Concurrent Validity of Systematic Nutritional Clinical Assessment in Hospitalized Adults: Comparative Analysis of Patients With and Without Excess Body Weight.

INTRODUCTION

Excess body weight can underestimate undernutrition in hospitalized patients. Performing standardised Nutrition-Focused Physical Examination may reduce subjectivity. This study aimed to assess the concurrent validity of the Systematic Nutritional Clinical Assessment tool and its ability to identify nutritional depletion in patients with excess body weight.

METHODS

This cross-sectional study included adult patients hospitalized in two Brazilian regions. Within 48 hours of admission, patients underwent anthropometric assessment, handgrip strength, Subjective Global Assessment or Patient-Generated Subjective Global Assessment, and Systematic Nutritional Clinical Assessment.

RESULTS

A total of 412 patients were included (57.6 ± 14.3 years; 58.7% male), from oncology (29.1%), hepatology (28.6%), cardiology (24.0%), and nephrology (18.2%). Undernutrition frequency was 51.4% by Subjective Global Assessment/Patient-Generated Subjective Global Assessment and 35.7% by Systematic Nutritional Clinical Assessment. The Systematic Nutritional Clinical Assessment showed moderate agreement with the Subjective Global Assessment (k = 0.572; p < 0.001), high diagnostic accuracy (AUROC 0.886), 63.7% sensitivity, and 94% specificity. In the subgroup of patients with excess body weight, the post-test probability for positive results increased from 31.7% to 93.1%. The biceps and triceps compartment stood out for high sensitivity (83.0%), while the dorsum of hands and interosseous muscles stood out for high specificity (87.5%).

CONCLUSION

The Systematic Nutritional Clinical Assessment is shown to be a reliable instrument for confirming nutritional depletion in patients with and without excess body weight. When a simplified physical examination is required during nutritional assessment, the evaluation of the dorsum of hands and interosseous muscles showed the highest specificity.