Malnutrition Universal Screening Tool Score Research Articles

High prevalence of malnutrition in systemic sclerosis: Results from a French monocentric cross-sectional study

ObjectivesSystemic sclerosis (SSc) can cause malnutrition due to frequent gastrointestinal involvement. However, prevalence of malnutrition in SSc is poorly known. The aim of this study was to evaluate the prevalence of malnutrition in SSc and its potential associations with disease features in patients from a tertiary referral center. MethodsAll patients meeting American College of Rheumatology/European Alliance of Associations for Rheumatology criteria for SSc followed between January 1, 1985, and January 1, 2019, at the Department of Internal Medicine, Saint Eloi University Hospital, were included. Malnutrition was assessed using the 2020 French recommendations for SSc and the malnutrition universal screening tool score. Severe malnutrition was defined via the French Haute Autorité de Santé (National Health Authority) 2007 criteria. ResultsA total of 120 patients were included, with mean age 64 (± 15) y and a female-to-male sex ratio of 5:1. According to 2020 French recommendations, 71 patients (59.2%) were malnourished and 30 (25%) had at least one criterion of severe malnutrition. With the malnutrition universal screening tool score, 41.7%, 20%, and 38.3%, respectively, had low, medium, and high risk of malnutrition. Multivariate analysis revealed the following results: 1) malnutrition was associated with cardiac involvement (P < 0.01); 2) a high malnutrition universal screening tool score was also associated with specific cardiac involvement (P < 0.01); and 3) severe malnutrition was strongly correlated with interincisal distance <35 mm (P = 0.02). ConclusionsMalnutrition affects more than half of SSc patients and is associated with specific cardiac involvement. Interincisal distance <35 mm could be a red flag for severe malnutrition in SSc.

Relationship between Nutritional Risk, Clinical and Demographic Characteristics, and Pressure Ulcers in Patients with Severe Acquired Brain Injuries Attending a Rehabilitative Program.

Preliminary evidence in the literature suggests a high prevalence of malnutrition (undernutrition) in patients with severe acquired brain injuries (sABI), with an expected negative impact on clinical outcomes and pressure ulcers (PUs) in particular. In a retrospective cohort study on patients discharged from intensive care units (ICU) and admitted to an intensive rehabilitation unit (IRU), the risk of malnutrition was systematically assessed, in addition to standard clinical procedures (including PUs evaluation), using two different tools: the Malnutrition Universal Screening Tool (MUST) and the Controlling Nutritional Status (CONUT) tool. Eighty-eight patients were included in the analysis. A high proportion (79.5%) of patients with sABI suffered from PUs, being older and more frequently men, with a longer ICU stay between the event and admission to IRU, and a greater MUST score. At discharge, when compared to patients whose PUs had healed, those with persisting PUs were more often men and had the worst cognitive performance at admission. As for nutritional risk, the baseline CONUT score was identified as an independent negative predictor of PUs at discharge by the logistic regression model. In conclusion, the assessment of nutritional risk using simple standard tools may be useful in the clinical evaluation of sABI patients with PUs.

Screening for malnutrition in emergency laparotomy patients: a comparison of three tools.

Malnourished patients undergoing emergency laparotomy are at risk of significant morbidity. The optimum screening tool to identify such patients in practice and research is yet to be determined. This study aims to compare the performance of three nutrition risk tools in predicting time without enteral nutrition in this population. A prospective cohort study (NCT04696367) was conducted across two sites, recruiting patients undergoing National Emergency Laparotomy Audit eligible procedures. Data collected included demographics, diagnosis, procedure and outcomes. Nutrition risk was assessed using three tools: Malnutrition Universal Screening Tool (MUST) score, Nutritional Risk Index (NRI) and Nutritional Risk Score 2002 (NRS-2002). Complications were assessed with the Comprehensive Complication Index. Quality of life was measured at baseline and 5 days postsurgery using EQ-5D-5L. A total of 59 patients were recruited. Median age was 69 years. Of the 59 participants, 23 were judged high risk using MUST score, 13 using NRS and 8 using NRI. Median time to restart enteral intake was 7 days (interquartile range 7-14). Time without intake was correlated with increasing score using MUST (r=0.463, p<0.001) and NRS-2002 (r=0.296, p=0.03) but not NRI (r=-0.121, p=0.38). High-risk nutritional groups also had increased length of hospital stay, but not complication scores. Patients undergoing emergency laparotomy spend a prolonged time without enteral nutrition. Although all nutritional tools demonstrated some propensity to identify patients at higher risk of needing nutritional support, their performance was variable. Nevertheless, some may be useful in future clinical studies.

