Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 19 , ISSUE 9 ( 2015 ) > List of Articles


Assessing nutrition in the critically ill elderly patient: A comparison of two screening tools

J.C. Mishra

Keywords : Critical care outcome, elderly critically ill, malnutrition, nutrition screening tools

Citation Information : Mishra J. Assessing nutrition in the critically ill elderly patient: A comparison of two screening tools. Indian J Crit Care Med 2015; 19 (9):518-522.

DOI: 10.4103/0972-5229.164798

License: CC BY-ND 3.0

Published Online: 01-08-2016

Copyright Statement:  Copyright © 2015; The Author(s).


Context: Few malnutrition screening tests are validated in the elderly Intensive Care Unit (ICU) patient. Aim: Having previously established malnutrition as a cause of higher mortality in this population, we compared two screening tools in elderly patients. Subjects and Methods: For this prospective study, 111 consecutive patients admitted to the ICU and > 65 years underwent the Malnutrition Universal Screening Tool (MUST), and the Geriatric Nutrition Risk Index (GNRI) screening tests. Statistical Analysis: Standard definition of malnutrition risk was taken as the gold standard to evaluate the sensitivity, specificity and predictive values of the tools. The k statistic was calculated to measure the agreement between the tools. The Shrout classification was used to interpret its values. Results: The mean age of the patients screened was 74.7 ± 8.4 (65-97 years). The standard definition, MUST and GNRI identified 52.2%, 65.4%, and 64.9% to be malnourished, respectively. The sensitivity and specificity of the tests were 96.5% computed tomography (CI) (87.9-99.5%) and 72.3% CI (57.5-84.5%) for MUST and 89.5% CI (75.2-96.7%) and 55.0% CI (75.2-96.9%) for GNRI, respectively. Screening was not possible by GNRI and MUST tool in 31% versus 4% of patients, respectively. The agreement between the tools was moderate for Standard-MUST k = 0.65 and MUST-GNRI k = 0.60 and fair for Standard-GNRI k = 0.43. Conclusions: The risk of malnutrition is high among our patients as identified by all the tools. Both GNRI and MUST showed a high sensitivity with MUST showing a higher specificity and greater applicability.

