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Cited by 41Nutrition and Health in AgingClinical Nutrition and GastroenterologyBody Composition Measurement Techniques

Malnutrition Screening Tools Are Not Sensitive Enough to Identify Older Hospital Patients with Malnutrition

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van Dronkelaar, Carliene, Tieland, Michael, Cederholm, Tommy, Reijnierse, Esmee M., Weijs, Peter J. M., Kruizenga, Hinke·2023·Nutrients
DOI 10.3390/nu15245126PMC PMC10745606
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Abstract

This study evaluates the concurrent validity of five malnutrition screening tools to identify older hospitalized patients against the Global Leadership Initiative on Malnutrition (GLIM) diagnostic criteria as limited evidence is available. The screening tools Short Nutritional Assessment Questionnaire (SNAQ), Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST), Mini Nutritional Assessment—Short Form (MNA-SF), and the Patient-Generated Subjective Global Assessment—Short Form (PG-SGA-SF) with cut-offs for both malnutrition (conservative) and moderate malnutrition or risk of malnutrition (liberal) were used. The concurrent validity was determined by the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the level of agreement by Cohen’s kappa. In total, 356 patients were included in the analyses (median age 70 y (IQR 63–77); 54% male). The prevalence of malnutrition according to the GLIM criteria without prior screening was 42%. The conservative cut-offs showed a low-to-moderate sensitivity (32–68%) and moderate-to-high specificity (61–98%). The PPV and NPV ranged from 59 to 94% and 67–86%, respectively. The Cohen’s kappa showed poor agreement (k = 0.21–0.59). The liberal cut-offs displayed a moderate-to-high sensitivity (66–89%) and a low-to-high specificity (46–95%). The agreement was fair to good (k = 0.33–0.75). The currently used screening tools vary in their capacity to identify hospitalized older patients with malnutrition. The screening process in the GLIM framework requires further consideration.

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  • The screening tool selected-tools that identify risk of malnutrition versus tools that identify malnutrition-affects the prevalence of malnutrition diagnosed by GLIM.

    “The experience collected after the introduction of the GLIM procedure indicates that the screening tool selected—ie, tools that identify “risk of malnutrition” vs tools that identify “malnutrition”—affects the prevalence of malnutrition diagnosed by GLIM. 37 , 38”

    From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [37]

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Authors
van Dronkelaar, C., Tieland, M., Cederholm, T., Reijnierse, E. M., Weijs, P. J. M., & Kruizenga, H.
Affiliations
  • Center of Expertise Urban Vitality, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, 1067 SM Amsterdam, The Netherlands
  • Amsterdam University of Applied Sciences (NL)
  • Uppsala University (SE)
  • Amsterdam Movement Sciences (NL)
  • Amsterdam Public Health (NL)
ORCID
Venue
Nutrients
Publisher
MDPI AG
Published
2023-12-17
Volume
15
Issue
24
Pages
5126
ISSN
2072-6643 (ISSN-L)
DOI
10.3390/nu15245126
PMC
PMC10745606
OpenAlex
W4389892645
Cited by
41
References
3
Citations by year
2026: 15 · 2025: 20 · 2024: 6
FWCI
7.28
Type
journal article
Language
en
Open access
Licence
Locations
  • Nutrients (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
  • Uppsala University Publications (Uppsala University) (submittedVersion, other-oa)
  • Pure Amsterdam UMC (submittedVersion, cc-by)
Topics
  • Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
Keywords
malnutrition screening, hospitalized older adults, concurrent validity, GLIM criteria, Short Nutritional Assessment Questionnaire, Malnutrition Universal Screening Tool, Malnutrition Screening Tool, Mini Nutritional Assessment Short Form, Patient-Generated Subjective Global Assessment, screening cut-off values, sensitivity and specificity
MeSH terms
Aged, Female, Hospitals, Humans, Male, Mass Screening, Nutritional Status, Predictive Value of Tests, Nutrition Assessment, Malnutrition

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