The validity of three malnutrition screening markers among older patients with cancer

BMJ Support Palliat Care. 2020 Sep;10(3):363-368. doi: 10.1136/bmjspcare-2018-001706. Epub 2019 Jun 25.


Background: Malnutrition is common in older adults with cancer and is associated with adverse clinical outcomes. We assessed and compared the validity of three tools commonly used to screen for malnutrition: The Mini Nutritional Assessment (MNA), weight loss and body mass index (BMI).

Methods: In this retrospective study, we reviewed patients over age 65 with a diagnosis of cancer who were treated at the MD Anderson Cancer Center between 1 January 2013 and 31 March 2017. All patients in this study were evaluated by a trained geriatrician as part of a comprehensive geriatric assessment (CGA). Malnutrition was diagnosed by both CGA and clinical examination. The sensitivity, specificity and Cohen's κ of each tool was also compared with the clinical diagnosis.

Results: A total of 454 older patients with cancer who had malnutrition information available were included in the analyses. The median age was 78%, and 42% (n=190) were clinically diagnosed with malnutrition at baseline. When the MNA was performed, 105 out of 352 patients (30%) were malnourished, and 122 (35%) at risk of malnutrition. Weight loss >3 kg was seen in 183 out of 359 (51%) patients, and BMI <20 kg/m2 was found in 30 of the 454 (7%) patients. MNA had the highest validity (area under curve (AUC)=0.83) and reliability (κ=0.67), weight loss had moderate validity (AUC=0.73) and reliability (κ=0.46), while BMI had the lowest validity (AUC=0.55) and reliability (κ=0.55).

Conclusions: For clinical practice, MNA should be incorporated for standard assessment/screening for these older patients with cancer.

Keywords: BMI; CGA; MNA; malnutrition; older patients with cancer; weight loss.

Publication types

  • Comparative Study
  • Validation Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biomarkers
  • Body Mass Index*
  • Female
  • Geriatric Assessment / methods*
  • Humans
  • Male
  • Malnutrition / diagnosis*
  • Malnutrition / etiology
  • Mass Screening / methods
  • Mass Screening / standards*
  • Neoplasms / complications
  • Nutrition Assessment*
  • Reproducibility of Results
  • Retrospective Studies
  • Sensitivity and Specificity
  • Weight Loss


  • Biomarkers