Ability of existing malnutrition screening tools to identify risk of starvation, sarcopenia and cachexia: A systematic review

Background and aims: Unintentional weight loss (UWL) is common in older adults, occurring in 27% of those aged 65 years and older, and is associated with increased mortality. It is critical to identify and treat the causes of UWL appropriately, with the three primary syndromes being starvation, sarcopenia and cachexia. Whilst Malnutrition Screening Tools are well established, it is unclear if they have the ability to detect separately the risk of those three syndromes. It is therefore the aim of this review to assess whether existing Malnutrition Screening Tools have the potential to screen for risk of starvation, sarcopenia or cachexia according to current diagnostic criteria. Methods: Five databases were systematically searched for studies describing the original development and/or validation of Malnutrition Screening Tools. A total of 33 articles describing 31 tools were reviewed. Results: Twenty tools appeared potentially appropriate for screening of starvation risk, with one tool incorporating all ideal measures. No tools contained all currently accepted components required for screening sarcopenia or cachexia risk. Key criteria that were commonly absent included assessment of muscle strength, muscle mass and physical function for sarcopenia risk, and fatigue for cachexia, and weight loss was often not quantified, or specified as unintentional. Conclusions: Ideally, future development of Malnutrition Screening Tools will include the ability to separately identify risk of starvation, sarcopenia and cachexia with a high level of validity and reliability, and should also have the ability to facilitate timely and appropriate referrals and treatment for these syndromes in dietetic practice.