To Evaluate Dietary Protein Intake As Per Recommended Dietary Allowance (Rda 2020) And Correlate It With The Malnutrition Universal Screening Tool Score (Must) In Urban Indians Aged 40-60 Years.

To Evaluate Dietary Protein Intake As Per Recommended Dietary Allowance (Rda 2020) And Correlate It With The Malnutrition Universal Screening Tool Score (Must) In Urban Indians Aged 40-60 Years.

Evaluation of prevalence of food intake monitoring during acute hospitalization and its association with malnutrition screening scores of inpatients who were not considered for enteral or parenteral nutrition

ObjectivesMalnutrition risk can be recognized by nurses using screening tools and food intake monitoring. We measured the prevalence of food intake reporting and its association with malnutrition screening scores or other patient characteristics. MethodsThis retrospective cohort study collected hospital database information regarding patients aged ≥18 y who were hospitalized for ≥ 7 consecutive days and were orally fed or had medical records that no tube feeding or parenteral nutrition had been administered. Data were collected and statistically analyzed focusing on food intake reporting, Malnutrition Universal Screening Tool (MUST) scores, oral nutritional intervention, and other secondary characteristics. ResultsOut of 5155 patients admitted to two internal medicine departments over 1 y (July 1, 2018, through August 31, 2019), 1087 fulfilled the inclusion criteria with a mean age of 72.4 ± 14.6 y; of these, 74.6% had sufficient food intake reports. No food intake was reported for one-third of patients with MUST scores ≥ 2. There were no differences between the groups of patients with and without reported food intake with regard to MUST scores, sex, mean albumin level, comorbidity, length of stay, all-cause in-hospital mortality, hospital-acquired pressure injury, or the rate of oral nutritional intervention. MUST scores ≥ 2 were not significantly associated with intake reporting. Increased probability of having food intake reported was found in patients ages ≥70 y (adjusted odds ratio = 1.36; P = 0.036 [95% CI, 1.02–1.82]) and those who had Norton scores ≤ 13 (adjusted odds ratio = 1.60; P = 0.013 [95% CI, 1.10–2.31]). However, the model had a weak predictive efficacy (area under the curve = 0.577; P < 0.0001 [95% CI, 0.538–0.616]). ConclusionsMore adherence to food intake monitoring guidelines is needed.

Increased Risk of Hospitalization, Surgery, and Venous Thromboembolism Among Patients With Inflammatory Bowel Disease and Malnutrition in a Large, Community-Based Health Care System.

Patients with inflammatory bowel disease (IBD) constitute a high-risk population for malnutrition. Routine screening with standardized tools is recommended but can be challenging. Outcome data specific to IBD are sparse. We performed a retrospective cohort study (2009-2019) and electronically screened a large community-based population with IBD for malnutrition risk by extracting height and longitudinal weight, data elements used in the Malnutrition Universal Screening Tool (MUST). We used Cox proportional hazards regression to evaluate whether an electronic medical record-derived modified MUST malnutrition risk score was associated with IBD-related hospitalization, surgery, and venous thromboembolism. Malnutrition risk was categorized as low in 10,844 patients with IBD (86.5%), medium in 1,135 patients (9.1%), and high in 551 patients (4.4%). In the 1-year follow-up period, medium and high malnutrition risks, compared with low risk, were associated with IBD-related hospitalization (medium-risk adjusted hazard ratio [aHR] 1.80, 95% confidence interval [CI] 1.34-2.42; high-risk aHR 1.90, 95% CI 1.30-2.78) and IBD-related surgery (medium risk aHR 2.28, 95% CI 1.60-3.26; high risk aHR 2.38, 95% CI 1.52-3.73). Only high malnutrition risk was associated with venous thromboembolism (aHR 2.79, 95% CI 1.33-5.87). Malnutrition risk is significantly associated with IBD-related hospitalization, surgery, and venous thromboembolism. Application of the MUST score to the electronic medical record can efficiently identify patients at risk for malnutrition and adverse outcomes, permitting concentration of nutritional and nonnutritional resources to those at greatest risk.

