Abstract
ObjectivesThe Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition have developed a set of consensus-derived indicators (the AACI) for the diagnosis of malnutrition in hospitalized adult and pediatric patients. This study aims to establish the predictive criterion and construct validity and reliability of the adult and pediatric AACI. MethodsWithin the context of a larger cohort study, 600 adult and 600 pediatric patients will be enrolled at ∼120 acute care hospital sites. Patients will be randomly selected and stratified approximately 1:1 as high- and low-risk for malnutrition based on the Malnutrition Screening Tool (adults) and STRONGkids screening tool (children). Registered dietitian nutritionists (RDNs) will collect AACI indicators and complete a Nutrition Focused Physical Exam for these patients. At a subset of 10–20 sites, bioelectrical impedance analysis (BIA) data will be collected to serve as an objective measure of body composition. After 90 days, follow-up data on nutrition care and medical outcomes (e.g., mortality, morbidity, hospital readmissions, length of stay, and healthcare costs) will be extracted from the medical record. Multilevel linear, logistic, multinomial, Poisson, or Cox regression models will be used to assess AACI validity as appropriate for each medical and BIA outcome, controlling for measures of disease severity, RDN-delivered medical nutrition therapy and other important patient-, RDN-, and site-level covariates as appropriate. The interrater reliability of the AACI will be evaluated by having multiple RDNs independently complete the AACI on the same patient to assess the agreement, using Cohen’s kappa, on specific indicators and overall malnutrition diagnosis. This study design follows recently published recommendations for assessing the validity and reliability of criteria for diagnosing malnutrition in hospitalized patients. ResultsN/A. ConclusionsValidation and reliability results will allow clinicians to standardize the way they diagnose malnutrition in hospitalized patients. Funding SourcesThis study is funded by the Academy of Nutrition and Dietetics Foundation, the Commission on Dietetic Registration, and the Pediatric Nutrition, Clinical Nutrition Management, and Renal Dietitians Dietetic Practice Groups.
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