Adult Malnutrition (Undernutrition) Screening: An Evidence Analysis Center Systematic Review

Area of Science:

• Clinical Nutrition
• Health Services Research
• Geriatric Medicine

Background:

• Effective malnutrition screening requires simple, reliable tools for timely dietitian referrals.
• Accurate tools prevent under- or over-referral of adult patients for nutritional assessment.

Purpose of the Study:

• To systematically review the validity, agreement, and reliability of adult malnutrition screening tools.
• To assess the costs associated with malnutrition screening procedures.

Main Methods:

• A comprehensive literature search was conducted across major databases (PubMed, MEDLINE, EMBASE, CINAHL) for studies published between 1997 and 2017.
• Included studies examined the validity, agreement, reliability, and costs of nutrition screening tools for adults.
• Sixty-nine studies met the inclusion criteria for the systematic review.

Main Results:

• The Malnutrition Screening Tool demonstrated moderate validity, agreement, and reliability (Grade I evidence).
• The Malnutrition Universal Screening Tool showed high validity and moderate agreement/reliability.
• Other tools like MNA-SF and NRS-2002 had moderate validity/reliability, but often lacked complete agreement or reliability data.

Conclusions:

• No single adult malnutrition screening tool exhibited high validity and reliability with strong supporting evidence.
• Most tools achieved moderate performance, with significant variability in results.
• Establishing minimum validity and reliability standards is crucial for future research and clinical practice.