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Validity of Thai Nutritional Assessment Form and Nutrition Triage 2013 to Diagnose Malnutrition in Non-Dialytic Chronic Kidney Disease

Background: Malnutrition inflammation score (MIS) is a universal tool to assess the presence of malnutrition among patients with chronic kidney disease (CKD). An appropriate diagnosis coding for malnutrition affects hospital reimbursement in Thailand. The Nutrition Alert Form (NAF) and the Nutritional Triage (NT-2013) have been approved as standard nutrition assessment tools for general populations.

Objective: To study the validity of the NAF and the NT-2013 among patients with MIS at non-dialytic CKD stages 3 to 5.

Materials and Methods: A cross-sectional study was conducted among the patients with non-dialytic CKD stages 3 to 5. NAF, NT-2013, and MIS nutritional assessment tools were performed in all subjects. Cohen’s kappa statistics and Pearson’s correlation were used to determine the validity of NAF and NT-2013.

Results: Two hundred seven participants were included in the present study. According to the MIS assessment classification, normal to mild, moderate, and severe malnutrition were diagnosed in 59.9%, 34.8%, and 5.3%, respectively. The correlation between NAF and NT-2013 when compared with MIS were r=0.619 and r=0.689 (p<0.001), respectively. The sensitivity, specificity, and area under receiver operating characteristic (ROC) curve of assessment score to diagnose moderate to severe malnutrition were 47.6, 75.9, and 0.698 (95% CI 0.628 to 0.768) in NAF score greater than 5, and 100, 3.6, and 0.707 (95% CI 0.637 to 0.777) in NT-2013 score greater than 7, respectively.

Conclusion: Among patients with CKD stages 3 to 5, the nutritional assessment tool NAF and NT-2013 correlated well with MIS. It seemed that NAF score is an alternative nutritional assessment tool with moderate sensitivity and specificity test, and NT-2013 score is suitable for a screening nutritional assessments tool to identify malnutrition with high sensitivity but very low specificity in a CKD population.

Keywords: Nutritional assessment form (NAF); Nutritional Triage 2013 (NT-2013); Malnutrition inflammation score (MIS); Chronic kidney disease