Department of Dietetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Eur J Clin Nutr. 2021 Sep;75(9):1398-1406. doi: 10.1038/s41430-020-00848-4. Epub 2021 Feb 15.
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/m vs. BMI ≥ 25 kg/m.
Of 430 patients analyzed (58 ± 16 years, 53% male, BMI 26.9 ± 5.5 kg/m), 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/m, MUST identified 31% as at risk vs. 52% by PG-SGA SF. In patients with BMI ≥ 25 kg/m, 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.
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.
背景/目的：传统的营养不良筛查工具，包括营养不良通用筛查工具（MUST），强烈依赖于低体重指数（BMI）和体重减轻。在超重/肥胖患者中，这可能导致营养不良风险的漏检。替代工具，如患者生成的主观整体评估简短形式（PG-SGA SF），包括与 BMI 无关的特征和危险因素。因此，我们旨在比较 MUST 和 PG-SGA SF 在超重/肥胖住院患者营养不良风险评估中的表现。
受试者/方法：我们在一所大学医院对入院的成年患者使用 MUST（≥1=增加风险）和 PG-SGA SF（≥4=增加风险）评估营养不良风险。我们比较了 BMI<25kg/m 与 BMI≥25kg/m 的患者的结果。
在分析的 430 名患者中（58±16 岁，53%为男性，BMI 为 26.9±5.5kg/m），35%为超重，25%为肥胖。根据 MUST，16%的患者存在营养不良风险，根据 PG-SGA SF，42%的患者存在营养不良风险。在 BMI<25kg/m 的患者中，MUST 识别出 31%的患者有风险，而 PG-SGA SF 识别出 52%的患者有风险。在 BMI≥25kg/m 的患者中，MUST 识别出 5%的患者有风险，而 PG-SGA SF 识别出 36%的患者有风险。MUST 和 PG-SGA SF 之间的一致性较低（к=0.143）。根据 PG-SGA SF 有风险的超重/肥胖患者中，83/92（90%）被 MUST 归类为低风险。
根据 PG-SGA SF，超过三分之一的超重/肥胖患者在入院时存在营养不良风险。他们中的大多数人都没有被 MUST 识别出来。需要认识到营养不良筛查工具的 BMI 依赖性，以及使用这些工具可能低估超重/肥胖患者的营养不良风险。
