Validity of Nutritional Screening Tools for Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis

Jennifer M J Isautier, Marija Bosnić, Suey S Y Yeung, Marijke C Trappenburg, Carel G M Meskers, Anna C Whittaker, Andrea B Maier

Research output: Contribution to JournalReview articleAcademicpeer-review

Abstract

OBJECTIVES: The aim of this systematic review was to summarize the validity of nutritional screening tools to detect the risk of malnutrition in community-dwelling older adults.

DESIGN: A systematic review and meta-analysis. The protocol for this systematic review was registered in the PROSPERO database (CRD42017072703).

SETTING AND PARTICIPANTS: A literature search was performed in PubMed, EMBASE, CINAHL, and Cochrane using the combined terms "malnutrition," "aged," "community-dwelling," and "screening." The time frame of the literature reviewed was from January 1, 2001, to May 18, 2018. Older community-dwellers were defined as follows: individuals with a mean/median age of >65 years who were community-dwellers or attended hospital outpatient clinics and day hospitals. All nutritional screening tools that were validated in community-dwelling older adults against a reference standard to detect the risk of malnutrition, or with malnutrition, were included.

MEASURES: Meta-analyses were performed on the diagnostic accuracy of identified nutritional screening tools validated against the Mini Nutritional Assessment-Long Form (MNA-LF). The symmetric hierarchical summary receiver operating characteristic models were used to estimate test performance.

RESULTS: Of 7713 articles, 35 articles were included in the systematic review, and 9 articles were included in the meta-analysis. Seventeen nutritional screening tools and 10 reference standards were identified. The meta-analyses showed average sensitivities and specificities of 0.95 (95% confidence interval [CI] 0.75-0.99) and 0.95 (95% CI 0.85-0.99) for the Mini Nutritional Assessment-Short Form (MNA-SF; cutoff point ≤11), 0.85 (95% CI 0.80-0.89) and 0.87 (95% CI 0.86-0.89) for the MNA-SF-V1 (MNA-SF using body mass index, cutoff point ≤11), 0.85 (95% CI 0.77-0.89) and 0.84 (95% CI 0.79-0.87) for the MNA-SF-V2 (MNA-SF using calf circumference instead of body mass, cutoff point ≤11), respectively, using MNA-LF as the reference standard.

CONCLUSIONS AND IMPLICATIONS: The MNA-SF, MNA-SF-V1, and MNA-SF-V2 showed good sensitivity and specificity to detect community-dwelling older adults at risk of malnutrition validated against the MNA-LF. Clinicians should consider the use of the cutoff point ≤11 on the MNA-SF, MNA-SF-V1, and MNA-SF-V2 to identify community-dwelling older adults at risk of malnutrition.

Original languageEnglish
Pages (from-to)1351.e13-1351.e25
JournalJournal of the American Medical Directors Association
Volume20
Issue number10
Early online date10 Aug 2019
DOIs
Publication statusPublished - Oct 2019

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Independent Living
Malnutrition
Meta-Analysis
Nutrition Assessment
Confidence Intervals
Hospital Outpatient Clinics
Sensitivity and Specificity
PubMed
ROC Curve
Body Mass Index
Databases

