Abstract
Coronavirus disease 2019 (COVID-19) is associated with high risk of malnutrition, primarily in older people; assessing nutritional risk using appropriate screening tools is critical. This systematic review identified applicable tools and assessed their measurement properties. Literature was searched in the MEDLINE, Embase, and LILACS databases. Four studies conducted in China met the eligibility criteria. Sample sizes ranged from six to 182, and participants’ ages from 65 to 87 years. Seven nutritional screening and assessment tools were used: the Nutritional Risk Screening 2002 (NRS-2002), the Mini Nutritional Assessment (MNA), the MNA-short form (MNA-sf), the Malnutrition Universal Screening Tool (MUST), the Nutritional Risk Index (NRI), the Geriatric NRI (GNRI), and modified Nutrition Risk in the Critically ill (mNUTRIC) score. Nutritional risk was identified in 27.5% to 100% of participants. The NRS-2002, MNA, MNA-sf, NRI, and MUST demonstrated high sensitivity; the MUST had better specificity. The MNA and MUST demonstrated better criterion validity. The MNA-sf demonstrated better predictive validity for poor appetite and weight loss; the NRS-2002 demonstrated better predictive validity for prolonged hospitalization. mNUTRIC score demonstrated good predictive validity for hospital mortality. Most instruments demonstrate high sensitivity for identifying nutritional risk, but none are acknowledged as the best for nutritional screening in older adults with COVID-19.
Highlights
Disease caused by the novel coronavirus 2019 (COVID-19) is currently the most serious public health issue on several continents [1]
The literature search was conducted on July 3, 2020, using the Medical Literature Analysis and Retrieval System Online database (MEDLINE, via PubMed), the Excerpta Medica Database (Embase), and the Latin American and Caribbean Health Sciences Literature (LILACS) database using a combination of the following descriptors and their synonyms: “nutrition risk”, “nutritional risk”, “nutritional screening”, “nutrition screening”, “nutritional assessment”, “nutritional index”, “Geriatric
Nutritional risk was highly prevalent among older adults with COVID-19 regardless of the nutritional screening tool applied
Summary
Disease caused by the novel coronavirus 2019 (COVID-19) is currently the most serious public health issue on several continents [1]. Older age (over 65 years) has been associated with more severe disease and worse prognoses [2,3] Factors such as the presence of comorbidities, greater propensity for systemic organ dysfunction, and poor nutritional status can contribute to the heightened risk of clinical complications in older adults with COVID-19 [4]. Nutrients 2020, 12, 2956 system and, the effectiveness of treatment, resulting in greater disease severity [6,7] In this sense, the early assessment of nutritional risk, defined as ‘chances of a better or worse outcome from disease or surgery according to actual or potential nutritional and metabolic status’ [8], can contribute to the determination of the most appropriate nutritional therapy. Adequate nutrition can provide a better immune system response and a more favorable prognosis [6,7]
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