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Background <p>Evaluating malnutrition in surgical patients is a critical yet often overlooked component of preoperative care. Currently, there is a lack of evidence-based validation for international screening tools within the specific context of the Malaysian healthcare system.</p> Objective <p>To explore the criterion validity and independent predictive performance of the Malnutrition Universal Screening Tool (MUST) and the Nutritional Risk Index (NRI) against a professional nutritionist’s evaluation in Malaysian surgical patients.</p> Methods <p>This prospective cohort study initially recruited 426 adult patients at a tertiary hospital; however, 210 patients (43.4%) were lost to follow-up due to inter-city referrals, leaving a final analytical cohort of 216. Nutritional risk was screened within 24&#xa0;h of admission using MUST, NRI, and serum albumin. Clinical outcomes included 30-day surgical site infection (SSI), length of stay (LOS), and mortality. Multivariate logistic regression was performed to adjust for age, BMI, and comorbidities, and a post hoc power analysis was conducted.</p> Results <p>The prevalence of malnutrition was 35.6%. MUST demonstrated the highest diagnostic accuracy with a sensitivity of 72.7% and an Area Under the Curve (AUC) of 0.838 (<i>p</i> &lt; 0.001), outperforming NRI (53.3% sensitivity, 0.748 AUC) and albumin (58.4% sensitivity, 0.792 AUC). While MUST and albumin were significantly associated with clinical outcomes, NRI failed to show a significant association with SSI (<i>p</i> = 0.080) or mortality (<i>p</i> = 1.000). After multivariate adjustment, the MUST score remained a robust independent predictor of SSI (aOR = 2.513; 95% CI: 1.32–4.77; <i>p</i> = 0.005).</p> Conclusion <p>MUST demonstrated superior diagnostic accuracy and independent predictive validity for surgical site infection, supporting its use as a reliable frontline nutritional screening tool in the admitted patients. Its routine implementation in preoperative assessment pathways can facilitate early risk stratification and targeted nutritional interventions, particularly in resource-constrained clinical settings.</p>

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An exploratory comparative validation of the malnutrition universal screening tool and nutritional risk index for nutritional risk stratification in Malaysian surgical patients

  • 期刊论文

  • 发表日期：

    2026年6月29日

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  • Tahneem Yaseen,
  • Omaid Hayat Khan,
  • Muhammad Salman Khanzada,
  • Andee Dzulkarnaen Zakaria,
  • Mohd Nizam Hashim,
  • Nehad Jaser Ahmed,
  • Amer Hayat Khan

摘要

Background

Evaluating malnutrition in surgical patients is a critical yet often overlooked component of preoperative care. Currently, there is a lack of evidence-based validation for international screening tools within the specific context of the Malaysian healthcare system.

Objective

To explore the criterion validity and independent predictive performance of the Malnutrition Universal Screening Tool (MUST) and the Nutritional Risk Index (NRI) against a professional nutritionist’s evaluation in Malaysian surgical patients.

Methods

This prospective cohort study initially recruited 426 adult patients at a tertiary hospital; however, 210 patients (43.4%) were lost to follow-up due to inter-city referrals, leaving a final analytical cohort of 216. Nutritional risk was screened within 24 h of admission using MUST, NRI, and serum albumin. Clinical outcomes included 30-day surgical site infection (SSI), length of stay (LOS), and mortality. Multivariate logistic regression was performed to adjust for age, BMI, and comorbidities, and a post hoc power analysis was conducted.

Results

The prevalence of malnutrition was 35.6%. MUST demonstrated the highest diagnostic accuracy with a sensitivity of 72.7% and an Area Under the Curve (AUC) of 0.838 (p < 0.001), outperforming NRI (53.3% sensitivity, 0.748 AUC) and albumin (58.4% sensitivity, 0.792 AUC). While MUST and albumin were significantly associated with clinical outcomes, NRI failed to show a significant association with SSI (p = 0.080) or mortality (p = 1.000). After multivariate adjustment, the MUST score remained a robust independent predictor of SSI (aOR = 2.513; 95% CI: 1.32–4.77; p = 0.005).

Conclusion

MUST demonstrated superior diagnostic accuracy and independent predictive validity for surgical site infection, supporting its use as a reliable frontline nutritional screening tool in the admitted patients. Its routine implementation in preoperative assessment pathways can facilitate early risk stratification and targeted nutritional interventions, particularly in resource-constrained clinical settings.