Screening method evaluated by nutritional status measurements can be used to detect malnourishment in chronic obstructive pulmonary disease

Objective: To evaluate and develop a screening method for malnutrition among patients with chronic obstructive pulmonary disease (COPD). Design: Findings from a screening sheet for malnutrition were compared with results from full nutritional assessment. The screening sheet included 7 questions regarding body mass index, anorexia, loss of weight, and other variables possibly affecting nutritional status. Each answer was assigned a point value, and a total of 4 and 5 points were tested as criterion for malnutrition. Full nutrition assessment included measurements of weight and height (body mass index), serum albumin and prealbumin, total lymphocyte count, triceps skinfold thickness, mid-arm muscle circumference or area, and information on unintentional weight loss. Malnutrition was defined by 3 or more values below reference values. Subjects: Randomly selected patients (n=34) with a clinical diagnosis of COPD, 15% of eligible patients admitted to the Department of Lung Medicine at National University Hospital, Reykjavik, Iceland, during the time of the study. Statistical analysis: Sensitivity, specificity, and predictive values were calculated to evaluate the screening sheet. Each of the 7 parameters used in a full nutrition assessment was similarly evaluated as an indicator to predict malnutrition. Results: Full nutrition assessment identified 13 of 34 patients (38%) as malnourished. Using 4 points as a criterion for malnutrition, the screening sheet to be used for patients with COPD resulted in sensitivity of 0.69 and specificity of 0.90. Conclusion: The results confirm the frequent finding of malnutrition among patients with COPD and show that a simple screening sheet can be used to identify which patients need further nutrition assessment and treatment.