Abstract
Background/objectivesTraditional malnutrition screening instruments, including the Malnutrition Universal Screening Tool (MUST), strongly rely on low body mass index (BMI) and weight loss. In overweight/obese patients, this may result in underdetection of malnutrition risk. Alternative instruments, like the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF), include characteristics and risk factors irrespective of BMI. Therefore, we aimed to compare performance of MUST and PG-SGA SF in malnutrition risk evaluation in overweight/obese hospitalized patients.Subjects/methodsWe assessed malnutrition risk using MUST (≥1 = increased risk) and PG-SGA SF (≥4 = increased risk) in adult patients at hospital admission in a university hospital. We compared results for patients with BMI < 25 kg/m2 vs. BMI ≥ 25 kg/m2.ResultsOf 430 patients analyzed (58 ± 16 years, 53% male, BMI 26.9 ± 5.5 kg/m2), 35% were overweight and 25% obese. Malnutrition risk was present in 16% according to MUST and 42% according to PG-SGA SF. In patients with BMI < 25 kg/m2, MUST identified 31% as at risk vs. 52% by PG-SGA SF. In patients with BMI ≥ 25 kg/m2, MUST identified 5% as at risk vs. 36% by PG-SGA SF. Agreement between MUST and PG-SGA SF was low (к = 0.143). Of the overweight/obese patients at risk according to PG-SGA SF, 83/92 (90%) were categorized as low risk by MUST.ConclusionsMore than one-third of overweight/obese patients is at risk for malnutrition at hospital admission according to PG-SGA SF. Most of them are not identified by MUST. Awareness of BMI-dependency of malnutrition screening instruments and potential underestimation of malnutrition risk in overweight/obese patients by using these instruments is warranted.
Highlights
The impact of disease-related malnutrition on both patient outcomes and health care systems, e.g., in terms of care burden, hospital costs and length of stay, has gained increasing attention over the last decades [1,2,3,4]
Of 92 overweight or obese patients at risk for malnutrition according to the PG-Subjective Global Assessment (SGA) SF, a striking 90% was categorized as low risk by the Malnutrition Universal Screening Tool (MUST)
Female overweight or obese patients, and patients admitted to a medical ward were more often at risk, and length of hospital stay was significantly higher in overweight or obese patients at increased malnutrition risk compared with patients with low malnutrition risk and a similar body mass index (BMI)
Summary
The impact of disease-related malnutrition on both patient outcomes and health care systems, e.g., in terms of care burden, hospital costs and length of stay, has gained increasing attention over the last decades [1,2,3,4]. In recognition of this worldwide issue, terminology and criteria for malnutrition have been defined and adjusted [5, 6], and various screening and assessment instruments have been developed and implemented to facilitate early detection and intervention [7, 8]. In an increasingly overweight and obese patient population, a high contribution of criteria that depend on BMI and weight loss for detection of malnutrition may result in underdetection of disease-related malnutrition and risk thereof [14]
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