An analytic appraisal of nutrition screening tools supported by original data with particular reference to age

Controversies exist as to the suitability of various nutrition screening tools for various age groups, the incorporation of age and age-related criteria into some tools, and the procedures associated with tool selection.

Reviews of the literature and national and local datasets were used to identify the types of screening tools available for different age groups, the origins of age-related criteria, and the value of tool selection procedures based on predicting clinical outcomes.

Nutrition screening can be undertaken in fetuses, children, and adults over narrow or wide age ranges, for diagnostic or prognostic purposes, with or without nutritional interventions. Certain tools can establish malnutrition risk without using any nutritional criteria, whereas others can do so only with nutritional criteria. The incorporation of age and age-specific body mass index criteria into adult screening tools can influence the prevalence and age distribution of malnutrition, but no justification is usually provided for their use. In several circumstances, age alone can predict mortality and length of hospital stay much better than screening tools. We identified various methodologic problems in nutrition screening tool selection.

A comparison of nutrition screening tools designed for different age groups and different purposes can be problematic. Age and screening tools incorporating risk factors that are non-modifiable or generally weakly modifiable by nutritional support (e.g., age, disease severity) may predict outcomes of disease, but they are not necessarily suitable for predicting outcomes of nutritional support. To contextualize the findings, a framework for screening tool selection is suggested that takes into account a matrix of needs.