Risk of malnutrition (over and under-nutrition): validation of the JaNuS screening tool

Abstract

Background & aims: Malnutrition (over and under-nutrition) is highly prevalent in patients admitted to hospital and it is a well-known risk factor for increased morbidity and mortality. Nutritional problems are often misdiagnosed, and especially the coexistence of over and undernutrition is not usually recognized. We aimed to develop and validate a screening tool for the easy detection and reporting of both undernutrition and overnutrition, specifically identifying the clinical conditions where the two types of malnutrition coexist.

Methods: The study consisted of three phases: 1) selection of an appropriate study population (estimation sample) and of the hospital admission parameters to identify overnutrition and undernutrition; 2) combination of selected variables to create a screening tool to assess the nutritional risk in case of undernutrition, overnutrition, or the copresence of both the conditions, to be used by non-specialist health care professionals; 3) validation of the screening tool in a different patient sample (validation sample).

Results: Two groups of variables (12 for undernutrition, 7 for overnutrition) were identified in separate logistic models for their correlation with the outcome variables. Both models showed high efficacy, sensitivity and specificity (overnutrition, 97.7%, 99.6%, 66.6%, respectively; undernutrition, 84.4%, 83.6%, 84.8%). The logistic models were used to construct a two-faced test (named JaNuS - Just A Nutritional Screening) fitting into a two-dimension Cartesian coordinate graphic system. In the validation sample the JaNuS test confirmed its predictive value. Internal consistency and test-retest analysis provide evidence for the reliability of the test.

Conclusion: The study provides a screening tool for the assessment of the nutritional risk, based on parameters easy-to-use by health care personnel lacking nutritional competence and characterized by excellent predictive validity. The test might be confidently applied in the clinical setting to determine the importance of malnutrition (including the copresence of over and undernutrition) as a risk factor for morbidity and mortality.

Keywords: JANUS; Malnutrition; Overnutrition; Screening tool; Undernutrition.