Bibliographical note

Copyright © 2019 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Cite this

Isautier, Jennifer M J ; Bosnić, Marija ; Yeung, Suey S Y ; Trappenburg, Marijke C ; Meskers, Carel G M ; Whittaker, Anna C ; Maier, Andrea B. / Validity of Nutritional Screening Tools for Community-Dwelling Older Adults : A Systematic Review and Meta-Analysis. In: Journal of the American Medical Directors Association. 2019 ; Vol. 20, No. 10. pp. 1351.e13-1351.e25.
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abstract = "OBJECTIVES: The aim of this systematic review was to summarize the validity of nutritional screening tools to detect the risk of malnutrition in community-dwelling older adults.DESIGN: A systematic review and meta-analysis. The protocol for this systematic review was registered in the PROSPERO database (CRD42017072703).SETTING AND PARTICIPANTS: A literature search was performed in PubMed, EMBASE, CINAHL, and Cochrane using the combined terms {"}malnutrition,{"} {"}aged,{"} {"}community-dwelling,{"} and {"}screening.{"} The time frame of the literature reviewed was from January 1, 2001, to May 18, 2018. Older community-dwellers were defined as follows: individuals with a mean/median age of >65 years who were community-dwellers or attended hospital outpatient clinics and day hospitals. All nutritional screening tools that were validated in community-dwelling older adults against a reference standard to detect the risk of malnutrition, or with malnutrition, were included.MEASURES: Meta-analyses were performed on the diagnostic accuracy of identified nutritional screening tools validated against the Mini Nutritional Assessment-Long Form (MNA-LF). The symmetric hierarchical summary receiver operating characteristic models were used to estimate test performance.RESULTS: Of 7713 articles, 35 articles were included in the systematic review, and 9 articles were included in the meta-analysis. Seventeen nutritional screening tools and 10 reference standards were identified. The meta-analyses showed average sensitivities and specificities of 0.95 (95{\%} confidence interval [CI] 0.75-0.99) and 0.95 (95{\%} CI 0.85-0.99) for the Mini Nutritional Assessment-Short Form (MNA-SF; cutoff point ≤11), 0.85 (95{\%} CI 0.80-0.89) and 0.87 (95{\%} CI 0.86-0.89) for the MNA-SF-V1 (MNA-SF using body mass index, cutoff point ≤11), 0.85 (95{\%} CI 0.77-0.89) and 0.84 (95{\%} CI 0.79-0.87) for the MNA-SF-V2 (MNA-SF using calf circumference instead of body mass, cutoff point ≤11), respectively, using MNA-LF as the reference standard.CONCLUSIONS AND IMPLICATIONS: The MNA-SF, MNA-SF-V1, and MNA-SF-V2 showed good sensitivity and specificity to detect community-dwelling older adults at risk of malnutrition validated against the MNA-LF. Clinicians should consider the use of the cutoff point ≤11 on the MNA-SF, MNA-SF-V1, and MNA-SF-V2 to identify community-dwelling older adults at risk of malnutrition.",
author = "Isautier, {Jennifer M J} and Marija Bosnić and Yeung, {Suey S Y} and Trappenburg, {Marijke C} and Meskers, {Carel G M} and Whittaker, {Anna C} and Maier, {Andrea B}",
note = "Copyright {\circledC} 2019 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.",
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Validity of Nutritional Screening Tools for Community-Dwelling Older Adults : A Systematic Review and Meta-Analysis. / Isautier, Jennifer M J; Bosnić, Marija; Yeung, Suey S Y; Trappenburg, Marijke C; Meskers, Carel G M; Whittaker, Anna C; Maier, Andrea B.

In: Journal of the American Medical Directors Association, Vol. 20, No. 10, 10.2019, p. 1351.e13-1351.e25.

