Validation of nutritional screening tools in patients undergoing cancer surgery in low- and middle-income countries

Jana Sremanakova; Stephen  Knight; Marie Carmela M. Lapitan; Edwin Yenli; Stephen Tabiri; Dhruva Ghosh; Pamela Kingsley; Apple P. Valparaiso; Ewen M. Harrison; Maria Thomas; Parvez Haque; Sreejith Veetil; Atul Suroy; Ashish Choudhrie; Rohin Mittal; Rajkumar Seenivasagam; Bipradas Roy; Debra Jones; Sorrel Burden

doi:10.3389/fnut.2025.1576916

Validation of nutritional screening tools in patients undergoing cancer surgery in low- and middle-income countries

Jana Sremanakova (Lead), Stephen Knight, Marie Carmela M. Lapitan, Edwin Yenli, Stephen Tabiri, Dhruva Ghosh, Pamela Kingsley, Apple P. Valparaiso, Ewen M. Harrison, Maria Thomas, Parvez Haque, Sreejith Veetil, Atul Suroy, Ashish Choudhrie, Rohin Mittal, Rajkumar Seenivasagam, Bipradas Roy, Debra Jones, Sorrel Burden

Nursing & Midwifery

Research output: Contribution to journal › Article › peer-review

Abstract

Approximately one-third of patients are severely malnourished prior to surgery in low- and middle-income countries (LMICs). Identifying the most appropriate tool for detecting malnutrition is a critical first step toward enabling effective treatment interventions. Therefore, this study aimed to assess the validity and reliability of nutritional screening tools in patients with cancer scheduled for surgery in LMICs. Participants included adults undergoing either curative elective or palliative surgeries in Ghana, India, and the Philippines. Nutritional status was assessed using anthropometric measurements, the Malnutrition Universal Screening Tool (MUST), and the Patient-Generated Subjective Global Assessment (PG-SGA). Data were analysed using Bland–Altman plots with confidence intervals (CIs) and intra-class correlation coefficients (ICCs) to assess inter-rater reliability. Sensitivity and specificity tests were conducted using the Area Under the Receiver Operating Characteristics Curve (AUROC). A total of 167 participants were recruited, with a mean age of 53.3 years (SD 14.7) and a mean body mass index (BMI) of 23.0 kg/m2 (SD 4.9). The proportion of participants identified as at risk of malnutrition was 53.3% using MUST, 47.3% using PG-SGA SF, and 66% using the full PG-SGA. When compared to the PG-SGA, MUST and PG-SGA SF had AUROCs of 0.78 (95% CI: 0.73–0.87) and 0.76 (95% CI: 0.68–0.83), respectively. MUST demonstrated a sensitivity of 85% and a specificity of 25%, while PG-SGA SF showed a sensitivity of 93% and a specificity of 42%. Excellent inter-rater agreement was observed for anthropometric measurements, with ICC values >0.9 across all assessments. Both MUST and PG-SGA SF demonstrated good sensitivity when compared to PG-SGA. However, PG-SGA SF demonstrated slightly greater specificity than MUST. Based on these findings, PG-SGA SF is recommended for preoperative nutritional screening in LMICs.

Original language	English
Journal	Frontiers in Nutrition
Volume	12
DOIs	https://doi.org/10.3389/fnut.2025.1576916
Publication status	Published - 5 Jun 2025

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10.3389/fnut.2025.1576916

HARG: Healthy Ageing Research Group
Todd, C. (Researcher), Stanmore, E. (Researcher), Hall, A. (Researcher), Littlewood, A. (Researcher), Davies, A. (Researcher), Sowerbutts, A. M. (Researcher), Maharani, A. (Researcher), Dowding, D. (Researcher), Jones, D. (Researcher), Boulton, L. (Researcher), Cruickshank, F. (Researcher), Hawley-Hague, H. (Researcher), Brooks, J. (Researcher), Griffiths, J. (Researcher), Spencer, K. (Researcher), Fisher, K. (Researcher), Mcgarrigle, L. (Researcher), Cook, M. (Researcher), Pendleton, N. (Researcher), Stanford, P. (Researcher), Lasrado, R. (Researcher), Ahmed, S. (Researcher), Clinch, S. (Researcher), Burden, S. (Researcher), Gluchowski, A. (Researcher), Ford, C. (PGR student), Al Zadjali, F. (PGR student), Sremanakova, J. (PGR student), Fisher, K. (PGR student), Zougar, M. (PGR student), Almohaisen, N. (PGR student), Yang, Y. (PGR student), Mckenzie, Y. (PGR student), O'Connor, S. (Researcher), Aminu, A. (Researcher), Bosco, A. (Researcher), Parchment, A. (Researcher), Money, A. (Researcher), Mackenzie, A. (Researcher), Karki, B. (PGR student), Poku, B. (Researcher), Eost-Telling, C. (Researcher), French, C. (PGR student), Harris, D. (PGR student), Damisa, E. (Researcher), Vardy, E. (Researcher), Hakeem, F. (Researcher), Donald, G. (Researcher), Bilsborough, H. (PGR student), Gangannagaripalli, J. (Researcher), Astbury, J. (Researcher), Garsden, J. (Researcher), Ventre, J. (Researcher), Aguilera Munoz, J. (Researcher), Allsopp, K. (Researcher), Mcgarrigle, L. (Researcher), Mott, L. (PGR student), Huang, L. (Researcher), Tomkow, L. (Researcher), Ahmed, N. (Researcher), Fox, S. (Researcher), Mcdermott, J. (Researcher), Hoodless, S. (Researcher), Dlima, S. (PGR student), Shi, Y. (PGR student) & Tang, Y. (PGR student)
Project: Research

