Comparison of Three Nutritional Screening Tools with the New Glim Criteria for Malnutrition and Association with Sarcopenia in Hospitalized Older Patients

Abstract

The integrated assessment of nutritional status and presence of sarcopenia would help improve clinical outcomes of in-hospital aged patients. We compared three common nutritional screening tools with the new Global Leadership Initiative on Malnutrition (GLIM) diagnostic criteria among hospitalized older patients. To this, 152 older patients were assessed consecutively at hospital admission by the Malnutrition Universal Screening Tool (MUST), the Subjective Global Assessment (SGA), and the Nutritional Risk Screening 2002 (NRS-2002). A 46% prevalence of malnutrition was reported according to GLIM. Sensitivity was 64%, 96% and 47%, and specificity was 82%, 15% and 76% with the MUST, SGA, and NRS-2002, respectively. The concordance with GLIM criteria was 89%, 53% and 62% for the MUST, SGA, and NRS-2002, respectively. All the screening tools had a moderate value to diagnose malnutrition. Moreover, patients at high nutritional risk by MUST were more likely to present with sarcopenia than those at low risk (OR 2.5, CI 1.3-3.6). To conclude, MUST is better than SGA and NRS-2002 at detecting malnutrition in hospitalized older patients diagnosed by the new GLIM criteria. Furthermore, hospitalized older patients at high risk of malnutrition according to MUST are at high risk of presenting with sarcopenia. Nutritional status should be determined by MUST in older patients at hospital admission, followed by both GLIM and the European Working Group on Sarcopenia in Older People (EWGSOP2) assessment.

Keywords: hospitalized older patients; nutritional screening tools; nutritional status; sarcopenia.

Figure 1

Participant flowchart. Other exclusion criteria were chronic bedridden conditions, physical handicap, severe neuromuscular disease, and use of drugs affecting body composition (such as glucocorticoids, statins, active vitamin D metabolites, anabolic steroids, selective estrogen receptor modulators). Diagnosis of malnutrition was performed according to the new criteria of the Global Leadership Initiative on Malnutrition.

Figure 2

Duration of the nutritional screening tools (time expressed in seconds), performed in all the 152 hospitalized patients enrolled in this study. Data are expressed as mean ± SD. Statistical differences were assessed by one-way ANOVA and Tukey as post hoc test. MUST, Malnutrition Universal Screening Tool; SGA, Subjective Global Assessment; NRS-2002, Nutritional Risk Screening 2002. ****: p < 0.0001 vs. MUST.

Figure 3

Receiver Operating Characteristic (ROC) curve for prediction of malnutrition based on the score obtained by the Malnutrition Universal Screening Tool (MUST, blue line), the Subjective Global Assessment (SGA, green line), and the Nutritional Risk Screening 2002 (NRS-2002, yellow line).