Concurrent and Predictive Validity of AND-ASPEN Malnutrition Consensus Is Satisfactory in Hospitalized Patients: A Longitudinal Study.
hospital
length of stay
malnutrition
mortality
nutrition assessment
Journal
JPEN. Journal of parenteral and enteral nutrition
ISSN: 1941-2444
Titre abrégé: JPEN J Parenter Enteral Nutr
Pays: United States
ID NLM: 7804134
Informations de publication
Date de publication:
07 2021
07 2021
Historique:
revised:
08
07
2020
received:
05
05
2020
accepted:
27
07
2020
pubmed:
2
8
2020
medline:
3
11
2021
entrez:
2
8
2020
Statut:
ppublish
Résumé
Subjective Global Assessment (SGA) is the reference method to identify hospital malnutrition. The Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition (AND-ASPEN) proposed a more objective consensus, but studies regarding its validity are still scarce. This study aimed to evaluate the concurrent and predictive validity of the AND-ASPEN Consensus. Prospective cohort conducted with hospitalized adult and elderly patients. At admission, general data were collected and patients were evaluated by SGA and AND-ASPEN with and without handgrip strength (HGS) for nutrition diagnoses. Patients were followed up for collection of outcomes-length of hospital stay (LOS), in-hospital death, readmission, and mortality within 6 months after being discharged. Concurrent and predictive validity were tested. Six hundred patients (55.7 ± 14.8 years, 51.3% males) were evaluated. The median of LOS was 10.0 (5.018.0) days and in-hospital mortality was 2.7%. SGA identified 34.0% and AND-ASPEN 34.6% of patients as malnourished. AND-ASPEN had substantial agreement with SGA (κ = 0.690) and satisfactory accuracy (AUC = 0.85; 95% CI, 0.810.88). Malnutrition defined by AND-ASPEN predicted about 1.4 times higher risk of prolonged LOS (95% CI, 1.2-1.6) and hospital readmission (95% CI, 1.2-1.8), besides 5.0 times higher risk of hospital death (95% CI, 1.3-18.8) and 6 months' death (95% CI, 2.6-9.9), in an adjusted analysis. The validity of AND-ASPEN without HGS was also satisfactory. AND-ASPEN can be used for malnutrition diagnoses, even without HGS because it has satisfactory concurrent and predictive validity.
Sections du résumé
BACKGROUND
Subjective Global Assessment (SGA) is the reference method to identify hospital malnutrition. The Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition (AND-ASPEN) proposed a more objective consensus, but studies regarding its validity are still scarce. This study aimed to evaluate the concurrent and predictive validity of the AND-ASPEN Consensus.
METHODS
Prospective cohort conducted with hospitalized adult and elderly patients. At admission, general data were collected and patients were evaluated by SGA and AND-ASPEN with and without handgrip strength (HGS) for nutrition diagnoses. Patients were followed up for collection of outcomes-length of hospital stay (LOS), in-hospital death, readmission, and mortality within 6 months after being discharged. Concurrent and predictive validity were tested.
RESULTS
Six hundred patients (55.7 ± 14.8 years, 51.3% males) were evaluated. The median of LOS was 10.0 (5.018.0) days and in-hospital mortality was 2.7%. SGA identified 34.0% and AND-ASPEN 34.6% of patients as malnourished. AND-ASPEN had substantial agreement with SGA (κ = 0.690) and satisfactory accuracy (AUC = 0.85; 95% CI, 0.810.88). Malnutrition defined by AND-ASPEN predicted about 1.4 times higher risk of prolonged LOS (95% CI, 1.2-1.6) and hospital readmission (95% CI, 1.2-1.8), besides 5.0 times higher risk of hospital death (95% CI, 1.3-18.8) and 6 months' death (95% CI, 2.6-9.9), in an adjusted analysis. The validity of AND-ASPEN without HGS was also satisfactory.
CONCLUSION
AND-ASPEN can be used for malnutrition diagnoses, even without HGS because it has satisfactory concurrent and predictive validity.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1061-1071Informations de copyright
© 2020 American Society for Parenteral and Enteral Nutrition.
Références
Jensen GL, Mirtallo J, Compher C, et al. Adult starvation and disease-related malnutrition: a proposal for etiology-based diagnosis in the clinical practice setting from the International Consensus Guideline Committee. JPEN J Parenter Enteral Nutr. 2010;34(2):156-159.
Cederholm T, Jensen GL, Correia MITD, et al; GLIM Core Leadership Committee, GLIM Working Group. GLIM criteria for the diagnosis of malnutrition-a consensus report from the global clinical nutrition community. Clin Nutr. 2019;38(1):1-9.
