Nutritional risk and status assessment in surgical patients: a challenge amidst plenty

Background and Aims: No gold standard exists for nutritional screening/assessment. This cross-sectional study aimed to collect/use a comprehensive set of clinical, anthropometric, functional data, explore interrelations,and derive a feasible/sensitive/specific method to assess nutritional risk and status in hospital practice. Patients and Methods: 100 surgical patients were evaluated,49M:51F, 55 ± 18.9(18-88) years. Nutritional risk assessment: Kondrup¿s Nutritional Risk Assessment, BAPEN¿s Malnutrition Screening Tool, Nutrition Screening Initiative, Admission Nutritional Screening Tool. Nutritional status: anthropometry categorised by Body Mass Index and McWhirter & Pennington criteria, re-cent weight loss > 10%, dynamometry, Subjective Glo-bal Assessment. Results: There was a strong agreement between all nutritional risk (k = 0.69-0.89, p 10% was the only method that agreed with all tools (k =0.86-0.94, p =0.05), and was thereafter used as the stan-dard. Kondrup¿s Nutritional Risk Assessment and Ad-mission Nutritional Screening Tool were unspecific but highly sensitive (=95%). Subjective Global Assessment was highly sensitive (100%) and specific (69%), and was the only method with a significant Youden value (0.7). Conclusions: Kondrup¿s Nutritional Risk Assessment and Admission Nutritional Screening Tool emerged as sensitive screening methods; the former is simpler to use, Kondrup¿s Nutritional Risk Assessment has been devised to direct nutritional intervention. Recent unintentional weight loss > 10% is a simple method whereas Subjective Global Assessment identified high-risk/un-dernourished patients