MNA和MUST用於癌症住院病患之營養篩檢

Nutrition screening of hospitalized patients with cancer using MNA and MUST

目標：本研究的目的為評估MNA和MUST兩種營養篩檢工具用於癌症住院病患的效度，以作為改善營養照護品質的參考。方法：從某教學醫院招募185位頭頸癌或腸胃道癌症住院病患，在入院48小時內，以PG-SGA、MNA和MUST進行營養篩檢，資料分析方法為以PG-SGA作為效標，分別計算MNA和MUST的敏感度、特異性、陽性預測值和陰性預測值，並以Kappa一致性係數考驗兩種篩檢工具與效標之篩檢結果一致性，最後再以ROC曲線分析營養篩檢工具之鑑別力。結果：（1）研究對象以PG-SGA、MNA和MUST進行營養篩檢，結果篩出可能具有營養不良危險性的比例分別為61.1%, 45.9% 和46.5%；（2）以PG-SGA作為效標，MNA和MUST的篩檢結果都和PG-SGA具有一致性（p < .001）；（3）比較兩種營養篩檢工具的結果，MNA的敏感度和特異性分別為67.3%和86.1%，都比MUST高，且MNA之ROC曲線下面積為0.818，鑑別力亦較MUST好。結論：本研究以PG-SGA作為效標，評估兩種營養篩檢工具，發現MNA比MUST更適合作為癌症住院病患的營養篩檢工具。

Objectives: This study evaluated the validity of mini nutritional assessment (MNA) and malnutrition universal screening tool (MUST) that was used in the oncology inpatient unit to acquire a reference for improving the quality of nutritional care. Methods: Subjects were 185 inpatients with head and neck cancer or gastrointestinal cancer recruited from a teaching hospital. Subjects were screened using patient generated-subjective global assessment (PG-SGA), MNA, and MUST within 48 hours of admission. The agreement level of distinguishing the risk of malnutrition between the gold standard and tested tools was examined using kappa coefficient of agreement. Sensitivity, specificity, positive predictive value, and negative predictive value of MNA and MUST were calculated as well. Finally, receiver operating characteristic curve was performed to figure out the discrimination of tested tools. Results: (1) Percentages of those subjects possibly had a malnutrition risk screened using PG-SGA, MNA, and MUST were 61.1%, 45.9%, and 46.5%, respectively. (2) Using PG-SGA as a gold standard, the screening results of MNA vs. standard and MUST vs. standard were both consistent (p<.001). (3) The sensitivity and specificity of MNA (67.3% and 86.1%) were both better than those of MUST. (4) Area under curve of MNA was 0.818, also better than that of MUST. Conclusions: MNA may have a better capacity for screening cancer inpatients at a malnutrition risk than MUST using PG-SGA as a gold standard.