title: ESPEN diagnostic criteria for malnutrition - A validation study in hospitalized patients.
abstract: The European Society for Clinical Nutrition and Metabolism (ESPEN) released a consensus statement for undernutrition diagnosis: ESPEN diagnostic criteria for malnutrition (EDC). The EDC lacks validation and therefore, the present study aims to assess the concurrent and predictive validity of this tool in a cohort of inpatients.
  
  
  
  A prospective observational study took place in a university hospital. Concurrent validity of EDC was evaluated using the Patient Generated Subjective Global Assessment (PG-SGA) nutrition status classification as the reference method. Sensitivity, specificity, positive and negative predictive values were determined. The EDC predictive validity was assessed by its independent association with length of hospital stay (LOS), applying Cox proportional hazards ratio method.
  
  
  
  Of the 632 included patients, 455 participants (72%) were nutritionally-at-risk (Nutritional Risk Screening initial screening). For those that had screened positive, 260 (57.1%) and 55 participants (12.1%) were undernourished according to PG-SGA and to EDC, respectively. Compared to PG-SGA, the EDC revealed a sensitivity of 17.1% and a specificity of 98.3%. Positive and negative predictive values were respectively 89.1% and 58.9%. Undernutrition evaluated by EDC was independently associated with lower hazard ratio for being discharged home over time, 0.695 (95% confidence interval: 0.509; 0.950).
  
  
  
  The EDC could be used in clinical settings to confirm undernutrition suggested by other methods. The independent association of undernutrition by EDC with LOS shows this method is of clinical relevance.
authors.affiliation: Departamento de Bioquímica, Faculdade de Medicina, Universidade do Porto, Portugal; UISPA, LAETA-INEGI, Faculdade de Engenharia, Universidade do Porto, Portugal; Centro Hospitalar do Porto, Portugal. Electronic address: ritacsguerra@gmail.com.
authors.forename: Rita S
authors.initials: RS
authors.lastname: Guerra
authors.affiliation: Centro Hospitalar do Porto, Portugal. Electronic address: isabelf27@gmail.com.
authors.forename: Isabel
authors.initials: I
authors.lastname: Fonseca
authors.affiliation: Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Portugal; Centro Hospitalar do Porto, Portugal. Electronic address: sofia.limas.sousa@gmail.com.
authors.forename: Ana S
authors.initials: AS
authors.lastname: Sousa
authors.affiliation: Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Portugal; Centro Hospitalar do Porto, Portugal. Electronic address: alisonkjesus@gmail.com.
authors.forename: Alison
authors.initials: A
authors.lastname: Jesus
authors.affiliation: Centro Hospitalar do Porto, Portugal. Electronic address: director.nutricao@hgsa.min-saude.pt.
authors.forename: Fernando
authors.initials: F
authors.lastname: Pichel
authors.affiliation: Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Portugal; UISPA, LAETA-INEGI, Faculdade de Engenharia, Universidade do Porto, Portugal. Electronic address: amaral.tf@gmail.com.
authors.forename: Teresa F
authors.initials: TF
authors.lastname: Amaral
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006785:Hospitals, University; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D008297:Male; D044342:Malnutrition / Q000175:diagnosis*; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D016016:Proportional Hazards Models; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Concurrent validity; NRS-2002; Predictive validity; Undernutrition