Performance of four malnutrition screening tools evaluated with the Global Leadership Initiative on Malnutrition framework and the Mini Nutritional Assessment Full Form in hospitalised patients with diabetic foot ulcers.

BACKGROUND & AIMS: Malnutrition is common in hospitalised patients with diabetic foot ulcers (DFUs) and adversely affects clinical outcomes. However, no consensus exists on the most appropriate screening tool for malnutrition in this population. This study evaluated the performance of four malnutrition screening tools with the Global Leadership Initiative on Malnutrition (GLIM) and the Mini Nutritional Assessment Full Form (MNA-FF) as reference methods in hospitalised DFU patients.

METHODS

Hospitalised DFU patients (≥18 years) were included. GLIM criteria, MNA-FF, the Short Nutritional Assessment Questionnaire (SNAQ), CONtrolling NUTritional status (CONUT), the Geriatric Nutritional Risk Index (GNRI), and the Mini Nutritional Assessment Short Form (MNA-SF) were assessed in each patient. Sensitivity, specificity, positive predictive value and negative predictive value were determined for SNAQ, CONUT, GNRI and MNA-SF by evaluating their dichotomized output against the GLIM framework and MNA-FF as reference methods.

RESULTS

75 patients were included (81% male). Malnutrition prevalence was 46% according to GLIM and 32% MNA-FF, respectively. SNAQ showed the highest sensitivity and specificity of > 70%. GNRI showed comparable sensitivity but lower specificity of 58%. CONUT and MNA-SF showed higher sensitivity but lower specificity of 9% and 21%, respectively.

CONCLUSION

SNAQ performed overall most optimal when evaluated with GLIM and MNA-FF in hospitalised DFU patients, although it failed to identify all patients malnourished patients. Tool discrepancies highlight that tool choice strongly affects identification of patients at risk of malnutrition. Future studies should evaluate direct application of the GLIM framework and earlier outpatient screening.