The SNAQ(RC), an easy traffic light system as a first step in the recognition of undernutrition in residential care.
OBJECTIVE
Development and validation of a quick and easy screening tool for the early detection of undernourished residents in nursing homes and residential homes.


METHODS
Multi-center, cross sectional observational study.


METHODS
Nursing homes and residential homes.


METHODS
The screening tool was developed in a total of 308 residents (development sample; sample A) and cross validated in a new sample of 720 residents (validation sample) consisting of 476 nursing home residents (Sample B1) and 244 residential home residents (sample B2).


METHODS
Patients were defined severely undernourished when they met at least one of the following criteria: BMI <or= 20 kg/m2 and/or >or= 5% unintentional weight loss in the past month and/or >or= 10% unintentional weight loss in the past 6 months. Patients were defined as moderately undernourished if they met the following criteria: BMI 20.1-22 kg/m2 and/or 5-10% unintentional weight loss in the past six months. The most predictive questions (originally derived from previously developed screening instruments) of undernourishment were selected in sample A and cross validated in sample B. In a second stage BMI was added to the SNAQRC in sample B. The diagnostic accuracy of the screening tool in the development and validation samples was expressed in sensitivity, specificity, and the negative and positive predictive value.


RESULTS
The four most predictive questions for undernutrition related to: unintentional weight loss more than 6 kg during the past 6 months and more than 3 kg in the past month, capability of eating and drinking with help, and decreased appetite during the past month. The diagnostic accuracy of these questions alone was insufficient (Se=45%, Sp=87%, PPV=50% and NPV=84%). However, combining the questions with measured BMI sufficiently improved the diagnostic accuracy (Se=87%, Sp=82%, PPV=59% and NPV=95%).


CONCLUSIONS
Early detection of undernourished nursing- and residential home residents is possible using four screening questions and measured BMI.
Kruizenga
H M
HM
Department of Nutrition and Dietetics, VU University Medical Center, Amsterdam, The Netherlands.
de Vet
H C W
HC
Van Marissing
C M E
CM
Stassen
E E P M
EE
Strijk
J E
JE
Van Bokhorst-de Van der Schueren
M A E
MA
Horman
J C H
JC
Schols
J M G A
JM
Van Binsbergen
J J
JJ
Eliens
A
A
Knol
D L
DL
Visser
M
M
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D015992:Body Mass Index; D005260:Female; D015577:Geriatric Assessment; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000175:diagnosis*; D008403:Mass Screening; D009426:Netherlands; D015596:Nutrition Assessment; D009752:Nutritional Status; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012112:Residential Facilities; D012307:Risk Factors; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires / Q000592:standards*; D015431:Weight Loss / Q000502:physiology