Impact of Malnutrition on Clinical Outcomes of Acutely Hospitalised Heart Failure Patients at Two Tertiary Hospitals in Australia: An Observational Study.

Malnutrition is common in patients with heart failure (HF) but is often neglected, despite guidelines suggesting that all hospitalised patients should undergo nutritional screening within 24-hours of admission. This study investigated the nutritional screening rates and determined the immediate and long-term clinical outcomes in patients with HF admitted at two tertiary hospitals in Australia. Nutritional screening was assessed by the Malnutrition Universal Screening Tool (MUST) completion rates. Patients were classified into two categories based on their MUST scores (0=low malnutrition risk and ≥1=at risk of malnutrition). Propensity-score-matching (PSM) was used to match 20 variables depending upon the risk of malnutrition. Clinical outcomes included the days-alive-and-out-of-hospital at 90 days of discharge (DAOH90), length of hospital stay, in-hospital, 30-day and 180-day mortality and 30-day readmissions. There were 5,734 HF admissions between 2013-2020, of whom, only 789 (13.8%) patients underwent MUST screening. The mean (SD) age was 76.2 (14.0) years and 51.9% were males. Five-hundred and fifty-four (554) (70.2%) patients were at low malnutrition risk and 235 (29.8%) at risk of malnutrition. In HF patients, who were at risk of malnutrition, the DAOH90 were lower by 5.9 days (95% CI -11.49 to -0.42, p=0.035) and 180-day mortality was significantly worse (coefficient 0.10, 95% CI 0.02-0.18, p=0.007) compared to those who were at low risk of malnutrition. However, other clinical outcomes were similar between the two groups. Nutrition screening is poor in hospitalised HF patients and long-term but not short-term clinical outcomes were worse in malnourished HF patients.

Can the Malnutrition Universal Screening Tool (MUST) Predict Healing Complications Following Microvascular Reconstruction of the Head and Neck?

Retrospective cohort study. Malnutrition has been found to have negative effects on the immune system and inflammatory responses, impairing the wound healing process. Free flap failure is a serious complication in patients undergoing microvascular reconstruction, as it increases patient morbidity, length of stay in the hospital, patient, and hospital costs, as well as causes the need for further surgical interventions1. Malnutrition is estimated to be present in 35-50% of head and neck cancer patients with higher rates in those experiencing hypo-oropharyngeal disease. This is often caused by functional and pain limitations from due to disease burden causing odynophagia and dysphagia. The Malnutrition Universal Screening Tool (MUST) is recommended for risk screening and provides three scores for risk classification: high, intermediate, and low2. We argue that the use of MUST as a preoperative assessment tool is useful to predict postoperative surgical site infection and delayed wound healing in patients that will undergo reconstruction with free flaps for head and neck defects. A retrospective cohort study was designed to include all subjects who underwent head and neck microvascular free tissue transfer at a single institution between 2013 and 2019. Primary and secondary reconstructions were included, for benign or malignant pathology, osteonecrosis, osteomyelitis, congenital defects, and trauma. The nutritional risk was evaluated using MUST, which analyzes body mass index, weight loss, and acute disease effect, to classify patients as low, intermediate, and high risk. We further divided the subjects into two comparison groups- low-intermediate and high risk. The primary outcome was surgical site complications and delayed wound healing. Data was analyzed as frequencies and means with standard deviations, as well as Fisher's exact test and t-test. P-values <0.05 were considered statistically significant. Analyses were done utilizing IBM SPSS Statistics Version 29. 131 subjects were included for data analysis, with 54 being considered low MUST risk, 12 intermediate risk (66 low-intermediate), and 65 were high risk. The mean BMI overall was 25.5 ±5.3, and 27.2 in the low-intermediate group, and 23.7 in the high-risk group. Eighty-two subjects experienced <5-pound weight loss in the preceding 6 months to surgery, while 17 lost between 5-10 pounds, and 23 lost 10< pounds. Cancer/osteonecrosis was the etiology for 54 (82%) subjects of the low-intermediate group, and 61 (92%) of the high-risk group (P = .089). The subjects classified in High-risk group according to the MUST score had 11% more surgical site complications (P = .120) and 13.7% more delayed wound healing and dehiscence(P = .09); only 3 subjects in the study presented total flap loss and they were all in the High-risk group. Surgical site complication, delayed wound healing rates and partial or total flap loss were not increased by any specific medical comorbidity or history such as radiation or chemotherapy. In conclusion, Subjects with high MUST score had increased complications and poor wound healing, and subjects with acute disease effect that induces a phase of nil per os for > 5 day have higher risk of total flap loss and surgical site complication.