Klek S, Krznaric Z, Gundogdu RH, et al. Prevalence of malnutrition in various political, economic, and geographic settings. JPEN J Parenter Enteral Nutr. 2015;39(2):200-210.
Correia MI, Perman MI, Waitzberg DL. Hospital malnutrition in Latin America: a systematic review. Clin Nutr. 2017;36(4):958-967.
Waitzberg DL, Caiaffa WT, Correia MITD. Hospital malnutrition: the Brazilian National Survey (IBRANUTRI): a study of 4000 patients. Nutrition. 2001;17(7-8):573-580.
Correia MITD, Campos ACL. Prevalence of hospital malnutrition in latin America: the Multicenter ELAN Study. Nutrition. 2003;19(10):823-825.
Lim SL, Ong KC, Chan YH, Loke WC, Ferguson M, Daniels L. Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Clin Nutr. 2012;31(3):345-350.
Detsky AS, McLaughlin JR, Baker JP, et al. What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr. 1987;11(1):8-13.
Barbosa-Silva MCG, Barros AJD. Avaliação nutricional subjetiva: parte 1- revisão de sua validade após duas décadas de uso. Arq Bras Gastroenterol. 2002;39(3):181-187.
Pham NV, Cox-Reijven PL, Greve JW, Soeters PB. Application of subjective global assessment as a screening tool for malnutrition in surgical patients in Vietnam. Clin Nutr 2006;25(1):102-108.
Raslan M, Gonzalez MC, Torrinhas RS, Ravacci GR, Pereira JC, Waitzberg DL. Complementarity of subjective global assessment (SGA) and nutritional risk screening 2002 (NRS 2002) for predicting poor clinical outcomes in hospitalized patients. Clin Nutr 2011;30(1):49-53.
Silva JF, Mello PD, Mello ED. Subjective global assessment of nutritional status-a systematic review of the literature. Clin Nutr. 2015;34(5):785-792.
Correia MI, Hegazi RA, Diaz-Pizarro Graf JI, et al. Addressing disease-related malnutrition in healthcare: a Latin American perspective. JPEN J Parenter Enteral Nutr. 2016;40(3):319-325.
White JV, Guenter P, Jensen G, Malone A, Schofield M; Academy Malnutrition Work Group; A.S.P.E.N. malnutrition task force; A.S.P.E.N. board of directors. Consensus statement: academy of nutrition and dietetics and american society for parenteral and enteral nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). JPEN J Parenter Enteral Nutr. 2012;36(3):275-283.
Hipskind P, Rath M, JeVenn A, et al. Correlation of new criteria for malnutrition assessment in hospitalized patients: and-aspen versus SGA. J Am Coll Nutr. Accepted manuscript. Published online December 30, 2019.
Ceniccola GD, Okamura AB, Neta JSS, et al. Association between AND-ASPEN malnutrition criteria and hospital mortality in critically Ill trauma patients: a Prospective Cohort Study. JPEN J Parenter Enteral Nutr. Accepted manuscript. Published online February 6, 2020.
Abahuje E, Niyongombwa I, Karenzi D, et al. Malnutrition in acute care surgery patients in Rwanda. World J Surg. 2020;44(5):1361-1367.
Rattanachaiwong S, Zribi B, Kagan I, Theilla M, Heching M, Singer P. Comparison of nutritional screening and diagnostic tools in diagnosis of severe malnutrition in critically ill patients. Clin Nutr. 2020;S0261-5614(20):30096-30099.
Guerra RS, Fonseca I, Pichel F, Restivo MT, Amaral TF. Usefulness of six diagnostic and screening measures for undernutrition in predicting length of hospital stay: a comparative analysis. J Acad Nutr Diet. 2015;115(6):927-938.
Guerra RS, Sousa AS, Fonseca I, et al. Comparative analysis of undernutrition screening and diagnostic tools as predictors of hospitalization costs. J Hum Nutr Diet. 2016;29(2):165-173.
Mosquera C, Koutlas NJ, Edwards KC, et al. Impact of malnutrition on gastrointestinal surgical patients. J Surg Res. 2016;205(1):95-101.
Hiller LD, Shaw RF, Fabri PJ. Difference in composite end point of readmission and death between malnourished and nonmalnourished veterans assessed using academy of nutrition and dietetics/American society for parenteral and enteral nutrition clinical characteristics. JPEN J Parenter Enteral Nutr. 2017;41(8):1316-1324.
