Malnutrition screening on hospital admission: impact of overweight and obesity on comparative performance of MUST and PG-SGA SF

Abstract

Background/objectives Traditional malnutrition screening instruments, including the Malnutrition Universal Screening Tool (MUST), strongly rely on low body mass index (BMI) and weight loss. In overweight/obese patients, this may result in underdetection of malnutrition risk. Alternative instruments, like the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF), include characteristics and risk factors irrespective of BMI. Therefore, we aimed to compare performance of MUST and PG-SGA SF in malnutrition risk evaluation in overweight/obese hospitalized patients. Subjects/methods We assessed malnutrition risk using MUST (≥1 = increased risk) and PG-SGA SF (≥4 = increased risk) in adult patients at hospital admission in a university hospital. We compared results for patients with BMI < 25 kg/m2 vs. BMI ≥ 25 kg/m2. Results Of 430 patients analyzed (58 ± 16 years, 53% male, BMI 26.9 ± 5.5 kg/m2), 35% were overweight and 25% obese. Malnutrition risk was present in 16% according to MUST and 42% according to PG-SGA SF. In patients with BMI < 25 kg/m2, MUST identified 31% as at risk vs. 52% by PG-SGA SF. In patients with BMI ≥ 25 kg/m2, MUST identified 5% as at risk vs. 36% by PG-SGA SF. Agreement between MUST and PG-SGA SF was low (к = 0.143). Of the overweight/obese patients at risk according to PG-SGA SF, 83/92 (90%) were categorized as low risk by MUST. Conclusions More than one-third of overweight/obese patients is at risk for malnutrition at hospital admission according to PG-SGA SF. Most of them are not identified by MUST. Awareness of BMI-dependency of malnutrition screening instruments and potential underestimation of malnutrition risk in overweight/obese patients by using these instruments is warranted.

Malnutrition Universal Screening Tool and Patient-Generated Subjective Global Assessment Short Form and their predictive validity in hospitalized patients

“…This indicates a higher prevalence of risk factors for malnutrition in patients admitted to medical wards, consistent with a previous multi-center study on Internal Medicine wards [43]. Our previous cross-sectional analysis of the current cohort, moreover, indicates that BMI is a major factor affecting differences in diagnostic properties of MUST as compared to PG-SGA SF, with the most pronounced difference in patients with an overweight or obese BMI [28]. This may be of particular and increasing relevance, in an ageing and increasingly obese society [44].…”

“…Observational studies in hospital patients and patients with chronic kidney disease have previously shown that the PG-SGA SF identifies a considerably larger percentage of patients at risk compared with the MUST [25e27]. This is consistent with a recent cross-sectional analysis from our hospital, in which we found an approximately 2.5-fold higher percentage of patients at risk according to the PG-SGA SF, compared with MUST [28]. However, whether this difference in classification, particularly the larger yield of the PG-SGA SF, has important clinical consequences, i.e., whether it also translates into corresponding higher risk of worse outcomes, has yet to be investigated.…”

“…This prospective observational cohort study was conducted at the University Medical Center Groningen (UMCG), a single academic center. Details on study design, inclusion and exclusion criteria have been described previously [28,29]. In short, adult patients (18 years) admitted to two surgical wards and two medical wards between March 2016 and July 2017, were asked to participate.…”

Nutritional screening through patient-generated subjective global assessment (PG-SGA) in gynecological cancer

“…Grupo total Idosas Adultas ...continuação -Tabela 3 não é recomendado para avaliar desnutrição em oncologia, uma vez que não consegue diferenciar com precisão os componentes do peso corporal, podendo mascarar a perda de massa magra em pessoas com IMC dentro da faixa saudável ou com excesso de peso 21,22 . O que torna importante a utilização de outros métodos de avaliação como a ASG-PPP que possui maior sensibilidade em pacientes com câncer 23,24 .…”

Chronic Dialysis Patients Are Depleted of Creatine: Review and Rationale for Intradialytic Creatine Supplementation

“…The following questionnaires will be administered: Six-Dimensional EuroQol Instrument (EQ-6D) [ 49 ] and the Short Form 36 Health Survey (SF36) [ 50 ] to assess HRQoL; Checklist Individual Strength (CIS) [ 51 ] to assess fatigue; Dialysis Symptom Indicator (DSI) [ 16 ] to assess the prevalence, severity, and impact of symptoms in hemodialysis patients; Groninger Frailty Indicator (GFI) [ 52 ] to identify frailty; Cognitive Failure Questionnaire (CFQ) [ 53 ] to assess cognitive failure; Patient Health Questionnaire-9 (PHQ-9) [ 54 ] to measure depressive disorders and depression severity; and the Patient-Generated Subjective Global Assessment (PG-SGA) [ 55 , 56 , 57 ] to assess nutritional status. Patients can fill in the questionnaires at home before the start of the hemodialysis session, or during the dialysis session with the help of a researcher.…”