Nutritional Risk Screening Tools for Older Adults with COVID-19: A Systematic Review

Nutrients. 2020 Sep 27;12(10):2956. doi: 10.3390/nu12102956.


Coronavirus disease 2019 (COVID-19) is associated with high risk of malnutrition, primarily in older people; assessing nutritional risk using appropriate screening tools is critical. This systematic review identified applicable tools and assessed their measurement properties. Literature was searched in the MEDLINE, Embase, and LILACS databases. Four studies conducted in China met the eligibility criteria. Sample sizes ranged from six to 182, and participants' ages from 65 to 87 years. Seven nutritional screening and assessment tools were used: the Nutritional Risk Screening 2002 (NRS-2002), the Mini Nutritional Assessment (MNA), the MNA-short form (MNA-sf), the Malnutrition Universal Screening Tool (MUST), the Nutritional Risk Index (NRI), the Geriatric NRI (GNRI), and modified Nutrition Risk in the Critically ill (mNUTRIC) score. Nutritional risk was identified in 27.5% to 100% of participants. The NRS-2002, MNA, MNA-sf, NRI, and MUST demonstrated high sensitivity; the MUST had better specificity. The MNA and MUST demonstrated better criterion validity. The MNA-sf demonstrated better predictive validity for poor appetite and weight loss; the NRS-2002 demonstrated better predictive validity for prolonged hospitalization. mNUTRIC score demonstrated good predictive validity for hospital mortality. Most instruments demonstrate high sensitivity for identifying nutritional risk, but none are acknowledged as the best for nutritional screening in older adults with COVID-19.

Keywords: COVID-19; coronavirus; elderly; malnutrition; nutritional assessment; nutritional risk; nutritional screening.

Publication types

  • Systematic Review

MeSH terms

  • Aged
  • Aged, 80 and over
  • Betacoronavirus*
  • COVID-19
  • Coronavirus Infections / complications*
  • Coronavirus Infections / physiopathology
  • Coronavirus Infections / virology
  • Female
  • Geriatric Assessment*
  • Humans
  • Male
  • Malnutrition / diagnosis*
  • Malnutrition / virology
  • Middle Aged
  • Nutrition Assessment*
  • Nutritional Status
  • Pandemics
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / physiopathology
  • Pneumonia, Viral / virology
  • Reproducibility of Results
  • Risk Assessment
  • SARS-CoV-2
  • Sensitivity and Specificity