Cite this

Sremanakova, J., Knight, S., Lapitan, M. C. M., Yenli, E., Tabiri, S., Ghosh, D., Kingsley, P., Valparaiso, A. P., Harrison, E. M., Thomas, M., Haque, P., Veetil, S., Suroy, A., Choudhrie, A., Mittal, R., Seenivasagam, R., Roy, B., Jones, D., & Burden, S. (2025). Validation of nutritional screening tools in patients undergoing cancer surgery in low- and middle-income countries. Frontiers in Nutrition, 12. https://doi.org/10.3389/fnut.2025.1576916

@article{8511a9b7ae4f4feba3d004b2e20156d4,

title = "Validation of nutritional screening tools in patients undergoing cancer surgery in low- and middle-income countries",

abstract = "Approximately one-third of patients are severely malnourished prior to surgery in low- and middle-income countries (LMICs). Identifying the most appropriate tool for detecting malnutrition is a critical first step toward enabling effective treatment interventions. Therefore, this study aimed to assess the validity and reliability of nutritional screening tools in patients with cancer scheduled for surgery in LMICs. Participants included adults undergoing either curative elective or palliative surgeries in Ghana, India, and the Philippines. Nutritional status was assessed using anthropometric measurements, the Malnutrition Universal Screening Tool (MUST), and the Patient-Generated Subjective Global Assessment (PG-SGA). Data were analysed using Bland–Altman plots with confidence intervals (CIs) and intra-class correlation coefficients (ICCs) to assess inter-rater reliability. Sensitivity and specificity tests were conducted using the Area Under the Receiver Operating Characteristics Curve (AUROC). A total of 167 participants were recruited, with a mean age of 53.3 years (SD 14.7) and a mean body mass index (BMI) of 23.0 kg/m2 (SD 4.9). The proportion of participants identified as at risk of malnutrition was 53.3% using MUST, 47.3% using PG-SGA SF, and 66% using the full PG-SGA. When compared to the PG-SGA, MUST and PG-SGA SF had AUROCs of 0.78 (95% CI: 0.73–0.87) and 0.76 (95% CI: 0.68–0.83), respectively. MUST demonstrated a sensitivity of 85% and a specificity of 25%, while PG-SGA SF showed a sensitivity of 93% and a specificity of 42%. Excellent inter-rater agreement was observed for anthropometric measurements, with ICC values >0.9 across all assessments. Both MUST and PG-SGA SF demonstrated good sensitivity when compared to PG-SGA. However, PG-SGA SF demonstrated slightly greater specificity than MUST. Based on these findings, PG-SGA SF is recommended for preoperative nutritional screening in LMICs.",

author = "Jana Sremanakova and Stephen Knight and Lapitan, {Marie Carmela M.} and Edwin Yenli and Stephen Tabiri and Dhruva Ghosh and Pamela Kingsley and Valparaiso, {Apple P.} and Harrison, {Ewen M.} and Maria Thomas and Parvez Haque and Sreejith Veetil and Atul Suroy and Ashish Choudhrie and Rohin Mittal and Rajkumar Seenivasagam and Bipradas Roy and Debra Jones and Sorrel Burden",

year = "2025",

month = jun,

day = "5",

doi = "10.3389/fnut.2025.1576916",

language = "English",

volume = "12",

journal = "Frontiers in Nutrition",

issn = "2296-861X",

publisher = "Frontiers Media S. A.",

}

Sremanakova, J, Knight, S, Lapitan, MCM, Yenli, E, Tabiri, S, Ghosh, D, Kingsley, P, Valparaiso, AP, Harrison, EM, Thomas, M, Haque, P, Veetil, S, Suroy, A, Choudhrie, A, Mittal, R, Seenivasagam, R, Roy, B, Jones, D & Burden, S 2025, 'Validation of nutritional screening tools in patients undergoing cancer surgery in low- and middle-income countries', Frontiers in Nutrition, vol. 12. https://doi.org/10.3389/fnut.2025.1576916

TY - JOUR

T1 - Validation of nutritional screening tools in patients undergoing cancer surgery in low- and middle-income countries

AU - Knight, Stephen

AU - Lapitan, Marie Carmela M.