Nutritional Status Indicators as a Predictor of Achieving Remission at Week 14 during Vedolizumab Therapy in Patients with Ulcerative Colitis: A Pilot Study.

Background: The loss of response or failure to achieve remission to vedolizumab in ulcerative colitis (UC) patients is currently a major clinical problem. Recently, Nutritional Risk Index (NRI), Controlling Nutritional Status (CONUT), and Malnutrition Universal Screening Tool (MUST) have been suggested as a new prognostic factor of UC activity. Here, we aimed at confirmation of hypotezis that NRI, CONUT and MUST may be used as inexpensive and efficient predictive biomarkers of response in UC patients treated with vedolizumab. Methods: This study was conducted in retrospective manner in 32 adult patients with UC of Caucasian origin (21 men and 11 women), who were qualified for 52-week therapy with vedolizumab and finished the 14-weeks from January 2020 to March 2022. Our study analyzed the 45 courses of vedolizumab therapy. Nutritional status indicators, i.e., the NRI, CONUT and MUST of each UC patient, were marked at the time of qualifying for biological treatment. Results: In our study, the MUST score was significantly lower in UC patients who positively achieved clinical remission at week 14 during vedolizumab induction therapy (0.33 ± 0.49 vs. 1.37 ± 0.83; p = 0.002). The analysis showed the lower baseline NRI and CONUT scores in patients with positive clinical remission at week 14 (NRI: 96.42 ± 4.29 vs. 101.41 ± 7.09; p = 0.024; CONUT: 1.00 ± 1.08 vs. 2.16 ± 1.46; p = 0.031). Conclusions: Nutritional status indicators (NRI, MUST and CONUT) may become valuable predictor of achieving remission at week 14 during vedolizumab therapy in UC patients.

Approximately 1 in 10 Ambulatory Inflammatory Bowel Disease Patients Are At Risk Of Malnutrition- A Prospective Singapore Cohort.

The prevalence of malnutrition amongst ambulatory IBD patients in Singapore is unknown. We aim to evaluate the prevalence of IBD patients at risk of malnutrition using the Malnutrition Universal Screening Tool (MUST) in the ambulatory setting and its clinical outcomes. IBD patients were recruited from March to June 2018. A score of 2 or more was used to define patients at risk of malnutrition (ARMN) vs patients not at risk (Non-ARMN). All recruited patients were followed up for a period of 6 months. 217 patients were recruited. 128(59.0%) ulcerative colitis and 89(41.0%) Crohn's disease. Mean BMI was 23.5 (±4.5) kg/m2 . 35(16.1%) patients were on biologics with 52(24%) on steroids. 25(11.5%) patients were ARMN. The majority of ARMN were UC patients (n=15, 60%). Majority of ARMN patients were underweight (n=23, 92.0%) and 114 (59.4%) Non-ARMN were overweight. ARMN patients had a significantly lower mean albumin (38.3 vs 41.9 g/L) and significantly increased proportion of patients with CRP > 5(mg/L) (36% vs 19.3%). There was a trend towards a longer length of stay amongst ARMN patients although this was not statistically significant. Use of biologics or immunomodulators and albumin levels were associated with being ARMN. Using the MUST score, 11.5% of ambulatory IBD patients in Singapore were identified to be at risk of malnutrition. Amongst patients at risk of malnutrition, a trend was demonstrated towards a longer length of stay for admitted patients. This underscores the need to actively screen ambulatory IBD patients for malnutrition.

Malnutrition universal screening tool predicts postoperative complications following major head and neck cancer surgery.

