Concurrent and Predictive Validity of AND‐ASPEN Malnutrition Consensus Is Satisfactory in Hospitalized Patients: A Longitudinal Study
Camila Ferri Burgel, Paula Portal Teixeira, Giovana Molon Leites, Gustavo Dal'Negro Carvalho, Paulo Victor Gomes Modanese, Estela Iraci Rabito, Flávia Moraes Silva
Abstract
BACKGROUND: Subjective Global Assessment (SGA) is the reference method to identify hospital malnutrition. The Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition (AND-ASPEN) proposed a more objective consensus, but studies regarding its validity are still scarce. This study aimed to evaluate the concurrent and predictive validity of the AND-ASPEN Consensus. METHODS: Prospective cohort conducted with hospitalized adult and elderly patients. At admission, general data were collected and patients were evaluated by SGA and AND-ASPEN with and without handgrip strength (HGS) for nutrition diagnoses. Patients were followed up for collection of outcomes-length of hospital stay (LOS), in-hospital death, readmission, and mortality within 6 months after being discharged. Concurrent and predictive validity were tested. RESULTS: Six hundred patients (55.7 ± 14.8 years, 51.3% males) were evaluated. The median of LOS was 10.0 (5.018.0) days and in-hospital mortality was 2.7%. SGA identified 34.0% and AND-ASPEN 34.6% of patients as malnourished. AND-ASPEN had substantial agreement with SGA (κ = 0.690) and satisfactory accuracy (AUC = 0.85; 95% CI, 0.810.88). Malnutrition defined by AND-ASPEN predicted about 1.4 times higher risk of prolonged LOS (95% CI, 1.2-1.6) and hospital readmission (95% CI, 1.2-1.8), besides 5.0 times higher risk of hospital death (95% CI, 1.3-18.8) and 6 months' death (95% CI, 2.6-9.9), in an adjusted analysis. The validity of AND-ASPEN without HGS was also satisfactory. CONCLUSION: AND-ASPEN can be used for malnutrition diagnoses, even without HGS because it has satisfactory concurrent and predictive validity.