Accuracy of three tools for malnutrition diagnosis in hospitalized patients: comparison to subjective global assessment.

Background Malnutrition is prevalent in hospital, and the Subjective Global Assessment (SGA) has been widely used for its identification. However, in the last decade new tools were proposed by the Academy of Nutrition and Dietetics-American Society for Parenteral and Enteral Nutrition (AND-ASPEN), European Society for Clinical Nutrition and Metabolism (ESPEN), and Global Leadership Initiative on Malnutrition (GLIM). The diagnostic test accuracy of these tools has been scarcely investigated. Thus, we aimed to compare the accuracy of AND-ASPEN, ESPEN, and GLIM for malnutrition diagnosis in hospitalized patients. Methods A cross sectional study was conducted with hospitalized patients aged ≥18 years from five-unit complex hospital. Malnutrition was diagnosed within 48 hours of admission using SGA, AND-ASPEN, ESPEN, and GLIM. The accuracy of these tools was evaluated by the area under the receiver operating characteristic (AUROC) curve, considering SGA as reference, which was compared by the DeLong test. Results Six hundred patients (55.7±14.8 years, 51.3% male) were evaluated. AND-ASPEN (AUROC 0.846; 95%CI, 0.810-0.883) and GLIM presented a satisfactory accuracy (AUROC 0.842; 95%CI, 0.807-0.877), while ESPEN had a substantially lower accuracy (AUROC, 0.572; 95%CI, 0.522-0.622). The AUROC of AND-ASPEN and GLIM were not different from each other (p=0.785) and both had significantly higher accuracy than ESPEN (p 80%, while ESPEN sensitivity was Conclusions AND-ASPEN and GLIM were accurate methods for diagnosing malnutrition and could be applied in hospitalized patients. In contrast, the ESPEN criteria had unsatisfactory accuracy.