两种最常用的营养筛查工具与新的营养不良诊断标准共识定义
前情提要
欧洲肠外肠内营养学会（ESPEN）最近提出的成人营养不良新定义，改变了营养不良的概念，提出了现有营养筛查工具的可靠性问题。
2017年8月，ESPEN《临床营养》将正式发表希腊雅典莱科总医院、亚里士多德大学、雅典福音医院、希波克拉底总医院、波兰斯坦利达德里克纪念医院的研究报告，通过比较ESPEN新标准的诊断结果，验证了两种最常用营养筛查工具的准确性。
该研究采用两种营养筛查工具：营养风险筛查（NRS）2002和营养不良通用筛查工具（MUST）对1146例入院患者（中位年龄60岁，四分位距44～73岁，男性617例，529例女性）患者进行营养筛查，然后将筛查结果与ESPEN营养不良诊断新标准进行比较。
结果发现：
根据NRS营养风险筛查工具，13.5%和27.9%的门诊和住院患者有中高度营养风险
根据MUST营养不良筛查工具，9.1%和14.9%的门诊和住院患者有中高度营养不良
根据ESPEN营养不良诊断标准，6.4%和11.3%的门诊和住院患者为营养不良
MUST与NRS2002相比，与ESPEN营养不良诊断标准的相关性较强：
MUST与ESPEN的相关性：门诊患者（K=0.777，p＜0.001）和住院患者（K=0.843，p＜0.001）
NRS与ESPEN的相关性：门诊患者（k=0.256，p＜0.001）和住院患者（k=0.228，p＜0.001）
MUST与NRS2002相比，受试者工作特征（ROC）曲线下面积（AUC）较高：
门诊患者：0.964比0.995
住院患者：0.980比0.686
因此，该研究首先根据新的ESPEN营养不良定义，对营养筛查工具的临床价值进行了分析。根据分析结果，MUST与营养不良定义的ESPEN标准有较好的相关性，故作者认为可在筛查过程中更有效地确定营养不良患者。
编者按：营养筛查包括营养风险筛查和营养不良筛查。由于NRS2002为营养风险筛查工具，主要用于筛查营养风险对临床结局的影响，并非营养不良筛查工具或诊断标准，故与营养不良筛查工具MUST、ESPEN营养不良诊断标准进行直接比较的意义不大。而且，筛查工具强调的是敏感性（尽量少漏诊），诊断标准强调的是特异性（尽量少误诊），故将筛查工具与诊断标准进行直接比较的意义也不大。
Clin Nutr. 2017 Aug;36(4):1130-1135.
The two most popular malnutrition screening tools in the light of the new ESPEN consensus definition of the diagnostic criteria for malnutrition.
Poulia KA, Klek S, Doundoulakis I, Bouras E, Karayiannis D, Baschali A, Passakiotou M, Chourdakis M.
Laiko General Hospital, Athens, Greece; Stanley Dudrick's Memorial Hospital, Skawina, Poland; Aristotle University of Thessaloniki, Thessaloniki, Greece; Evangelismos Hospital, Athens, Greece; Ippokratio General Hospital, Thessaloniki, Greece.
BACKGROUND: The new definition of malnutrition in adults proposed recently by The European Society for Clinical Nutrition and Metabolism (ESPEN) changed the view on the issue and raised the question of the reliability of available diagnostic tools. Therefore, the aim of this study was to verify the accuracy of the two most commonly used screening tools by comparing their findings with the new ESPEN criteria.
METHODS: Nutritional screening was performed in 1146 (median age 60 years, interquartile range: 44-73 years, 617 males, 529 females) patients on admission to hospitals with two nutritional screening tools: Nutritional Risk Screening 2002 (NRS2002) and Malnutrition Universal Screening Tool (MUST). The screening results were then compared to the ESPEN new diagnostic criteria for malnutrition.
RESULTS: According to the NRS2002 13.5% and 27.9% of the outpatients and hospitalized patients respectively were found to be at moderate/high risk of malnutrition. With the use of MUST 9.1% and 14.9% of the outpatients and hospitalized patients respectively were found to be at moderate/high risk of malnutrition. According to the ESPEN diagnostic criteria 6.4% and 11.3% of outpatients and hospitalized patients respectively were classified as malnourished. MUST was found to be better correlated to the latter for both outpatients (K = 0.777, p < 0.001) and hospitalized patients (K = 0.843, p < 0.001) as compared to NRS2002 (k = 0.256, p < 0.001 and k = 0.228, p < 0.001). ROC plots Area Under the Curve (AUC) was found to be higher for MUST compared to NRS2002 (0.964 vs. 0.695 for outpatients and 0.980 vs 0.686 for hospitalized patients respectively).
CONCLUSION: To our knowledge, this study is the first to analyze the clinical value of a malnutrition screening tool in the light of the new ESPEN definition for malnutrition. According to our results, MUST was better correlated with ESPEN criteria for the definition of malnutrition, leading us to the conclusion that it can more efficiently identify the malnourished patients, during the screening process.
KEYWORDS: Diagnostic criteria; Disease related malnutrition; ESPEN malnutrition definition; Nutritional screening; Screening tools
PMID: 27546796
DOI: 10.1016/j.clnu.2016.07.014