Research output: Contribution to JournalReview articleAcademicpeer-review

TY - JOUR

T1 - Validity of Nutritional Screening Tools for Community-Dwelling Older Adults

T2 - A Systematic Review and Meta-Analysis

AU - Isautier, Jennifer M J

AU - Bosnić, Marija

AU - Yeung, Suey S Y

AU - Trappenburg, Marijke C

AU - Meskers, Carel G M

AU - Whittaker, Anna C

AU - Maier, Andrea B

N1 - Copyright © 2019 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

PY - 2019/10

Y1 - 2019/10

N2 - OBJECTIVES: The aim of this systematic review was to summarize the validity of nutritional screening tools to detect the risk of malnutrition in community-dwelling older adults.DESIGN: A systematic review and meta-analysis. The protocol for this systematic review was registered in the PROSPERO database (CRD42017072703).SETTING AND PARTICIPANTS: A literature search was performed in PubMed, EMBASE, CINAHL, and Cochrane using the combined terms "malnutrition," "aged," "community-dwelling," and "screening." The time frame of the literature reviewed was from January 1, 2001, to May 18, 2018. Older community-dwellers were defined as follows: individuals with a mean/median age of >65 years who were community-dwellers or attended hospital outpatient clinics and day hospitals. All nutritional screening tools that were validated in community-dwelling older adults against a reference standard to detect the risk of malnutrition, or with malnutrition, were included.MEASURES: Meta-analyses were performed on the diagnostic accuracy of identified nutritional screening tools validated against the Mini Nutritional Assessment-Long Form (MNA-LF). The symmetric hierarchical summary receiver operating characteristic models were used to estimate test performance.RESULTS: Of 7713 articles, 35 articles were included in the systematic review, and 9 articles were included in the meta-analysis. Seventeen nutritional screening tools and 10 reference standards were identified. The meta-analyses showed average sensitivities and specificities of 0.95 (95% confidence interval [CI] 0.75-0.99) and 0.95 (95% CI 0.85-0.99) for the Mini Nutritional Assessment-Short Form (MNA-SF; cutoff point ≤11), 0.85 (95% CI 0.80-0.89) and 0.87 (95% CI 0.86-0.89) for the MNA-SF-V1 (MNA-SF using body mass index, cutoff point ≤11), 0.85 (95% CI 0.77-0.89) and 0.84 (95% CI 0.79-0.87) for the MNA-SF-V2 (MNA-SF using calf circumference instead of body mass, cutoff point ≤11), respectively, using MNA-LF as the reference standard.CONCLUSIONS AND IMPLICATIONS: The MNA-SF, MNA-SF-V1, and MNA-SF-V2 showed good sensitivity and specificity to detect community-dwelling older adults at risk of malnutrition validated against the MNA-LF. Clinicians should consider the use of the cutoff point ≤11 on the MNA-SF, MNA-SF-V1, and MNA-SF-V2 to identify community-dwelling older adults at risk of malnutrition.

AB - OBJECTIVES: The aim of this systematic review was to summarize the validity of nutritional screening tools to detect the risk of malnutrition in community-dwelling older adults.DESIGN: A systematic review and meta-analysis. The protocol for this systematic review was registered in the PROSPERO database (CRD42017072703).SETTING AND PARTICIPANTS: A literature search was performed in PubMed, EMBASE, CINAHL, and Cochrane using the combined terms "malnutrition," "aged," "community-dwelling," and "screening." The time frame of the literature reviewed was from January 1, 2001, to May 18, 2018. Older community-dwellers were defined as follows: individuals with a mean/median age of >65 years who were community-dwellers or attended hospital outpatient clinics and day hospitals. All nutritional screening tools that were validated in community-dwelling older adults against a reference standard to detect the risk of malnutrition, or with malnutrition, were included.MEASURES: Meta-analyses were performed on the diagnostic accuracy of identified nutritional screening tools validated against the Mini Nutritional Assessment-Long Form (MNA-LF). The symmetric hierarchical summary receiver operating characteristic models were used to estimate test performance.RESULTS: Of 7713 articles, 35 articles were included in the systematic review, and 9 articles were included in the meta-analysis. Seventeen nutritional screening tools and 10 reference standards were identified. The meta-analyses showed average sensitivities and specificities of 0.95 (95% confidence interval [CI] 0.75-0.99) and 0.95 (95% CI 0.85-0.99) for the Mini Nutritional Assessment-Short Form (MNA-SF; cutoff point ≤11), 0.85 (95% CI 0.80-0.89) and 0.87 (95% CI 0.86-0.89) for the MNA-SF-V1 (MNA-SF using body mass index, cutoff point ≤11), 0.85 (95% CI 0.77-0.89) and 0.84 (95% CI 0.79-0.87) for the MNA-SF-V2 (MNA-SF using calf circumference instead of body mass, cutoff point ≤11), respectively, using MNA-LF as the reference standard.CONCLUSIONS AND IMPLICATIONS: The MNA-SF, MNA-SF-V1, and MNA-SF-V2 showed good sensitivity and specificity to detect community-dwelling older adults at risk of malnutrition validated against the MNA-LF. Clinicians should consider the use of the cutoff point ≤11 on the MNA-SF, MNA-SF-V1, and MNA-SF-V2 to identify community-dwelling older adults at risk of malnutrition.

U2 - 10.1016/j.jamda.2019.06.024

DO - 10.1016/j.jamda.2019.06.024

M3 - Review article

VL - 20

SP - 1351.e13-1351.e25

JO - Journal of the American Medical Directors Association

JF - Journal of the American Medical Directors Association

SN - 1525-8610

IS - 10

ER -