Malnutrition is a risk factor for disease progression and poor prognosis in chronic kidney disease (CKD). However, the complexity of nutritional status assessment limits its clinical application. This study explored a new method of nutritional assessment in CKD (stage 1-5) patients using the Subjective Global Assessment (SGA) as the gold standard and evaluated its applicability. The kappa test was used to analyze the consistency of the Renal Inpatient Nutrition Screening Tool (Renal iNUT) with SGA and protein-energy wasting. Logistic regression analysis was used to analyze the risk factors of CKD malnutrition and calculate the prediction probability of multiple indicators combined for the diagnosis of CKD malnutrition. The receiver operating characteristic curve of the prediction probability was drawn to evaluate its diagnostic efficiency. A total of 161 CKD patients were included in this study. The prevalence of malnutrition according to SGA was 19.9%. The results showed that Renal iNUT had a moderate consistency with SGA and a general consistency with protein-energy wasting. Age > 60 years (odds ratio, OR = 6.78), neutrophil-lymphocyte ratio > 2.62 (OR = 3.862), transferrin < 200 mg/dL (OR = 4.222), phase angle < 4.5° (OR = 7.478), and body fat percentage < 10% (OR = 19.119) were risk factors for malnutrition in patients with CKD. The area under the receiver operating characteristic curve of multiple indicators for the diagnosis of CKD malnutrition was 0.89 (95% confidence interval: 0.834-0.946, p < 0.001). This study demonstrated that Renal iNUT has good specificity as a new tool for the nutrition screening of CKD patients, but its sensitivity needs to be optimized. Advanced age, high neutrophil-lymphocyte ratio, low transferrin level, low phase angle, and low body fat percentage are risk factors for malnutrition in patients with CKD. The combination of the above indicators has high diagnostic efficiency in the diagnosis of CKD malnutrition, which may be an objective, simple, and reliable method to evaluate the nutritional status of patients with CKD.

UNASSIGNED: Malnutrition in cancer patients reduces response to chemotherapy, increases the hospitalization costs, hospital infections, and deaths. The aim of this study was to determine the prevalence, level of malnutrition, and its related factors in cancer patients at a local hospital in Southern Vietnam.
UNASSIGNED: A descriptive cross-sectional study was performed on all 118 cancer patients who were undergoing inpatient treatment at Long An General Hospital, Vietnam from May to September 2020. Data were collected from patients by face-to-face interviewing using a subjective global assessment (SGA) and from medical records. Malnutrition is divided into three groups: SGA-A (normal), SGA-B (mild/moderate/suspected malnutrition), SGA-C (severe malnutrition). Multivariable logistic regression is used to identify factors related to malnutrition with statistical significance p < 0.05.
UNASSIGNED: Out of 118 participants, 72 (61.0%) were males and 84 (71.2%) aged ⩾60 years. The prevalence of malnutrition in cancer patients was 84.7% (100/118), in which 33% (39/118) were severe (SGA-C) and 51.7% (61/118) were mild-moderate (SGA-B). Pancreatic and lung cancers are the most malnourished. The results of multivariate logistic regression analysis showed that the factors related to malnutrition in cancer patients were gastrointestinal symptoms lasting 2 weeks (odds ratio: 6.10, 95% confidence interval: 1.12-33.35), patients with decreased motor function (odds ratio: 13.73, 95% confidence interval: 2.56-73.86), blood albumin <35 g/l (odds ratio: 6.42, 95% confidence interval: 1.54-26.82), and blood lymphocyte ⩽ 1700 cells/mm3 (odds ratio: 5.36, 95% confidence interval: 1.31-21.97).
UNASSIGNED: There was a high proportion of malnutrition in cancer patients. Therefore, it is necessary to strengthen nutrition counseling and intervention for these patients, especially those that have prolonged gastrointestinal symptoms, reduced motor function, and low blood albumin or low blood lymphocytes.