Head and neck cancer patients are at risk for malnutrition, which can impact postoperative outcomes. This study evaluates the Malnutrition Universal Screening Tool (MUST) to predict outcomes in major head and neck surgeries. A retrospective chart review included 275 major surgical procedures performed on 242 patients over the age of 18 years between May 2015 and May 2020. The majority of patients had a MUST score of zero (68.7%). Just under 17% scored 2 or greater indicating malnourishment. Having a MUST score of 2 or higher was associated with occurrence of a postoperative complication (p < 0.001). Patients with alcohol use disorder or depression were 5.2 (CI: 2.0-13.7, p=0.001) and 2.75 (CI 1.1-7.0; p=0.033) times more likely to develop a postoperative complication, respectively. Malnutrition and comorbidities were associated with complications in our surgical cohort. MUST is a novel tool to identify patients who may benefit from nutritional interventions.

Improving nutritional assessment in acute medical admissions at a district general hospital.

Malnutrition adversely affects clinical outcomes, necessitating a prompt and accurate assessment of nutritional status on admission. A variety of tools exist to aid nutritional assessment, of which the malnutrition universal screening tool (MUST) is recommended, but remains difficult to implement in practice. The aim of this audit was to improve the utilisation of the malnutrition universal screening tool (MUST) in the Acute Medical Unit (AMU) at Queen Elizabeth Hospital, King's Lynn. Specifically, patients should have a completed and accurate MUST score within 6hours of arrival to AMU and high-risk patients (MUST score ≥2) should be referred to dieticians within 48hours of admission. The first cycle was conducted by March 2019 and the second cycle was completed 1 year later to allow assessment of interventions actioned after the first cycle. We conducted a two-cycle audit evaluating the MUST completion and dietician referral rate of high-risk patients (defined as MUST ≥2) on the Acute Medical Unit in a district general hospital, with the standards of 80% and 100% respectively. A questionnaire was distributed after the first cycle exploring nurses' current experience and competence in using MUST. In the first cycle, MUST scores were calculated correctly in 111/150 patients (74%) and 1/9 (11%) high-risk patients were referred to dieticians. After interventions, MUST scores were calculated correctly in 77/101 patients (76%) and 2/4 high-risk patients (50%) were referred to dieticians. The nurses (n = 19) who took part in the questionnaire felt confident in MUST completion, but the average score in an objective assessment was67%. As per the literature, the first cycle demonstrated the under-utilisation of MUST in clinical practice. In response, we proposed additional face-to-face training for existing staff, the inclusion of an e-learning module within the staff's induction, and provision of ward MUST 'troubleshooting' booklets. MUST utilisation rates improved upon re-auditing, but not to target standards. We will need to consider potential barriers to sustainable change and implement interventions such as identification of nursing champions to overcome them.

Every fifth patient suffered a high nutritional risk-Results of a prospective patient survey in an oncological outpatient center.

Malnutrition in cancer patients often remains undetected and underestimated in clinical practice despite studies revealing prevalences from 20 to 70%. Therefore, this study aimed to identify patient groups exposed to an increased nutritional risk in a university oncological outpatient center. Between May 2017 and January 2018 we screened oncological patients there using the malnutrition universal screening tool (MUST). Qualitative data were collected by a questionnaire to learn about patients' individual information needs and changes in patients' diets and stressful personal nutrition restrictions. We included 311 patients with various cancers. 20.3% (n = 63) were found to be at high risk of malnutrition, 16.4% (n = 51) at moderate risk despite a mean body mass index (BMI) of 26.5 ± 4.7 kg/m2. The average age was 62.7 (± 11.8) with equal gender distribution (52% women, n = 162). In 94.8% (n = 295) unintended weight loss led to MUST scoring. Patients with gastrointestinal tumors (25%, n = 78) and patients >65 years (22%, n = 68) were at higher risk. Furthermore, there was a significant association between surgery or chemotherapy within six months before survey and a MUST score ≥2 (OR = 3.6). Taste changes, dysphagia, and appetite loss were also particular risk factors (OR = 2.3-3.2). Young, female and normal-weight patients showed most interest in nutrition in cancer. However, only 38% (n = 118) had a nutritional counseling. This study confirms that using the MUST score is a valid screening procedure to identify outpatients at risk of developing malnutrition. Here one in five was at high risk, but only 1% would have been detected by BMI alone. Therefore, an ongoing screening procedure with meaningful parameters should be urgently implemented into the clinical routine of cancer outpatients as recommended in international guidelines.