AU - Yenli, Edwin

AU - Tabiri, Stephen

AU - Ghosh, Dhruva

AU - Kingsley, Pamela

AU - Valparaiso, Apple P.

AU - Harrison, Ewen M.

AU - Thomas, Maria

AU - Haque, Parvez

AU - Veetil, Sreejith

AU - Suroy, Atul

AU - Choudhrie, Ashish

AU - Mittal, Rohin

AU - Seenivasagam, Rajkumar

AU - Roy, Bipradas

AU - Jones, Debra

AU - Burden, Sorrel

A2 - Sremanakova, Jana

PY - 2025/6/5

Y1 - 2025/6/5

N2 - Approximately one-third of patients are severely malnourished prior to surgery in low- and middle-income countries (LMICs). Identifying the most appropriate tool for detecting malnutrition is a critical first step toward enabling effective treatment interventions. Therefore, this study aimed to assess the validity and reliability of nutritional screening tools in patients with cancer scheduled for surgery in LMICs. Participants included adults undergoing either curative elective or palliative surgeries in Ghana, India, and the Philippines. Nutritional status was assessed using anthropometric measurements, the Malnutrition Universal Screening Tool (MUST), and the Patient-Generated Subjective Global Assessment (PG-SGA). Data were analysed using Bland–Altman plots with confidence intervals (CIs) and intra-class correlation coefficients (ICCs) to assess inter-rater reliability. Sensitivity and specificity tests were conducted using the Area Under the Receiver Operating Characteristics Curve (AUROC). A total of 167 participants were recruited, with a mean age of 53.3 years (SD 14.7) and a mean body mass index (BMI) of 23.0 kg/m2 (SD 4.9). The proportion of participants identified as at risk of malnutrition was 53.3% using MUST, 47.3% using PG-SGA SF, and 66% using the full PG-SGA. When compared to the PG-SGA, MUST and PG-SGA SF had AUROCs of 0.78 (95% CI: 0.73–0.87) and 0.76 (95% CI: 0.68–0.83), respectively. MUST demonstrated a sensitivity of 85% and a specificity of 25%, while PG-SGA SF showed a sensitivity of 93% and a specificity of 42%. Excellent inter-rater agreement was observed for anthropometric measurements, with ICC values >0.9 across all assessments. Both MUST and PG-SGA SF demonstrated good sensitivity when compared to PG-SGA. However, PG-SGA SF demonstrated slightly greater specificity than MUST. Based on these findings, PG-SGA SF is recommended for preoperative nutritional screening in LMICs.

AB - Approximately one-third of patients are severely malnourished prior to surgery in low- and middle-income countries (LMICs). Identifying the most appropriate tool for detecting malnutrition is a critical first step toward enabling effective treatment interventions. Therefore, this study aimed to assess the validity and reliability of nutritional screening tools in patients with cancer scheduled for surgery in LMICs. Participants included adults undergoing either curative elective or palliative surgeries in Ghana, India, and the Philippines. Nutritional status was assessed using anthropometric measurements, the Malnutrition Universal Screening Tool (MUST), and the Patient-Generated Subjective Global Assessment (PG-SGA). Data were analysed using Bland–Altman plots with confidence intervals (CIs) and intra-class correlation coefficients (ICCs) to assess inter-rater reliability. Sensitivity and specificity tests were conducted using the Area Under the Receiver Operating Characteristics Curve (AUROC). A total of 167 participants were recruited, with a mean age of 53.3 years (SD 14.7) and a mean body mass index (BMI) of 23.0 kg/m2 (SD 4.9). The proportion of participants identified as at risk of malnutrition was 53.3% using MUST, 47.3% using PG-SGA SF, and 66% using the full PG-SGA. When compared to the PG-SGA, MUST and PG-SGA SF had AUROCs of 0.78 (95% CI: 0.73–0.87) and 0.76 (95% CI: 0.68–0.83), respectively. MUST demonstrated a sensitivity of 85% and a specificity of 25%, while PG-SGA SF showed a sensitivity of 93% and a specificity of 42%. Excellent inter-rater agreement was observed for anthropometric measurements, with ICC values >0.9 across all assessments. Both MUST and PG-SGA SF demonstrated good sensitivity when compared to PG-SGA. However, PG-SGA SF demonstrated slightly greater specificity than MUST. Based on these findings, PG-SGA SF is recommended for preoperative nutritional screening in LMICs.

U2 - 10.3389/fnut.2025.1576916

DO - 10.3389/fnut.2025.1576916

M3 - Article

SN - 2296-861X

VL - 12

JO - Frontiers in Nutrition

JF - Frontiers in Nutrition

ER -

Validation of nutritional screening tools in patients undergoing cancer surgery in low- and middle-income countries

Abstract

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