Similar health economic outcomes in low-risk and high-risk malnourished inpatients as screened by the Malnutrition Screening Tool after delivery of oral nutritional supplements

Risk of malnutrition assessment in hospitalised adults: A scoping review of existing instruments

AIMS AND OBJECTIVES

The aim of this study was to find tools for screening the risk of malnutrition in adult hospitalised patients, evaluate their key characteristics including selected psychometric properties and propose the most appropriate tools for nursing practice.

BACKGROUND

A large number of existing tools for nutritional screening make it difficult to be aware of all the possibilities and especially to select the optimal tool.

DESIGN

The research methodology was designed as secondary research using a scoping review search to map and compare existing tools for assessing the risk of malnutrition in hospitalised adults.

METHODS

The analysis focused on the selected psychometric properties of the instruments (sensitivity, specificity, positive and negative predictive value) and key characteristics relevant to the selection of an appropriate instrument. This study follows the PRISMA-ScR Checklist.

RESULTS

The review included 27 publications containing 17 tools. The best sensitivity (57%-100%) and specificity (76%-96%) were achieved by the Malnutrition Universal Screening Tool (MUST) and the Nutritional Risk Screening 2002 (NRS 2002). Minimal Eating Observation and Nutrition Form-Version II (MEONF-II) has solid sensitivity (up to 73%), specificity (88%) and high positive predictive values (81%-82%).

CONCLUSIONS

The MUST, NRS 2002 and MEONF-II showed satisfactory psychometric properties. MEONF-II and MUST are able to assess risk without weighing the patient. The Hand Grip Strength (HGS) assessment can be recommended to detect reductions in muscle strength.

RELEVANCE TO CLINICAL PRACTICE

We recommend the MUST, NRS 2002 and MEONF-II tools for use in clinical practice, as they have the best psychometric properties and are user-friendly. The HGS, which proved to be related to the length of hospital stay (LOS) and used as an indicator of protein-energy malnutrition in obese patients, may be a useful complementary tool. For nursing practice, we recommend selecting a tool with respect to the specifics of a particular workplace.

Applicability of five nutritional screening tools in Chinese patients undergoing colorectal cancer surgery: a cross-sectional study

OBJECTIVES

To identify the most appropriate nutritional risk screening tool for patients undergoing colorectal cancer surgery, five nutritional screening tools, including the Nutritional Risk Screening 2002 (NRS 2002), Short Form of Mini Nutritional Assessment (MNA-SF), Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST) and Nutritional Risk Index (NRI), were employed to evaluate the nutritional risk at admission and short-term clinical outcome prediction.

DESIGN

A cross-sectional study.

SETTING

A comprehensive affiliated hospital of a university in Shenyang, Liaoning Province, China.

PARTICIPANTS

301 patients diagnosed with colorectal cancer were continuously recruited to complete the study from October 2020 to May 2021.

PRIMARY AND SECONDARY OUTCOME MEASURES

Within 48 hours of hospital admission, five nutritional screening tools were used to measure the nutritional risk and to determine their relationship with postoperative short-term clinical outcomes.

RESULTS

The nutritional risk assesed by the five tools ranged from 25.2% to 46.2%. Taking the Subject Global Assessment as the diagnostic standard, MNA-SF had the best consistency (κ=0.570, p<0.001) and MST had the highest sensitivity (82.61%). Multivariate Logistic regression analysis after adjusting confounding factors showed that the NRS 2002 score ≥3 (OR 2.400, 95% CI 1.043 to 5.522) was an independent risk factor for postoperative complications and was the strongest predictor of postoperative complications (area under the curve 0.621, 95% CI 0.549 to 0.692). The scores of NRS 2002 (r=0.131, p<0.001), MNA-SF (r=0.115, p<0.05) and NRI (r=0.187, p<0.05) were poorly correlated with the length of stay. There was no correlation between the five nutritional screening tools and hospitalisation costs (p>0.05).

CONCLUSIONS

Compared with the other four nutritional screening tools, we found that NRS 2002 is the most appropriate nutritional screening tool for Chinese patients with colorectal cancer.

Nutrition Care for Poorly Nourished Outpatients Reduces Resource Use and Lowers Costs

Background and Objectives:

Over 25% of United States (US) community-dwelling, older adults are at nutritional risk. Health and cost burdens of poor nutrition can be lowered by nutrition programs for hospital inpatients, but few studies have looked at the impact on outpatients. The objective of our study was to assess outcomes of a nutrition focused quality improvement program (QIP) on healthcare resource use and costs in poorly nourished outpatients.

Methods:

This pre-post QIP study was implemented at 3 US healthcare system clinics. Included patients (n = 600) were ≥45 years old, had ≥2 chronic conditions, and were enrolled over a 15-month interval. For comparison, historical (n = 600) and concurrent control (n = 600) groups were used. Assessment of poor nutritional status was performed during each patient’s baseline visit. Healthcare resource use (hospitalizations, emergency department visits, and outpatient clinic visits), medication use, and costs were determined for a 90-day interval.

Results:

QIP patients (mean age 61.6 years) were predominantly female (62.5%) and overweight/obese (81.7%). The proportion of QIP outpatients presenting for healthcare services was significantly reduced compared to both historical and concurrent controls—relative risk reduction (RRR) versus historical (11.6%, P < .001) and versus concurrent (8.9%, P = .003). Of those who presented, RRR for healthcare resource use by QIP was significant in comparison with historical (12.9%, P = .022) but not concurrent controls. No significant differences were observed for medication usage. Lower resource use among QIP patients yielded total cost savings of $290 923 or per-patient savings of $485.

Conclusions:

Nutrition QIPs in outpatient clinics are feasible and can reduce healthcare resource use and cut costs. Such findings underscore benefits of nutritional interventions for community-dwelling outpatients with poor nutritional status.