AIMS AND OBJECTIVES: The aim of this study was to find tools for screening the risk of malnutrition in adult hospitalised patients, evaluate their key characteristics including selected psychometric properties and propose the most appropriate tools for nursing practice. BACKGROUND: A large number of existing tools for nutritional screening make it difficult to be aware of all the possibilities and especially to select the optimal tool. DESIGN: The research methodology was designed as secondary research using a scoping review search to map and compare existing tools for assessing the risk of malnutrition in hospitalised adults. METHODS: The analysis focused on the selected psychometric properties of the instruments (sensitivity, specificity, positive and negative predictive value) and key characteristics relevant to the selection of an appropriate instrument. This study follows the PRISMA-ScR Checklist. RESULTS: The review included 27 publications containing 17 tools. The best sensitivity (57%-100%) and specificity (76%-96%) were achieved by the Malnutrition Universal Screening Tool (MUST) and the Nutritional Risk Screening 2002 (NRS 2002). Minimal Eating Observation and Nutrition Form-Version II (MEONF-II) has solid sensitivity (up to 73%), specificity (88%) and high positive predictive values (81%-82%). CONCLUSIONS: The MUST, NRS 2002 and MEONF-II showed satisfactory psychometric properties. MEONF-II and MUST are able to assess risk without weighing the patient. The Hand Grip Strength (HGS) assessment can be recommended to detect reductions in muscle strength. RELEVANCE TO CLINICAL PRACTICE: We recommend the MUST, NRS 2002 and MEONF-II tools for use in clinical practice, as they have the best psychometric properties and are user-friendly. The HGS, which proved to be related to the length of hospital stay (LOS) and used as an indicator of protein-energy malnutrition in obese patients, may be a useful complementary tool. For nursing practice, we recommend selecting a tool with respect to the specifics of a particular workplace.

Department of Otorhinolaryngology and Head and Neck Surgery Pardubice Hospital Hospitals of the Pardubice Region Pardubice Czech Republic

Faculty of Health Studies University of Pardubice Pardubice Czech Republic

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Abd Aziz, N., Mohd Fahmi Teng, N. I., & Kamarul Zaman, M. (2019). Geriatric nutrition risk index is comparable to the mini nutritional assessment for assessing nutritional status in elderly hospitalized patients. Clinical Nutrition ESPEN, 29, 77-85. https://doi.org/10.1016/j.clnesp.2018.12.002

Alston, L., Green, M., Nichols, M., Partridge, S. R., Buccheri, A., Bolton, K. A., Versace, V. L., Field, M., Launder, A. J., Lily, A., Allender, S., & Orellana, L. (2022). Testing the accuracy of a bedside screening tool framework to clinical Records for Identification of patients at risk of malnutrition in a rural setting: An exploratory study. Nutrients, 14(1), 205. https://doi.org/10.3390/nu14010205

Anthony, P. (2008). Nutrition screening tools for hospitalized patients. Nutrition in Clinical Practice, 23(4), 373-382. https://doi.org/10.1177/0884533608321130

Blanař, V., Eglseer, D., Lohrmann, C., & Hödl, M. (2020). Changes in the availability of clinical practice guidelines for malnutrition: A 6-y multicenter study. Nutrition, 71, 110617. https://doi.org/10.1016/j.nut.2019.110617

Cederholm, T., Jensen, G. L., Correia, M. I. T. D., Gonzalez, M. C., Fukushima, R., Higashiguchi, T., Baptista, G., Barazzoni, R., Blaauw, R., Coats, A., Crivelli, A., Evans, D. C., Gramlich, L., Fuchs-Tarlovsky, V., Keller, H., Llido, L., Malone, A., Mogensen, K. M., Morley, J. E., … Yu, J. (2019). GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community. Clinical Nutrition, 38(1), 1-9. https://doi.org/10.1016/j.clnu.2018.08.002

Chrástecká, M. (2020). Tools for malnutrition risk assessment among hospitalized patients: A scoping review (Bachelor thesis). University of Pardubice, Pardubice, Czech Republic https://dk.upce.cz/bitstreamupce/handle/10195/76072/ChrasteckaM_NastrojeHodnoceni_VB_2020.pdf?sequence=4