This study aimed to assess malnutrition using the Global Leadership Initiative on Malnutrition (GLIM) criteria and Subjective Global Assessment (SGA) at baseline and determine the GLIM criteria that best predicted unplanned hospitalization in outpatients with unintentional weight loss (UWL).
We performed a retrospective cohort study of 257 adult outpatients with UWL. The GLIM criteria and SGA agreement were reported using the Cohen kappa coefficient. Kaplan-Meier survival curves and adjusted Cox regression analyses were used for survival data. Logistic regression was used for the other correlation analysis.
This study collected data from 257 patients for 2 years. Based on the GLIM criteria and SGA, malnutrition prevalence was 79.0% and 72.0%, respectively (κ = 0.728, P < 0.001). Using the SGA as a standard, GLIM had a sensitivity of 97.8%, a specificity of 69.4%, a positive predictive value of 89.2%, and a negative predictive value of 92.6%. Malnutrition was associated with higher rates of unplanned hospital admission independent of other prognostic factors (GLIM: hazard ratio [HR]=2.85, 95% CI=1.22-6.68; SGA: HR=2.07, 95% CI=1.13-3.79). Of the five GLIM criteria-related diagnostic combinations, disease burden or inflammation was the most important to predict unplanned hospital admission in multivariable analysis (HR=3.27, 95% CI=2.03-5.28).
There was good agreement between the GLIM criteria and the SGA. GLIM-defined malnutrition, as well as all five GLIM criteria-related diagnosis combinations, had the potential to predict unplanned hospital admissions in outpatients with UWL within 2 years.

UNASSIGNED: To compare the Simple Nutrition Screening Tool (SNST) with other nutritional screening tools [Nutrition Risk Screening 2002 (NRS-2002), Nutrition Risk index (NRI)], nutritional assessment parameters, and the Subjective Global Assessment (SGA) in surgical patients.
UNASSIGNED: A comparative observational study with a total of 122 surgical patients. Patients were assessed during the first 24 h of admission in the ward from January to July 2022 using the NRI, NRS-2002, SNST, body mass index (BMI), mid-upper arm circumferences (MUAC), albumin serum, hemoglobin level, total lymphocyte count (TLC), and SGA. Sensitivity, specificity and predictive values were calculated to evaluate NRI, NRS-2002, SNST, BMI, MUAC, albumin, hemoglobin, TLC compared to SGA.
UNASSIGNED: The screening tools identified a high nutritional risk in surgical patients from 58.2%-72.1%. Meanwhile, about 29.5% to 71.3% was affected by malnutrition based on nutritional assessment tools. There were significant associations between the type of disease, the screening tools, the anthropometric parameters, albumin, TLC as well and SGA (p<0.05). The SNST has a good category among the nutritional screening tools with sensitivity and specificity >80%, as well as area under the curve >0.8.
UNASSIGNED: There were significant associations for screening (NRS-2002, SNST) and nutritional assessment tools (BMI, MUAC, albumin) compared with SGA. Both these tools can be used to determine the risk of malnutrition in surgical patients.
UNASSIGNED: Cerrahi hastalarda Basit Beslenme Tarama Aracını (SNST) diğer beslenme tarama araçları [Beslenme Riski Taraması 2002 (NRS-2002), Beslenme Riski indeksi (NRI)], beslenme değerlendirme parametreleri ve Subjektif Global Değerlendirme (SGA) ile karşılaştırmaktır.
UNASSIGNED: Çalışmamız toplam 122 cerrahi hasta ile karşılaştırmalı bir gözlemsel çalışmadır. Hastalar, Ocak-Temmuz 2022 arasında hastaneye yatışlarının ilk 24 saatinde NRI, NRS-2002, SNST, vücut kitle indeksi (VKİ) orta-üst kol çevresi (MUAC), albumin serumu, hemoglobin seviyesi, toplam lenfosit sayısı (TLC) ve SGA kullanılarak değerlendirildi. NRI, NRS-2002, SNST, VKİ, MUAC, albumin, hemoglobin ve TLC’yi SGA’ya kıyasla değerlendirmek için sensitivite, spesifite ve prediktif değerler hesaplandı.
UNASSIGNED: Tarama araçları ile cerrahi hastalarda %58,2 ila %72,1 arasında yüksek bir beslenme riski belirlendi. Bu arada, beslenme değerlendirme araçlarına göre hastaların yaklaşık %29,5 ila %71,3’ünün yetersiz beslenmeden etkilendiği görüldü. Hastalık tipi, tarama araçları, antropometrik parametreler, albumin, TLC ve SGA arasında anlamlı ilişki vardı (p<0,05). SNST >%80 duyarlılık ve özgüllük ve eğri altındaki alan >0,8 ile beslenme tarama araçları arasında iyi bir yere sahiptir.
UNASSIGNED: SGA ile karşılaştırıldığında tarama (NRS-2002, SNST) ve beslenme değerlendirme araçları (VKİ, MUAC, albumin) açısından anlamlı ilişkiler bulunmuştur. Bu araçların her ikisi de cerrahi hastalarda yetersiz beslenme riskini belirlemek için kullanılabilir.