S930 Identifying Risk Factors and Predictors of Malnutrition in Patients With Inflammatory Bowel Disease at a Tertiary Care Center

Introduction: Malnutrition is highly prevalent in patients with inflammatory bowel disease (IBD). Nutritional assessment tools have been created to identify malnourished individuals and facilitate prompt nutritional intervention. The Malnutrition Universal Screening Tool (MUST) is a validated tool recommended for patients across all healthcare settings. In the present study, we implemented the MUST among patients with IBD at outpatient clinics in an academic health system. The aim of this study was to examine the relationship between patient and clinical characteristics, and laboratory markers of nutrition with the MUST nutritional risk score in patients with IBD. Methods: This was a multi-center retrospective study conducted in outpatient clinics throughout the MedStar Healthcare System. 199 patients with IBD were screened using the MUST between February 10, 2022, and May 31, 2022. Low, medium, and high nutritional risk scores were defined as a score of 0, 1, or ≥ 2, respectively. We examined the association between the MUST scores and patient demographic data, markers of nutrition, and markers of disease activity. Univariate and multivariate logistic regression was used to examine associations between independent risk factors with nutritional risk score. Results: Among the 199 patients screened, 87% were classified as low risk for malnutrition, 9% as moderate risk, and 4% as high risk. There was no statistically significant association between nutritional risk score and sex, IBD diagnosis, or age. In univariate analysis, IBD-related hospitalizations within one year of screening (p = 0.022), recent steroid use (p < .001), and elevated C-reactive protein (CRP) (p = 0.027) were associated with moderate-to-high risk of malnutrition as compared to low risk (Table). Decreased albumin (OR: 0.10; 95% CI: 0.02-0.57) and decreased hemoglobin (OR: 0.58; 95% CI: 0.40-0.84) were also significant predictors of malnutrition. In multivariate analysis, recent steroid use remained an independent risk factor for malnutrition. Conclusion: In this study, we demonstrate that MUST screening correlates to markers of disease activity, inflammation, and nutrition in patients with IBD. Univariate analysis identified IBD-related hospitalizations, recent steroid use, elevated CRP, decreased albumin, and decreased hemoglobin as risk factors. Only recent steroid use was identified as an independent risk factor. Further study on nutritional risk screening and disease markers in larger populations is warranted. Table 1. - Univariate analysis of risk factors associated with moderate-high risk nutritional risk score Characteristic Odds Ratio 95% Confidence Interval P-Value Lower Limit Upper Limit Steroid Use 7.314 2.346 22.805 < .001 IBD-related Hospitalization 4.632 1.247 17.213 0.022 CRP (mg/L) 1.129 1.014 1.257 0.027 Fecal Calprotectin (mcg/gm) 1.001 1.000 1.002 0.062 Albumin (gm/dL) 0.101 0.018 0.570 0.009 Hemoglobin (gm/dL) 0.580 0.403 0.835 0.003

Are We Identifying Malnutrition in Hospitalized Patients with Hematologic Malignancies? Results from a Quality Clinical Audit.

Disease-related malnutrition (DRM) is highly prevalent among patients with hematologic malignancies. The aim of the present study was to evaluate the prevalence of DRM in hospitalized patients with hematologic malignancies and investigate the level of awareness of DRM among the medical team treating this group of patients. A cross sectional quality clinical audit took place in two hematology units of a tertiary university hospital. Inpatients were screened within 48 h of their admission using the Malnutrition Universal Screening Tool (MUST) to identify their nutritional risk, and they were reassessed to identify the implemented interventions during their hospitalization. One hundred eighty-five patients were included in the audit analysis. On admission, 37.3% of the audited population was identified as being at high risk of malnutrition according to the MUST score. Forty-nine (26.5%) patients reported reduced food intake during the past 5 days, while four (2.2%) reported no food intake. During the hospitalization, only five patients (2.7%) received nutritional support, as indicated. Low levels of awareness of the early detection and treatment of DMS were found. Moreover, the prevalence of DRM and low nutritional intake was reported to be low. Measures to increase awareness of DMR in the medical team and better coordination of the nutrition support teams is vital to ensure better management and early nutrition intervention in hematological patients.

Risk of misclassification during diagnosis of malnutrition in retroperitoneal sarcoma patients.