PDF Share
  1. Sungurtekin H, Sungurtekin U, Okke D. Nutrition assessment in critically ill patients. Nutr Clin Pract 2008;23:635-41.
  2. Feldblum I, German L, Castel H, Harman-Boehm I, Bilenko N, Eisinger M, et al. Characteristics of undernourished older medical patients and the identification of predictors for undernutrition status. Nutr J 2007;6:37.
  3. Durán Alert P, Milà Villarroel R, Formiga F, Virgili Casas N, Vilarasau Farré C. Assessing risk screening methods of malnutrition in geriatric patients: Mini Nutritional Assessment (MNA) versus Geriatric Nutritional Risk Index (GNRI). Nutr Hosp 2012;27:590-8.
  4. Tripathy S, Mishra JC, Dash SC. Critically ill elderly patients in a developing world - Mortality and functional outcome at 1 year: A prospective single-center study. J Crit Care 2014;29:474.e7-13.
  5. Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, et al. What is subjective global assessment of nutritional status? 1987. Classical article. Nutr Hosp 2008;23:400-7.
  6. Malnutrition Advisory Group. A consistent and reliable tool for malnutrition screening. Nurs Times 2003;99:26-7.
  7. Ferguson M, Capra S, Bauer J, Banks M. Development of a valid and reliable malnutrition screening tool for adult acute hospital patients. Nutrition 1999;15:458-64.
  8. Anthony PS. Nutrition screening tools for hospitalized patients. Nutr Clin Pract 2008;23:373-82.
  9. Bouillanne O, Morineau G, Dupont C, Coulombel I, Vincent JP, Nicolis I, et al. Geriatric Nutritional Risk Index: A new index for evaluating at-risk elderly medical patients. Am J Clin Nutr 2005;82:777-83.
  10. Malnutrition Universal Screening Tool. Available from: Last accessed 24/3/15.
  11. Detsky AS, Smalley PS, Chang J. The rational clinical examination. Is this patient malnourished? JAMA 1994;271:54-8.
  12. Kruizenga HM, Wierdsma NJ, van Bokhorst-de van der Schueren MA, Hollander HJ, Jonkers-Schuitema CF, Van der Heijden E, et al. Screening of nutritional status in The Netherlands. Clin Nutr 2003;22:147-52.
  13. Stratton RJ, Green CJ, Elia M. Scientific criteria for defining malnutrition. In: Richards G, editor. Disease Related Malnutrition: An Evidence-Based Approach to Treatment. Cambridge: CABI Publishing; 2003. p. 1-34.
  14. FAO/WHO/UNU. Energy and Protein Requirements, 724. Technical Report Series. Geneva: WHO; 1985.
  15. Yamada K, Furuya R, Takita T, Maruyama Y, Yamaguchi Y, Ohkawa S, et al. Simplified nutritional screening tools for patients on maintenance hemodialysis. Am J Clin Nutr 2008;87:106-13.
  16. Henderson S, Moore N, Lee E, Witham MD. Do the Malnutrition Universal Screening Tool (MUST) and Birmingham nutrition risk (BNR) score predict mortality in older hospitalised patients? BMC Geriatr 2008;8:26.
  17. Stratton RJ, King CL, Stroud MA, Jackson AA, Elia M. ′Malnutrition Universal Screening Tool′ predicts mortality and length of hospital stay in acutely ill elderly. Br J Nutr 2006;95:325-30.
  18. Cereda E, Pedrolli C. The Geriatric Nutritional Risk Index. Curr Opin Clin Nutr Metab Care 2009;12:1-7.
  19. Buzby GP, Knox LS, Crosby LO, Eisenberg JM, Haakenson CM, McNeal GE, et al. Study protocol: A randomized clinical trial of total parenteral nutrition in malnourished surgical patients. Am J Clin Nutr 1988;47 2 Suppl: 366-81.
  20. Shrout PE. Measurement reliability and agreement in psychiatry. Stat Methods Med Res 1998;7:301-17.
  21. Chima CS, Dietz-Seher C, Kushner-Benson S. Nutrition risk screening in acute care: A survey of practice. Nutr Clin Pract 2008;23:417-23.
  22. Neelemaat F, Meijers J, Kruizenga H, van Ballegooijen H, van Bokhorst-de van der Schueren M. Comparison of five malnutrition screening tools in one hospital inpatient sample. J Clin Nurs 2011;20:2144-52.
  23. Alberda C, Gramlich L, Jones N, Jeejeebhoy K, Day AG, Dhaliwal R, et al. The relationship between nutritional intake and clinical outcomes in critically ill patients: Results of an international multicenter observational study. Intensive Care Med 2009;35:1728-37.
  24. Heyland DK, Cahill N, Day AG. Optimal amount of calories for critically ill patients: Depends on how you slice the cake! Crit Care Med 2011;39:2619-26.
  25. Casaer MP, Mesotten D, Hermans G, Wouters PJ, Schetz M, Meyfroidt G, et al. Early versus late parenteral nutrition in critically ill adults. N Engl J Med 2011;365:506-17.
  26. Casaer MP, Wilmer A, Hermans G, Wouters PJ, Mesotten D, Van den Berghe G. Role of disease and macronutrient dose in the randomized controlled EPaNIC trial: A post hoc analysis. Am J Respir Crit Care Med 2013;187:247-55.
  27. Doig GS, Simpson F, Sweetman EA, Finfer SR, Cooper DJ, Heighes PT, et al. Early parenteral nutrition in critically ill patients with short-term relative contraindications to early enteral nutrition: A randomized controlled trial. JAMA 2013;309:2130-8.
  28. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Rice TW, Wheeler AP, Thompson BT, Steingrub J, Hite RD, et al. Initial trophic vs. full enteral feeding in patients with acute lung injury: The EDEN randomized trial. JAMA 2012;307:795-803.
  29. Casaer MP, Van den Berghe G. Nutrition in the acute phase of critical illness. N Engl J Med 2014;370:2450-1.
  30. Heyland DK, Dhaliwal R, Jiang X, Day AG. Identifying critically ill patients who benefit the most from nutrition therapy: The development and initial validation of a novel risk assessment tool. Crit Care 2011;15:R268.
  31. Preiser JC. Do we need an assessment of the nutrition risk in the critically ill patient? Crit Care 2012;16:101.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.