Hudson L, Chittams J, Griffith C, Compher C. Malnutrition identified by academy of nutrition and dietetics/American society for parenteral and enteral nutrition is associated with more 30-day readmissions, greater hospital mortality, and longer hospital stays: a retrospective analysis of nutrition assessment data in a major medical center. JPEN J Parenter Enteral Nutr. 2018;42(5):892-897.
Ceniccola GD, Holanda TP, Pequeno RSF, et al. Relevance of AND-ASPEN criteria of malnutrition to predict hospital mortality in critically ill patients: a Prospective Study. J Crit Care. 2018;44:398-403.
Yeo HJ, Byun KS, Han J, et al. Prognostic significance of malnutrition for long-term mortality in community-acquired pneumonia: a propensity score matched analysis. Korean J Intern Med. 2019;34(4):841-849.
Hiura G, Lebwohl B, Seres DS. Malnutrition diagnosis in critically Ill patients using 2012 academy of nutrition and dietetics/American society for parenteral and enteral nutrition standardized diagnostic characteristics is associated with longer hospital and intensive care unit length of stay and increased in-hospital mortality. JPEN J Parenter Enteral Nutr. 2020;44(2):256-264.
Allard JP, Keller H, Gramlich L, Jeejeebhoy KN, Laporte M, Duerksen DR. GLIM criteria has fair sensitivity and specificity for diagnosing malnutrition when using SGA as comparator. Clin Nutr. 2019;S0261-5614(19):33172-33173.
Contreras-Bolívar V, Sánchez-Torralvo FJ, Ruiz-Vico M, et al. GLIM criteria using hand grip strength adequately predict six-month mortality in cancer inpatients. Nutrients. 2019;11(9):2043.
Skeie E, Tangvik RJ, Nymo LS, Harthug S, Lassen K, Viste A. Weight loss and BMI criteria in GLIM's definition of malnutrition is associated with postoperative complications following abdominal resections - Results from a National Quality Registry. Clin Nutr. 2020;39(5):1593-1599.
Yilmaz M, Atilla FD, Sahin F, Saydam G. The effect of malnutrition on mortality in hospitalized patients with hematologic malignancy. Support Care Cancer. 2020;28(3):1441-1448.
Maeda K, Ishida Y, Nonogaki T, Mori N. Reference body mass index values and the prevalence of malnutrition according to the global leadership initiative on malnutrition criteria. Clin Nutr. 2020;39(1):180-184.
Sanz-París A, Martín-Palmero A, Gomez-Candela C, et al. GLIM criteria at hospital admission predict 8-year all-cause mortality in elderly patients with type 2 diabetes mellitus: results from VIDA Study. JPEN J Parenter Enteral Nutr. Accepted manuscript. Published online February 6, 2020.
Charlson ME, Pompei P, Ales KL, Mackenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis. 1987;40(5):373-383.
Hall WH, Ramachandran R, Narayan S, et al. An electronic application for rapidly calculating Charlson comorbidity score. BMC Cancer. 2004;4(1):94.
Budziareck MB, Duarte RRP, Barbosa-Silva MCG. Reference values and determinants for handgrip strength in healthy subjects. Clin Nutr. 2008;27(3):357-362.
Hagan JC. Acute and chronic diseases. In: Mulner RM, ed. Encyclopedia of Health Services Research. Vol 1. Thousand Oaks, CA: Sage; 2009:25
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33(1):159-174.
Skipper A, Coltman A, Tomesko J, et al. Position of the academy of nutrition and dietetics: malnutrition (undernutrition) screening tools for all adults. J Acad Nutr Diet. 2020;120(4):709-713.
Dowhan L, DeChicco R, Welsh R, et al. Comparison between handgrip dynamometry and manual muscle testing performed by registered dietitians in measuring muscle strength and function of hospitalized patients. JPEN J Parenter Enteral Nutr. 2016;40(7):951-958.
Sánchez-Rodríguez D, Marco E, Ronquillo-Moreno N, et al. ASPEN-AND-ESPEN: a postacute-care comparison of the basic definition of malnutrition from the American society of parenteral and enteral nutrition and academy of nutrition and dietetics with the European society for clinical nutrition and metabolism definition. Clin Nutr. 2019;38(1):297-302.
Nicolo M, Compher CW, Still C, Huseini M, Dayton S, Jensen GL. Feasibility of accessing data in hospitalized patients to support diagnosis of malnutrition by the A.S.P.E.N. Malnutrition consensus recommended clinical characteristics. JPEN J Parenter Enteral Nutr. 2014;38(8):954-959.
Cederholm T, Bosaeus I, Barazzoni R, et al. Diagnostic criteria for malnutrition-an ESPEN consensus statement. Clin Nutr. 2015;34(3):335-340.