Retroperitoneal sarcoma (RPS) is a rare tumour that can reach exceptionally large size at diagnosis and affects body weight with its volume. We investigated the risk of nutritional status misclassification based on the Global Leadership Initiative on Malnutrition (GLIM) criteria in RPS patients. We retrospectively analyzed the baseline data of patients with primary RPS including anthropometry, Malnutrition Universal Screening Tool (MUST) score and skeletal muscle index (SMI) calculated on preoperative CT scan. Phenotypic GLIM criteria considered were non-volitional weight loss, low-BMI and low muscle mass. MUST score, being inclusive of weight loss, was chosen as its surrogate. Reduced muscle mass was defined with SMI cut-offs <38.5-52.4cm2/m2 for female and male respectively. From 2018 to 2020, 100 consecutive patients (male/female: 48/52) were included. Median age was 61 (48-68) years, median BMI 24.6 (21.5-27.4) kg/m2. Seven patients (7%) reported MUST score ≥2 and 80 (80%) score 0. Five patients (5%) were underweight, 44 (44%) overweight and obese. Sixty patients (60%) presented low SMI, of those 56 (93%) were normal or overweight, and 46 (77%) not at nutritional risk according to the MUST score. Both underweight BMI and MUST score ≥2 were not correlated with low SMI (p=0.406, p=0.612, respectively). No relevant discrepancy was found in the postoperative course of patients with low or normal muscle mass, although SMI was able to better characterize nutritional risk in the proportion of patents with high-grade liposarcoma and predicted worst overall survival. GLIM criteria are a useful tool for diagnosis of malnutrition. However, our analysis suggests that phenotypic criteria are not interchangeable with each other. An altered body composition is often hidden in patients with retroperitoneal sarcoma and the use of weight-based classification does not seem to be appropriate, enhancing the role of mass muscle measurement to prevent misdetections of malnourished patient.

Nutritional Risk Screening in Hospitalized Adults Using the Malnutrition Universal Screening Tool at a Tertiary Care Hospital in South India.

Background and objectivesMalnutrition is still widely prevalent in India. Various nutritional screening tools have been developed to screen for nutritional risk status but no one tool is considered the best. The Malnutrition Universal Screening Tool (MUST) is accepted by the European Society for Clinical Nutrition and Metabolism and validated for use in hospitalized adults. Hence, it was used in this study to estimate the prevalence of malnutrition in hospitalized adults and its association with socioeconomic inequality.MethodsA sample of randomly selected 358 ambulatory hospitalized patients above 18 years of age was used in the study. Data pertaining to demography, socioeconomic status, medical history, and MUST were collected using a structured questionnaire. The height and weight of the patients were measured, and their BMI was determined. The patients were classified into five socioeconomic classes and their MUST scores were determined.ResultsStatistically significant (P < 0.05) increasing trend was observed in the height, weight, and BMI of patients with increasing socioeconomic status. Diabetes mellitus (39%) followed by hypertension (30%) were the predominant comorbid conditions. According to MUST, the overall prevalence of medium and high risk of malnutrition was 11% and 24%, respectively, and the socioeconomic class that was most impacted was Class 4 (1,130-2,259 INR per capita monthly income).Interpretation and conclusionsSocioeconomic status influences the prevalence of malnutrition, comorbid conditions, and the anthropometric measurements of admitted patients. The prevalence of nutritional risk status irrespective of sex was found to be 34.91% (24.3% in males and 10.61% in women) in the study.

Can Malnutrition at the Time of Heart Transplantation Affect Early and Late Mortality?

