Validated screening tools for the assessment of cachexia, sarcopenia, and malnutrition: a systematic review

Janice Miller, Liz Wells, Ugochinyere Nwulu, David Currow, Miriam J Johnson, Richard Skipworth

Research output: Contribution to journalArticlepeer-review

Abstract

Background: There is great overlap between the presentation of cachexia, sarcopenia, and malnutrition. Distinguishing between these conditions would allow for better targeted treatment for patients. Objectives: The aim was to systematically review validated screening tools for cachexia, sarcopenia, and malnutrition in adults and, if a combined tool is absent,make suggestions for the generation of a novel screening tool. Design: A systematic search was performed in Ovid Medline, EMBASE, CINAHL, andWeb of Science. Two reviewers performed data extraction independently. Each tool was judged for validity against a reference method. Psychometric evaluation was performed as was appraisal of the tools’ ability to assess the patient against consensus definitions. Results: Thirty-eight studies described 22 validated screening tools. The Cachexia score was the only validated screening tool for cachexia and performed well against the consensus definition. Two tools assessed sarcopenia [the Short Portable Sarcopenia Measure (SPSM) and the SARC-F] and scored well against the 1998 Baumgartner definition. The SPSM required large amounts of equipment, and the SARC-F had a low sensitivity. Nineteen tools screened for malnutrition. The 3-Minute Nutrition Score performed best, meeting consensus definition criteria (European Society for Clinical Nutrition and Metabolism) and having a sensitivity and specificity of >80%. No tool contained all of the currently accepted components to screen for all 3 conditions. Only 3 tools were measured against cross-sectional imaging, a clinical tool that is gaining wider interest in body-composition analysis. Conclusions: No single validated screening tool can be implemented for the simultaneous assessment of cachexia, sarcopenia, and malnutrition. The development of a tool that encompasses consensus definition criteria and directs clinicians toward the underlying diagnosis would be optimal to target treatment and improve outcomes. We propose that tool should incorporate a stepwise assessment of nutritional status–oral intake, disease status, age, musclemass and function, andmetabolic derangement. AmJ Clin Nutr 2018;108:1–13. Keywords: cachexia, sarcopenia, malnutrition, screening, assessment
Original languageEnglish
JournalAmerican Journal of Clinical Nutrition
DOIs
Publication statusPublished - 12 Dec 2018

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