Prospective validation of five malnutrition screening and assessment instruments among medical inpatients: Secondary analysis of a randomized clinical trial
Open accessAbstract
Background & aims Screening for malnutrition upon hospital admission is the first crucial step for proper nutritional assessment and treatment. While several nutritional screening and assessment instruments exist, there is a lack of head-to-head validation of these instruments. We studied the ability of five different nutrition screening and assessment instruments to predict 1-year mortality and response to nutritional treatment in participants of the EFFORT randomized trial. Methods In this secondary analysis of a Swiss-wide multicenter, randomized clinical trial comparing individualized nutritional support with usual care nutrition in medical inpatients, we prospectively classified patients as low, intermediate, and high nutritional risk based on five nutritional screening and assessment instruments (NRS 2002, SGA, SNAQ, MNA and MUST). Results Overall mortality at 1-year in the 1866 included patients was 30.4%. There were significant correlations and a significant concordance between all instruments with r-values ranging from 0.23 to 0.55 and kappa values ranging from 0.10 to 0.36. While high nutritional risk was associated with higher mortality in all instruments, SGA and MNA showed the strongest association with adjusted odds ratios of 3.17 (95%CI, 2.18 to 4.61, p Conclusion Among all five screening and assessment instruments, higher nutritional risk was associated with higher risk for mortality and adverse clinical outcome, but not with more or less treatment response fr…
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When comparing mortality in intervention group patients to control group patients stratified by severity of malnutrition, there was overall no clear trend towards more benefit in patients with more severe malnutrition.
“When comparing mortality in intervention group (IG) patients to the control group (CG) stratified by severity of malnutrition, there was overall no clear trend towards more benefit in patients with more severe malnutrition, with NRS 2002 and SGA showing the most pronounced relationship between the severity of malnutrition and reduction in mortality as a response to nutritional support [31].”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [31]
NRS 2002 and SGA showed the most pronounced relationship between severity of malnutrition and reduction in mortality as a response to nutritional support.
“When comparing mortality in intervention group (IG) patients to the control group (CG) stratified by severity of malnutrition, there was overall no clear trend towards more benefit in patients with more severe malnutrition, with NRS 2002 and SGA showing the most pronounced relationship between the severity of malnutrition and reduction in mortality as a response to nutritional support [31].”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [31]
High nutritional risk was associated with higher mortality in all nutrition screening tools.
“While high nutritional risk was associated with higher mortality in all tools, SGA and MNA-SF showed the strongest association with adjusted odds ratios of 3.17 (95% CI, 2.18 to 4.61, p < 0.001) and 3.45 (95% CI, 2.28 to 5.22, p < 0.001).”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [31]
SGA and MNA-SF showed the strongest association with 1-year mortality, with adjusted odds ratios of 3.17 (95% CI 2.18 to 4.61, p<0.001) and 3.45 (95% CI 2.28 to 5.22, p<0.001).
“While high nutritional risk was associated with higher mortality in all tools, SGA and MNA-SF showed the strongest association with adjusted odds ratios of 3.17 (95% CI, 2.18 to 4.61, p < 0.001) and 3.45 (95% CI, 2.28 to 5.22, p < 0.001).”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [31]
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Protein and energy supplementation in elderly people at risk from malnutrition
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ESPEN guidelines on nutritional support for polymorbid internal medicine patients
Gomes, F., Schuetz, P., Bounoure, L., Austin, P., Ballesteros-Pomar, M., Cederholm, T., Fletcher, J., Laviano, A., Norman, K., Poulia, K.-A., et al. (2018) · Clinical Nutrition · doi:10.1016/j.clnu.2017.06.025 · Cited by 363 · see citing works
Self-citationThe economic impact of disease-related malnutrition at hospital admission
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Individualized Nutritional Support for Hospitalized Patients With Chronic Heart Failure
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Inflammation and nutrition: friend or foe?
Stumpf, F., Keller, B., Gressies, C., & Schuetz, P. (2023) · Nutrients · doi:10.3390/nu15051159 · Cited by 213 · see citing works
Self-citationESPEN guideline on nutritional support for polymorbid medical inpatients
Wunderle, C., Gomes, F., Schuetz, P., Stumpf, F., Austin, P., Ballesteros-Pomar, M. D., Cederholm, T., Fletcher, J., Laviano, A., Norman, K., et al. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2023.06.023 · Cited by 105 · see citing works
“When comparing mortality in intervention group (IG) patients to the control group (CG) stratified by severity of malnutrition, there was overall no clear trend towards more benefit in patients with more severe malnutrition, with NRS 2002 and SGA showing the most pronounced relationship between the severity of malnutri…”
ResultSelf-citation
- Authors
- Stalder, L., Kaegi-Braun, N., Gressies, C., Gregoriano, C., Tribolet, P., Lobo, D. N., Gomes, F., Hoess, C., Pavlicek, V., Bilz, S., Sigrist, S., Brändle, M., Henzen, C., Thomann, R., Rutishauser, J., Aujesky, D., Rodondi, N., Donzé, J., Stanga, Z., Mueller, B., & Schuetz, P.
- Affiliations
- Kantonsspital Aarau (CH)
- Bern University of Applied Sciences (CH)
- Nottingham University Hospitals NHS Trust (GB)
- New York Academy of Sciences (US)
- Kantonsspital Münsterlingen (CH)
- Kantonsspital St. Gallen (CH)
- Luzerner Kantonsspital (CH)
- Kantonsspital Baden (CH)
- University of Bern (CH)
- University of Basel (CH)
- Corresponding author
- Schuetz, Philipp
- ORCID
- Venue
- Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2022-06
- Volume
- 41
- Issue
- 6
- Pages
- 1307-1315
- ISSN
- 0261-5614 (ISSN-L)
- OpenAlex
- W4224981083
- Cited by
- 23
- References
- 6
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 6 · 2023: 6 · 2022: 6
- FWCI
- 3.27
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Licence
- Locations
- Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Repository@Nottingham (University of Nottingham) (acceptedVersion, other-oa)
- Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by-nc-nd)
- ARBOR - Bern University of Applied Sciences Repository (submittedVersion)
- Bern Open Repository and Information System (University of Bern) (submittedVersion, cc-by-nc-nd)
- Funders
- Swiss National Science Foundation
- Topics
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Health Professions › Health Information Management › Dietetics, Nutrition, and Education
- Keywords
- malnutrition screening, nutritional risk, one-year mortality, nutritional support, medical inpatients, NRS-2002, Subjective Global Assessment, Mini Nutritional Assessment, must, Simplified Nutritional Appetite Questionnaire, instrument validation, malnutrition severity, treatment response
- MeSH terms
- Humans, Inpatients, Nutritional Status, Nutrition Assessment, Nutritional Support, Malnutrition
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