Psychometric properties of most common malnutrition functional assessments: systematic review

To determine most often used functional outcome measures for malnutrition assessment and analyze their psychometric properties. PubMed, Science Direct, SAGE Journals, Web of Science, SCOPUS and ProQuest were searched for articles published until October 2019, using key word “Malnutrition” and MeSH terms. Cut-off for most commonly used measures was 5%. To analyze each measurement property an already defined criterions (positive, negative, indeterminate) by Terwee et al. were used. 1311 studies described 92 functional assessments. Most commonly used outcome measures were: Mini Nutritional Assessment (MNA) – 312 times (30%), Subjective Global Assessment (SGA) – 139 times (13%), Nutritional Risk Screening 2002 (NRS-2002) – 96 times (9%), Malnutrition Universal Screening Tool (MUST) – 83 times (8%) and Patient-Generated Subjective Global Assessment (PG-SGA) – 47 times (5%). MNA proved to have most varied number of studies available. According to criteria, MNA had positive internal consistency (α=0.830) and test-retest reliability (ICC=0.89), among other properties, and no floor or ceiling effect was found to be present. A lot of information was missing on SGA psychometrics, but whatever could be found, indicated positive internal consistency (α=0.707) and reproducibility. The biggest literature gap, however, was detected for NRS-2002, even though first validation studies on it were published in early 2000s. Available evidence established positive content validity, test-retest reliability (κ =0.956) and responsiveness. For MUST English version most of the indicators were positive in different settings, but contradicting results were observed for culturally adapted versions. PG-SGA is a comprehensive outcome measure, including both patient’s and physician’s perspective, it has a strong base of evidence and positive ratings on almost all properties, however, lacks evidence on interpretability, to give context for clinically meaningful changes in results. MNA is the most commonly used malnutrition functional assessment. The amount and quality of evidence available on it, indicate overall positive measurement properties.