate risk and 28 % at high risk. Increased sensitivity of Renal iNUT (p < 0.007) vs MUST (62.5 vs 33.3 %) and similar specificity (87.1 vs 90.6 %) were found, together with an acceptable correlation compared to SGA (r = 0.75, 95 % CI: 0.67 to 0.83). the Spanish version of Renal iNUT is a useful and easy-to-understand tool for health professionals. We also confirm its good correlation with SGA, with greater sensitivity than MUST for the risk of malnutrition detection in CKD inpatients.

Diagnostic accuracy of a validated screening tool for monitoring nutritional status in patients with colorectal cancer: a systematic review protocol

Evaluation of the efficacy of six nutritional screening tools to predict malnutrition in the elderly

Malnutrition is a common problem in patients with end-stage liver disease requiring liver transplantation. The aim of this study was to evaluate nutritional status by using nutritional screening tools [Nutritional Risk Screening (NRS) 2002, Malnutrition Universal Screening Tool (MUST) and Subjective Global Assessment (SGA)] in patients before and after liver transplantation. We analyzed medical record, blood test, nutrient intake and malnutrition rate just before transplantation and at discharge, and at 3, 6, 12 months after transplantation respectively. Initially 33 patients enrolled as study subjects and finally 28 patients completed the study. Nutrients intake such as energy, fiber, calcium, potassium, vitamin C, and folate were insufficient at 12 months after transplantation. The rates of malnutrition before transplantation were very high, reported at 81.8% for the NRS 2002, 87.9% for the MUST, and 84.8% for the SGA. By 12 months after operation, malnutrition rates reported at NRS, MUST and SGA had decreased to 6.1%, 10.7%, and 10.7%, respectively. Sensitivity was 87.1% for the NRS 2002, 82.0% for the MUST, and 92.0% for the SGA. Of these screening tools the SGA was the highest sensitive tool that predict the risk of mortality in malnutrition patients who received transplantation. Further studies on nutritional status of patients and proper tools for nutrition intervention are needed to provide adequate nutritional care for patients.

The aim of this study was to assess the prognostic value of different nutritional screening tools in patients undergoing cardiopulmonary bypass, with regard to adverse clinical outcome. This prospective cohort study analysed 1193 adult patients who underwent cardiopulmonary bypass. Patients were screened using five nutritional screening tools: Subjective Global Assessment (SGA), Nutritional Risk Screening 2002 (NRS-2002), Malnutrition Universal Screening Tool (MUST), Mini-Nutritional Assessment (MNA) and Short Nutritional Assessment Questionnaire (SNAQ). In-hospital mortality, postoperative complications, length of stay in intensive care unit and length of hospitalization were analysed. Multivariate backward logistic regression analysis was used to assess the independent predictive value of the studied screening tools. In accordance with univariate analysis, malnutrition detected by SNAQ, MUST, NRS-2002 and MNA was associated with postoperative complications (odds ratio [OR] 1.8, 95% confidence interval [95% CI] 1.3-2.4; OR 1.9, 95% CI 1.4-2.6; OR 1.8, 95% CI 1.2-2.9 and OR 1.9, 95% CI 1.4-2.6). Malnutrition detected by MUST, NRS-2002, MNA and SGA was associated with intensive care unit stay >2 days (OR 1.5, 95% CI 1.1-2.1; OR 2.3, 95% CI 1.5-3.7; OR 1.7, 95% CI 1.2-2.2 and OR 2.7, 95% CI 1.6-4.6). Prolonged hospitalization (>20 days) was predicted by SNAQ, MUST and MNA (OR 1.4, 95% CI 1-1.9; OR 1.6, 95% CI 1.2-2.2 and OR 1.6, 95% CI 1.2-2.2). In accordance with multivariate analysis, only MUST and MNA independently predicted postoperative complications (OR 1.6, 95% CI 1.1-2.3 and OR 1.6, 95% CI 1.1-2.2). Other independent factors influencing postoperative complications were well-known logistic EuroSCORE (OR 1.06, 95% CI 1-1.1) and the duration of cardiopulmonary bypass in minutes (OR 1.01, 95% CI 1-1.01). MUST and MNA both have independent predictive values with regard to postoperative complications. Taking into account simplicity, MUST is preferable for the cardiac surgical population.