This cross-sectional study aims to explore the prevalence of protein-energy wasting (PEW) in dialysis patients in Catalonia, Spain, using a new and practical online tool which enables rapid calculation and comparison with other nutritional scores.
METHODS: A web tool (Nutrendial) was created to introduce different variables and automatically calculate PEW, Malnutrition inflammation Score (MIS) and Subjective Global Assessment (SGA) in 1389 patients (88% in haemodialysis (HD)), 12% in peritoneal dialysis (PD) from different regions of Catalonia.
RESULTS: A prevalence of 23.3% (26% HD, 10.2% PD) of PEW was found, with a mean MIS score of 6 and SGA score of C in 7% of the patients. ROC analysis showed MIS as the best nutritional score to diagnose PEW (AUC 0.85). Albumin delivered lower diagnostic precision (AUC 0.77) and sensitivity (66%). A cut off point of 7 (86% sensitivity and 75% specificity) for MIS and 3.7 mg/dL for albumin were found to predict the appearance of PEW in this population. SGA B or C showed an 87% sensitivity and 55% specificity to diagnose PEW. Very low nutritional intervention (14%) was recorded with this tool in patients with PEW.
CONCLUSIONS: This new online tool facilitated the calculation of PEW, enabling different professionals-including nephrologists, dieticians and nurses-to efficiently obtain insights into the nutritional status of the Catalonian dialysis population and implement the required nutritional interventions. MIS is the score with more sensitivity to diagnose PEW.

The mid-arm circumference (MAC) is an accessible, quick, and inexpensive measurement, which can be performed at the bedside only with a measuring tape. In this sense, the present study aims to suggest MAC cut-off values to assess the nutritional status and its association with mortality of hospitalised patients with decompensated cirrhosis.
A prospective cohort study was performed with decompensated cirrhotic patients. Nutritional status was assessed by MAC and Subjective Global Assessment (SGA). Considering the SGA as the reference standard and based on receiver operating characteristic curve analysis, the MAC cut-off values with the best sensitivity and specificity were selected. Predictors of mortality were identified using multivariate analysis.
The study included 100 patients with a mean ± SD age of 60.1 ± 10.3 years. The median follow-up time was 11.2 months and overall mortality was 60%. Considering malnutrition assessed by SGA as the reference standard, the area under the curve of MAC for women and men was 0.947 (95% confidence interval [CI] = 0.878-1.000) and 0.813 (95% CI = 0.694-0.932). The MAC cut-off values of ≤ 28 cm for women and ≤ 30 cm for men reached a sensitivity and specificity of 85.5% and 71%, respectively. According to multivariate analysis, a low MAC was significantly associated with mortality (hazard ratio = 2.41; 95% CI = 1.20-4.84).
The MAC cut-off values had satisfactory accuracy for men and women in predicting malnutrition. Additionally, a low MAC was an independent predictor of mortality. Thus, these MAC cut-off values can be used as the first step of nutritional assessment to prioritise patients who require more detailed assessment.