Detsky, A., McLaughlin, J., Baker, J., Johnston, N., Whittaker, S., Mendelson, R., & Jeejeebhoy, K. (1987). What is subjective global assessment of nutritional status? Journal of Parenteral and Enteral Nutrition, 11(1), 8-13. https://doi.org/10.1177/014860718701100108

Efthymiou, A., Hersberger, L., Reber, E., Schönenberger, K. A., Kägi-Braun, N., Tribolet, P., Mueller, B., Schuetz, P., Stanga, Z., & EFFORT Study Group. (2021). Nutritional risk is a predictor for long-term mortality: 5-year follow-up of the EFFORT trial. Clinical Nutrition, 40(4), 1546-1554. https://doi.org/10.1016/j.clnu.2021.02.032

Eglseer, D., Halfens, R., & Lohrmann, C. (2017). Is the presence of a validated malnutrition screening tool associated with better nutritional care in hospitalized patients? Nutrition, 37, 104-111. https://doi.org/10.1016/j.nut.2016.12.016

Eglseer, D., Schoberer, D., Halfens, R., & Lohrmann, C. (2018). The impact of using a malnutrition screening tool in a hospital setting: A mixed methods study. European Journal of Clinical Nutrition, 73(2), 284-292. https://doi.org/10.1038/s41430-018-0339-z

Ferguson, M., Capra, S., Bauer, J., & Banks, M. (1999). Development of a valid and reliable malnutrition screening tool for adult acute hospital patients. Nutrition, 15(6), 458-464. https://doi.org/10.1016/S0899-9007(99)00084-2

Fernández, C. A., Vidal Casariego, A., Cano Rodríguez, I., & Ballesteros Pomar, M. D. (2015). EFICACIA Y EFECTIVIDAD DE LAS DISTINTAS HERRAMIENTAS DE CRIBADO NUTRICIONAL EN UN HOSPITAL DE TERCER NIVEL [Efficacy and effectiveness of different nutritional screening tools in a tertiary hospital]. Nutricion Hospitalaria, 31(5), 2240-2246. https://doi.org/10.3305/nh.2015.31.5.8606

Freijer, K., Tan, S., Koopmanschap, M., Meijers, J., Halfens, R., & Nuijten, M. (2013). The economic costs of disease related malnutrition. Clinical Nutrition, 32(1), 136-141. https://doi.org/10.1016/j.clnu.2012.06.009

Frew, E., Cant, R., & Sequeira, J. (2010). Capturing the data: Nutrition risk screening of adults in hospital. Nutrients, 2(4), 438-448. https://doi.org/10.3390/nu2040438

Gibson, S., Seqeira, J., Cant, R., & Ku, C. (2012). Identifying malnutrition risk in acute medical patients: Validity and utility of malnutrition universal screening tool and modified malnutrition screening tool. Nutrition & Dietetics, 69(4), 309-314. https://doi.org/10.1111/j.1747-0080.2012.01605.x

Green, S. M., James, E. P., Latter, S., Sutcliffe, M., & Fader, M. J. (2014). Barriers and facilitators to screening for malnutrition by community nurses: A qualitative study. Journal of Human Nutrition and Dietetics, 27(1), 88-95. https://doi.org/10.1111/jhn.12104

Guerra, R., Fonseca, I., Pichel, F., Restivo, M., & Amaral, T. (2014). Handgrip strength cutoff values for undernutrition screening at hospital admission. European Journal of Clinical Nutrition, 68(12), 1315-1321. https://doi.org/10.1038/ejcn.2014.226

Guerra, R., Fonseca, I., Pichel, F., Restivo, M., & Amaral, T. (2015). Usefulness of six diagnostic and screening measures for undernutrition in predicting length of hospital stay: A comparative analysis. Journal of the Academy of Nutrition and Dietetics, 115(6), 927-938. https://doi.org/10.1016/j.jand.2014.11.015

