Predictive and concurrent validity of the Malnutrition Universal Screening Tool using mid-upper arm circumference instead of body mass index.

BACKGROUND: Considering the difficulty in obtaining weight and height measurements of patients at hospital admission, the Malnutrition Universal Screening Tool (MUST) proposes the use of mid-upper arm circumference (MUAC) instead of body mass index (BMI) as an alternative for screening of malnutrition risk. The present study aimed to evaluate the performance of MUST with MUAC in place of BMI to identify nutritional risk and predict prolonged hospitalisation and mortality in hospitalised patients. METHODS: The prospective cohort study involved ambulant patients aged ≥18 years who were admitted to the emergency department of a public hospital. A questionnaire concerning clinical and socio-demographic data was applied and anthropometric measurements were performed (weight, height, BMI and MUAC). Nutritional risk screening was performed using the original MUST (BMI) and MUST-MUAC tools. The outcomes were length of hospital stay and death. RESULTS: Seven hundred and fifty-two patients were included and followed-up for 13.5 (interquartile range 3.00-19.00) days. The frequency of patients at nutritional risk was higher according to MUST-MUAC (48.9%) compared to the original MUST (37.1%). MUST-MUAC showed concurrent validity, demonstrating good agreement with the original MUST (k = 0.690), high sensitivity (95.3%) and accuracy (area under the curve = 0.868; 95% confidence interval = 0.841-0.895) with respect to identifying nutritional risk. The presence of nutritional risk detected by the MUST-MUAC increased the chance of prolonged hospital stay by 1.9 (95% CI. 1.4-2.7)-fold and mortality by 3.2 (95% CI. 1.1-9.4)-fold. CONCLUSIONS: MUST-MUAC showed satisfactory concurrent and predictive validity. Considering that MUAC measurement is easier to perform than BMI, the MUST-MUAC should be used for screening of nutritional risk in hospitalised patients.

Nutrition screening in public hospital emergency rooms: Malnutrition Universal Screening Tool and Nutritional Risk Screening-2002 can be applied.

OBJECTIVE: To evaluate the agreement between two nutritional screening tools (Malnutrition Universal Screening Tool [MUST] and Nutritional Risk Screening-2002 [NRS-2002]) and Subjective Global Assessment (SGA) to identify nutritional risk in patients admitted to public emergency rooms. STUDY DESIGN: Cross-sectional study. METHODS: Patients aged ≥18 years who were admitted to an emergency room of a tertiary public hospital were evaluated. A nutritional risk assessment was performed in the first 48 h following hospital admission, through MUST, NRS-2002, and SGA. The Cohen's kappa coefficient was calculated. RESULTS: The study included 577 patients, with an average age of 53.9 ± 15.8 years; 56% of whom were women. Prevalence of nutritional risk was 35.3% and 28.5% according to MUST and NRS-2002, respectively, and malnutrition prevalence was equal to 32.9% according to SGA. The Cohen's kappa coefficient between SGA and MUST was 0.67 and between SGA and NRS-2002 was 0.62. CONCLUSION: MUST and NRS-2002 showed good agreement with SGA in identification of nutritional risk, suggesting that both tools have similar applicability for nutritional screening in adults or older patients admitted to public emergency rooms.

Dietary intake of cancer patients on radiotherapy.

UNLABELLED: The dietary intake of cancer patients can affect their nutritional status. OBJECTIVES: To assess the dietary intake and nutritional status of head and neck cancer patients on radiotherapy. METHODS: 24-hour recalls and anthropometric measures were taken during the first and third weeks of radiotherapy. RESULTS: Of the 62 patients, significant reductions were found in arm muscle area (p = 0.001) and arm muscle circumference (p < 0.001), and 69% of patients had an average weight loss of 5.7% in three weeks. With regards to their dietary intake, reductions were found in energy (26.5 kcal/kg/d-21.3 kcal/kg/d, p < 0.001), carbohydrate (196.9 g/d - 180.5 g/d, p = 0.020), protein (1.19 g/kg/d-0.93 g/kg/d, p = 0.009) and fat (44.4 g/d-33.1 g/d, p < 0.001) intakes during the study period. DISCUSSION: The changes that result from cancer radiotherapy led to reductions in dietary intake and negatively affected body composition measures.

Validation of predictive equations for weight and height using a metric tape.

UNLABELLED: Weight and height measurements are important data for the evaluation of nutritional status but some situations prevent the execution of these measurements in the standard manner, using special equipment or an estimate by predictive equations. Predictive equations of height and weight requiring only a metric tape as an instrument have been recently developed. OBJECTIVE: To validate three predictive equations for weight and two for height by Rabito and evaluating their agreement with the equations proposed by Chumlea. METHODS: The following data were collected: sex, age and anthropometric measurements, ie, weight (kg), height (m), subscapular skinfold (mm), calf (cm), arm (cm) and abdominal (cm) circumferences, arm length (cm), and half span (cm). Data were analyzed statistically using the Lin coefficient to test the agreement between the equations and the St. Laurent coefficient to compare the estimated weight and height values with real values. RESULTS: 100 adults (age 48 +/- 18 years) admitted to the University Hospital (HCFMRP/USP) were evaluated. Equations I: W(kg) = 0.5030 (AC) + 0.5634 (AbC) + 1.3180 (CC) +0.0339 (SSSF) - 43.1560 and II: W (kg) = 0.4808 (AC) + 0.5646 (AbC) +1.3160 (CC) - 42.2450 showed the highest coefficients of agreement for weight and equations IV and V showed the highest coefficients of agreement for height. The St. Laurent coefficient indicated that equations III and V were valid for weight and height, respectively. CONCLUSION: Among the validated equations, the number III W (kg) = 0.5759 (AC) + 0.5263 (AbC) +1.2452 (CC) - 4.8689 (S) - 32.9241 and VH (m) = 63,525 -3,237(S) - 0,06904 (A) + 1,293 (HS) are recommended for height or weight because of their easy use for hospitalized patients and the equations be validated in other situations.