<h3>Purpose</h3> To analyze early and late clinical outcomes of malnourished patients undergoing heart transplantation. <h3>Methods</h3> We retrospectively evaluated all patients ≥18 years of age, who received a heart transplant between January 2015 and July 2020 at our center. For each patient, we calculated the semi-quantitative Malnutrition Universal Screening Tool (MUST) score at the time of transplantation to assess the patient nutritional status. A Cox regression analysis was performed to assess follow-up mortality and postoperative complications risk. <h3>Results</h3> Data from 177 patients (median age 58, IQR 49-65; M 134, 76%) were collected. Median preoperative BMI was 24kg/mq (IQR 21-28). Preoperative MUST score was 0, 1, 2 or >2 in 100 (57%), 24 (14%), 40 (23%) and 12 (6%) patients, respectively. Median preoperative eGFR was 64 ml/min (IQR 49-83). An increase in MUST score (from 0 to 2) was not associated with higher in-hospital mortality (hazard ratio 0.99, 95% CI 2.06-0.45, p=0.99), and was only related to increased risk of postoperative acute kidney injury requiring renal replacement therapy (hazard ratio 2.04, 95% CI 1.06-3.95, p=0.033) or septicemia (hazard ratio 3.37, 95% CI 1.08-10.54, p=0.036) within 24 hours after transplantation. Postoperative data and associated hazard ratios are summarized in Table 1. Survival rates at 3 and 5 years were respectively 77% (95% CI 71-84, patients at risk n=83) and 73% (95 CI 66-82, patients at risk 28). An analogous increase in MUST score was associated with increased follow-up mortality risk (hazard ratio 1.67, 95% CI 1.07-2.61, p=0.025). <h3>Conclusion</h3> Severe malnutrition (evaluated with a multi-variable semi-quantitative parameter as MUST score) in patients receiving heart transplantation is a risk factor for late death. However, it is not associated with increased in-hospital mortality or major postoperative complications except for early septicemia or renal function.

Validity of the Malnutrition Universal Screening Tool for Evaluation of Frailty Status in Older Hospitalised Patients.

The malnutrition-universal-screening-tool (MUST) is commonly used for screening malnutrition in hospitalised patients but its utility in the detection of frailty is unknown. This study determined the utility of MUST in detection of frailty in older hospitalised patients. This prospective-study enrolled 243 patients ⩾65 years in a tertiary-teaching hospital in Australia. Patients with a MUST score of ⩾1 were classified as at-risk of malnutrition. Frailty status was determined by the Edmonton-Frail-Scale (EFS) and patients with an EFS score of >8 were classified as frail. We validated the MUST against the EFS by plotting a receiver-operating-characteristic-curve (ROC) curve and area-under-the-curve (AUC) was determined. The mean (SD) age was 83.9 (6.5) years and 126 (51.8%) were females. The EFS determined 149 (61.3%) patients as frail, while 107 (44.1%) patients were at-risk of malnutrition according to the MUST. There was a positive linear but weak association between the MUST and the EFS scores (Pearson’s correlation coefficient= .22, 95% CI .12– .36, p < .001). The sensitivity, specificity, positive and negative predictive value of MUST in the detection of frailty was 51%, 67%, 78.5% and 37%, respectively and the AUC was .59 (95% CI .53–.65, p < .001). The MUST is moderately sensitive in detection of frailty in older-hospitalised patients.

P-EGS04 Assessment of Malnutrition in emergency laparotomy patients. A QIP highlighting simple measures can improve early recognition and optimisation of high-risk patients

Abstract Background Early recognition of high-risk malnourished patients is important for optimisation of nutritional status leading to better outcomes. The accurate recording of malnutrition universal screening tool (MUST) results is vital in this regard. This quality improvement project (QIP) aimed to review the quality of nutritional assessment of emergency laparotomy patients against the National Institute for Health and Care Excellence (NICE) guidelines and outline area of improvement. Methods The QIP was conducted at Royal Oldham Hospital in 2019-2020 over a seven-month period. Fifty random patients were included in the first audit cycle over a 4-month period, followed by implementation of recommended changes and a re-audit of 30 patients over a 2-month period. The initial MUST scores which were calculated and documented by nursing staff were identified as the nursing staff MUST score (NSMS). To assess the accuracy of NSMS, we developed a MUST rescoring method which was performed by a senior member of the medical team and was identified as the medical team MUST rescore (MTMR). Results The initial audit showed a significant difference between NSMS and MTMR scores. According to MTMR, 23 patients (46%) had an inaccurate MUST score assessment by the nursing staff. A multidisciplinary approach using a standard online calculator were recommended. The second phase of the QIP showed an obvious improvement in the accuracy of MUST assessment. Our interventions improved the accuracy rate of MUST scores significantly (27, 54% vs 29, 96.6%, P = 0.00005). Conclusions A multidisciplinary team approach and online calculator are useful in improving the accuracy of MUST assessment in emergency laparotomy patients. This helped early involvement of the dietitian leading to improvement in morbidity and mortality.