Guerra, R., Sousa, A., Fonseca, I., Pichel, F., Restivo, M., Ferreira, S., & Amaral, T. (2016). Comparative analysis of undernutrition screening and diagnostic tools as predictors of hospitalisation costs. Journal of Human Nutrition and Dietetics, 29(2), 165-173. https://doi.org/10.1111/jhn.12288

Guigoz, Y. (2006). The mini nutritional assessment (MNA) review of the literature--what does it tell us? Journal of Nutrition, Health And Aging, 10(6), 466-487. https://pubmed.ncbi.nlm.nih.gov/17183419/

Jeznach-Steinhagen, A., Ostrowska, J., & Czerwonogrodzka-Senczyn, A. (2016). Evaluation of conducting a screening assessment of nutritional status of hospitalized patients. Presentation of main goals and objectives of the global health project “NutritionDay”. Przegl Epidemiolgiczny, 70(1), 71-75 https://pubmed.ncbi.nlm.nih.gov/27344478/

Khalatbari-Soltani, S., & Marques-Vidal, P. (2015). The economic cost of hospital malnutrition in Europe; a narrative review. Clinical Nutrition ESPEN, 10(3), e89-e94. https://doi.org/10.1016/j.clnesp.2015.04.003

Kohutová, M. (2018). Nutriční screening jako nástroj prevence rizik u hospitalizovaných pacientů z pohledu nutričního terapeuta/terapeutky. Management rizik ve zdravotnictví, 2(2), 22-31 https://kramerius.medvik.cz/search/pdf/web/viewer.html?pid=uuid:b7fc6693-5dd3-499d-9f8b-80e5ecd53acd

Kondrup, J., Allison, S., Elia, M., Vellas, B., & Plauth, M. (2003). ESPEN guidelines for nutrition screening 2002. Clinical Nutrition, 22(4), 415-421. https://doi.org/10.1016/S0261-5614(03)00098-0

Kozáková, R., Jarošová, D., Zeleníková, R., & Bocková, S. (2011). Nutrition screening tools for hospitalized patients. Hygie, 56(1), 18-21.

Kruizenga, H., Seidell, J., de Vet, H., Wierdsma, N., & van Bokhorst-de van der Schueren, M. (2005). Development and validation of a hospital screening tool for malnutrition: The short nutritional assessment questionnaire (SNAQ©). Clinical Nutrition, 24, 75-82. https://doi.org/10.1016/j.clnu.2004.07.015

Kruizenga, H., van Keeken, S., Weijs, P., Bastiaanse, L., Beijer, S., Huisman-de Waal, G., Jager-Wittenaar, H., Jonkers-Schuitema, C., Klos, M., Remijnse-Meester, W., Witteman, B., & Thijs, A. (2016). Undernutrition screening survey in 564,063 patients: Patients with a positive undernutrition screening score stay in hospital 1.4 d longer. The American Journal of Clinical Nutrition, 103(4), 1026-1032. https://doi.org/10.3945/ajcn.115.126615

Massy-Westropp, N., Gill, T., Taylor, A., Bohannon, R., & Hill, C. (2011). Hand Grip Strength: Age and gender stratified normative data in a population-based study. BMC Research Notes, 4(1), 127. https://doi.org/10.1186/1756-0500-4-127

Munn, Z., Peters, M. D. J., Stern, C., Tufanaru, C., McArthur, A., & Aromataris, E. (2018). Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Medical Research Methodology, 18(1), 143. https://doi.org/10.1186/s12874-018-0611-x

Muscaritoli, M., Lucia, S., Farcomeni, A., Lorusso, V., Saracino, V., Barone, C., Plastino, F., Gori, S., Magarotto, R., Carteni, G., Chiurazzi, B., Pavese, I., Marchetti, L., Zagonel, V., Bergo, E., Tonini, G., Imperatori, M., Iacono, C., Maiorana, L., et al. (2017). Prevalence of malnutrition in patients at first medical oncology visit: The PreMiO study. Oncotarget, 8(45), 79884-79896. https://doi.org/10.18632/oncotarget.20168

