A comparison of the malnutrition screening tools, MUST, MNA and bioelectrical impedance assessment in frail older hospital patients.
OBJECTIVE
This cohort study aimed to investigate and compare the ability to predict malnutrition in a group of frail older hospital patients in the United Kingdom using the nutritional risk screening tools, MUST (malnutrition universal screening tool), MNA-SF(®) (mini nutritional assessment-short form) and bioelectrical impedance assessment (BIA) of body composition.


METHODS
MUST and MNA-SF was performed on 78 patients (49 males and 29 females, age: 82 y ± 7.9, body mass index (BMI): 25.5 kg/m(2) ± 5.4), categorised by nutritional risk, and statistical comparison and test reliability performed. BIA was performed in 66 patients and fat free mass (FFM), fat mass (FM) and body cell mass (BCM) and index values (kg/m(2)) calculated and compared against reference values.


RESULTS
MUST scored 77% patients 'low risk', 9% 'medium risk' and 14% 'high risk', compared to MNA-SF categorisation: 9%, 46% and 45%, respectively (P < 0.000001). Reliability assessment found poor reliability between the screening tools (coefficient, r = 0.4). Significant positive correlations were found between most variables (P < 0.05-<0.001); although females exhibited greater variation. FFM index analysis found 40% of males low/depleted, 21% borderline/at risk with 96% categorised by MNA-SF as either malnourished or at risk (MUST-35%). 29% males had low FM index and all appropriately classified by MNA-SF. 30% females had low FFM index or borderline, MNA-SF screening appropriately categorised 86% (compared to MUST-29%).


CONCLUSIONS
This preliminary data may have significant clinical implications and highlights the potential ability of the MNA-SF and BIA to accurately assess malnutrition risk over MUST in frail older hospital patients.
School of Life Sciences, Brayford Pool Campus, Lincoln, Lincolnshire LN6 7TS, UK. Electronic address: aslee@lincoln.ac.uk.
Adrian
A
Slee
Lincoln Hospital, ULHT, Lincoln, Lincolnshire LN2 5QY, UK. Electronic address: deborah.birch@ulh.nhs.uk.
Deborah
D
Birch
St Barnabas Hospice, ULHT, Lincoln, Lincolnshire LN2 1RE, UK. Electronic address: david.stokoe@stbarnabashospice.co.uk.
David
D
Stokoe
D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015331:Cohort Studies; D017097:Electric Impedance; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D007297:Inpatients; D008297:Male; D044342:Malnutrition / Q000175:diagnosis* / Q000503:physiopathology; D008403:Mass Screening / Q000379:methods*; D015596:Nutrition Assessment; D009752:Nutritional Status; D012307:Risk Factors; D006113:United Kingdom
Bioelectrical impedance assessment; Frailty; MNA; MUST; Malnutrition