OBJECTIVE: Disease-related malnutrition (DRM) coding rate is usually low in hospitalised patients. The objective of our study was to estimate the percentage of correct DRM coding in cancer inpatients and to calculate the economic losses caused by such lack of coding.
METHODS: This was an observational, prospective study that was conducted in patients hospitalised in the Medical Oncology Unit of our hospital. A nutritional assessment was performed through subjective global assessment (SGA). The all patient refined-diagnosis related group (APR-DRG) weights were obtained at the moment of discharge; moreover, recalculation was done after including the diagnosis of malnutrition in the medical record of those patients in whom it had not been initially coded. The associated cost reimbursement were calculated based on the weight before and after revising the diagnosis of DRM.
RESULTS: A total of 266 patients were evaluated. From them, 220 (82.7%) suffered from DRM according to the SGA. In 137 (51.5%) of these patients, diagnosis was coded, as opposed to 83 (31.2%) cases (33 subjects with moderate and 50 with severe DRM) in whom it was not coded. The sum of the APR-DRG weights before revising the diagnosis of malnutrition was 343.4 points (mean: 1.29 ± 0.89). Whereas, after revising the diagnosis, it increased up to 384.3 (1.44 ± 0.96). The total cost reimbursement for the hospital before revising the diagnosis of malnutrition was 1,607,861.21€ and after revision it increased up to 1,799,199.69€, which means that 191,338.48€ were not reimbursed to the hospital due to the lack of coding of malnutrition. The cost reimbursement for each admission increased an average of 719.32€.
CONCLUSIONS: The prevalence of DRM in cancer inpatients is high. Nevertheless, the diagnosis is not coded in one third of patients, which results in important economic losses for the hospitals.

Disease-related malnutrition is associated with adverse outcomes such as increased rates of morbidity and mortality, prolonged hospital stay, and extra costs of health care. This study was conducted to assess nutritional status among patients and to determine the risk factors for malnutrition in Iran university f.
Persian Nutritional Survey In Hospitals (PNSI) was a cross-sectional study that conducted in 20 university hospitals across Iran. All the patients with age range of 18 to 65 years, who were admitted or discharged, were assessed by subjective global assessment (SGA).
In total, 2109 patients were evaluated for malnutrition. Mean values of age and body mass index were 44.68 ± 14.65 years and 25.44 ± 6.25 kg/m2, respectively. Malnutrition (SGA-B & C) was identified in 23.92% of the patients, 26.23 and 21% of whom were among the admitted and discharged patients, respectively. The highest prevalence of malnutrition was in burns (77.70%) and heart surgery (57.84%) patients. Multivariate analysis presented male gender (OR = 1.02, P < 0.00), malignant disease (OR = 1.40, P < 0.00), length of hospital stay (OR = 1.20, P < 0.00), and polypharmacy (OR = 1.06, P < 0.00) as independent risk factors for malnutrition. Malnutrition was not associated with age (P = 0.10).
This study provides an overall and comprehensive illustration of hospital malnutrition in Iran university hospitals, finding that one out of four patients were malnourished; thus, appropriate consideration and measures should be taken to this issue.