Neelemaat, F., Meijers, J., Kruizenga, H., van Ballegooijen, H., & van Bokhorst-de van der Schueren, M. (2011). Comparison of five malnutrition screening tools in one hospital inpatient sample. Journal of Clinical Nursing, 20(15-16), 2144-2152. https://doi.org/10.1111/j.1365-2702.2010.03667.x

Nursal, T., Noyan, T., Atalay, B., Köz, N., & Karakayali, H. (2005). Simple two-part tool for screening of malnutrition. Nutrition, 21(6), 659-665. https://doi.org/10.1016/j.nut.2004.10.016

Peters, M., Godfrey, C., McInerney, P., Munn, Z., Trico, A., & Khalil, H. (2020). Chapter 11: Scoping reviews. In JBI manual for evidence synthesis. JBI. https://doi.org/10.46658/JBIMES-20-12

Poulia, K., Klek, S., Doundoulakis, I., Bouras, E., Karayiannis, D., Baschali, A., Passakiotou, M., & Chourdakis, M. (2017). The two most popular malnutrition screening tools in the light of the new ESPEN consensus definition of the diagnostic criteria for malnutrition. Clinical Nutrition, 36(4), 1130-1135. https://doi.org/10.1016/j.clnu.2016.07.014

Raja, R., Lim, A. V., Lim, Y. P., Lim, G., Chan, S. P., & Vu, C. K. F. (2004). Malnutrition screening in hospitalised patients and its implication on reimbursement. Internal Medicine Journal, 34(4), 176-181. https://doi.org/10.1111/j.1444-0903.2004.00518.x

Raslan, M., Gonzalez, M. C., Gonçalves Dias, M. C., Nascimento, M., Castro, M., Marques, P., Segatto, S., Torrinhas, R. S., Cecconello, I., & Waitzberg, D. L. (2010). Comparison of nutritional risk screening tools for predicting clinical outcomes in hospitalized patients. Nutrition, 26(7-8), 721-726. https://doi.org/10.1016/j.nut.2009.07.010

Reber, E., Gomes, F., Vasiloglou, M., Schuetz, P., & Stanga, Z. (2019). Nutritional risk screening and assessment. Journal of Clinical Medicine, 8(7), 1065. https://doi.org/10.3390/jcm8071065

Roller, R., Eglseer, D., Eisenberger, A., & Wirnsberger, G. (2016). The Graz Malnutrition Screening (GMS): A new hospital screening tool for malnutrition. British Journal of Nutrition, 115(4), 650-657. https://doi.org/10.1017/S0007114515004924

Ruiz, A., Buitrago, G., Rodríguez, N., Gómez, G., Sulo, S., Gómez, C., Partridge, J., Misas, J., Dennis, R., Alba, M., Chaves-Santiago, W., & Araque, C. (2019). Clinical and economic outcomes associated with malnutrition in hospitalized patients. Clinical Nutrition, 38(3), 1310-1316. https://doi.org/10.1016/j.clnu.2018.05.016

Sharma, P., Rauf, A., Matin, A., Agarwal, R., Tyagi, P., & Arora, A. (2017). Handgrip strength as an important bed side tool to assess malnutrition in patient with liver disease. Journal of Clinical and Experimental Hepatology, 7(1), 16-22. https://doi.org/10.1016/j.jceh.2016.10.005

Skipper, A., Coltman, A., Tomesko, J., Charney, P., Porcari, J., Piemonte, T. A., Handu, D., & Cheng, F. W. (2020). Adult malnutrition (undernutrition) screening: An evidence analysis center systematic review. Journal of the Academy of Nutrition and Dietetics, 120(4), 669-708. https://doi.org/10.1016/j.jand.2019.09.010

Smith, S., Westergren, A., Saunders, J., & Hagell, P. (2016). Nutritional screening: A user-friendly tool adapted from Sweden. British Journal of Nursing, 25(4), 208-211. https://doi.org/10.12968/bjon.2016.25.4.208

Stratton, R., Hackston, A., Longmore, D., Dixon, R., Price, S., Stroud, M., King, C., & Elia, M. (2004). Malnutrition in hospital outpatients and inpatients: Prevalence, concurrent validity and ease of use of the ‘malnutrition universal screening tool’ (‘MUST’) for adults. British Journal of Nutrition, 92(5), 799-808. https://doi.org/10.1079/BJN20041258

Taipa-Mendes, A. M., Amaral, T. F., & Gregório, M. (2021). Undernutrition risk and nutritional screening implementation in hospitals: Barriers and time trends (2019-2020). Clinical Nutrition ESPEN, 45, 192-199. https://doi.org/10.1016/j.clnesp.2021.08.029

Timsina, P., Joshi, H. N., Cheng, F. Y., Kersch, I., Wilson, S., Colgan, C., Freeman, R., Reich, D. L., Mechanick, J., Mazumdar, M., Levin, M. A., & Kia, A. (2020). MUST-Plus: A machine learning classifier that improves malnutrition screening in acute care facilities. Journal of the American College of Nutrition, 40(1), 3-12. https://doi.org/10.1080/07315724.2020.1774821

Tran, Q., Banks, M., Hannan-Jones, M., Do, T., & Gallegos, D. (2018). Validity of four nutritional screening tools against subjective global assessment for inpatient adults in a low-middle income country in Asia. European Journal of Clinical Nutrition, 72(7), 979-985. https://doi.org/10.1038/s41430-018-0217-8

Tricco, A., Lillie, E., Zarin, W., O'Brien, K., Colquhoun, H., Levac, D., Moher, D., Peters, M., Horsley, T., Weeks, L., Hempel, S., Akl, E., Chang, C., McGowan, J., Stewart, L., Hartling, L., Aldcroft, A., Wilson, M., Garritty, C., et al. (2018). PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and explanation. Annals of Internal Medicine, 169(7), 467-473. https://doi.org/10.7326/M18-0850

Vallén, C., Hagell, P., & Westergren, A. (2011). Validity and user-friendliness of the minimal eating observation and nutrition form - Version II (MEONF - II) for undernutrition risk screening. Food & Nutrition Research, 55(1). https://doi.org/10.3402/fnr.v55i0.5801

van Bokhorst-de van der Schueren, M., Guaitoli, P., Jansma, E., & de Vet, H. (2014a). A systematic review of malnutrition screening tools for the nursing home setting. Journal of the American Medical Directors Association, 15(3), 171-184. https://doi.org/10.1016/j.jamda.2013.10.006

van Bokhorst-de van der Schueren, M., Guaitoli, P., Jansma, E., & de Vet, H. (2014b). Nutrition screening tools: Does one size fit all? A systematic review of screening tools for the hospital setting. Clinical Nutrition, 33(1), 39-58. https://doi.org/10.1016/j.clnu.2013.04.008

van Vliet, I., Gomes-Neto, A., de Jong, M., Jager-Wittenaar, H., & Navis, G. (2020). High prevalence of malnutrition both on hospital admission and predischarge. Nutrition, 77, 110814. https://doi.org/10.1016/j.nut.2020.110814

VanDerBosch, G., Sulo, S., Dziadosz, M., Kozmic, S. E., Sorkin, K., Lanctin, D., & Isenring, L. (2019). Similar health economic outcomes in low-risk and high-risk malnourished inpatients as screened by the Malnutrition Screening Tool after delivery of oral nutritional supplements. Nutrition, 67-68, 110519. https://doi.org/10.1016/j.nut.2019.05.011

Volkert, D., Beck, A., Cederholm, T., Cruz-Jentoft, A., Goisser, S., Hooper, L., Kiesswetter, E., Maggio, M., Raynaud-Simon, A., Sieber, C., Sobotka, L., van Asselt, D., Wirth, R., & Bischoff, S. (2019). ESPEN guideline on clinical nutrition and hydration in geriatrics. Clinical Nutrition, 38(1), 10-47. https://doi.org/10.1016/j.clnu.2018.05.024

Westergren, A., Norberg, E., & Hagell, P. (2011). Diagnostic performance of the Minimal Eating Observation and Nutrition Form-Version II (MEONF-II) and Nutritional Risk Screening 2002 (NRS 2002) among hospital inpatients-A cross-sectional study. BMC Nursing, 10(1), 1-7. https://doi.org/10.1186/1472-6955-10-24