BACKGROUND: Identification and treatment of malnutrition are essential in upper gastrointestinal (UGI) cancer. However, there is limited understanding of the nutritional status of UGI cancer patients at the time of curative surgery. This prospective point prevalence study involving 27 Australian tertiary hospitals investigated nutritional status at the time of curative UGI cancer resection, as well as presence of preoperative nutrition impact symptoms, and associations with length of stay (LOS) and surgical complications.
METHODS: Subjective global assessment, hand grip strength (HGS) and weight were performed within 7 days of admission. Data on preoperative weight changes, nutrition impact symptoms, and dietary intake were collected using a purpose-built data collection tool. Surgical LOS and complications were also recorded. Multivariate regression models were developed for nutritional status, unintentional weight loss, LOS and complications.
RESULTS: This study included 200 patients undergoing oesophageal, gastric and pancreatic surgery. Malnutrition prevalence was 42% (95% confidence interval (CI) 35%, 49%), 49% lost ≥5% weight in 6 months, and 47% of those who completed HGS assessment had low muscle strength with no differences between surgical procedures (p = 0.864, p = 0.943, p = 0.075, respectively). The overall prevalence of reporting at least one preoperative nutrition impact symptom was 55%, with poor appetite (37%) and early satiety (23%) the most frequently reported. Age (odds ratio (OR) 4.1, 95% CI 1.5, 11.5, p = 0.008), unintentional weight loss of ≥5% in 6 months (OR 28.7, 95% CI 10.5, 78.6, p < 0.001), vomiting (OR 17.1, 95% CI 1.4, 207.8, 0.025), reduced food intake lasting 2-4 weeks (OR 7.4, 95% CI 1.3, 43.5, p = 0.026) and ≥1 month (OR 7.7, 95% CI 2.7, 22.0, p < 0.001) were independently associated with preoperative malnutrition. Factors independently associated with unintentional weight loss were poor appetite (OR 3.7, 95% CI 1.6, 8.4, p = 0.002) and degree of solid food reduction of <75% (OR 3.3, 95% CI 1.2, 9.2, p = 0.02) and <50% (OR 4.9, 95% CI 1.5, 15.6, p = 0.008) of usual intake. Malnutrition (regression coefficient 3.6, 95% CI 0.1, 7.2, p = 0.048) and unintentional weight loss (regression coefficient 4.1, 95% CI 0.5, 7.6, p = 0.026) were independently associated with LOS, but no associations were found for complications.
CONCLUSIONS: Despite increasing recognition of the importance of preoperative nutritional intervention, a high proportion of patients present with malnutrition or clinically significant weight loss, which are associated with increased LOS. Factors associated with malnutrition and weight loss should be incorporated into routine preoperative screening. Further investigation is required of current practice for dietetics interventions received prior to UGI surgery and if this mitigates the impact on clinical outcomes.

Health-related quality of life (HRQoL) is severely impaired in persons receiving dialysis. Malnutrition has been associated with some measures of poor HRQoL in cross-sectional analyses in dialysis populations, but no studies have assessed the impact of malnutrition and dietary intake on change in multiple measures of HRQoL over time. We investigated the most important determinants of poor HRQoL and the predictors of change in HRQoL over time using several measures of HRQoL. We enrolled 119 haemodialysis and thirty-one peritoneal dialysis patients in this prospective study. Nutritional assessments (Subjective Global Assessment (SGA), anthropometry and 24-h dietary recalls) and HRQoL questionnaires (Short Form-36 (SF-36) mental (MCS) and physical component scores (PCS) and European QoL-5 Dimensions (EQ5D) health state (HSS) and visual analogue scores (VAS)) were performed at baseline, 6 and 12 months. Mean age was 64 (14) years. Malnutrition was present in 37 % of the population. At baseline, malnutrition assessed by SGA was the only factor independently (and negatively) associated with all four measures of HRQoL. No single factor was independently associated with decrease in all measures of HRQoL over 1 year. However, prevalence/development of malnutrition over 1 year was an independent predictor of 1-year decrease in EQ5D HSS, and 1-year decrease in fat intake independently predicted the 1-year decline in SF-36 MCS and PCS, and EQ5D VAS. These findings strengthen the importance of monitoring for malnutrition and providing nutritional advice to all persons on dialysis. Future studies are needed to evaluate the impact of nutritional interventions on HRQoL and other long-term outcomes.