• Chiara Lorini, Francesca Collini, Mariangela Castagnoli, Mauro Di Bari, Maria Chiara Cavallini, Nicoletta Zaffarana, Pasquale Pepe, Ersilia Lucenteforte, Alfredo Vannacci, and Guglielmo Bonaccorsi.
• Department of Health Science, University of Florence, Florence, Italy. Electronic address: chiara.lorini@unifi.it.
• Nutrition. 2014 Oct 1;30(10):1171-6.

ObjectiveThe aim of this study was to use the Malnutrition Universal Screening Tool (MUST) to assess the applicability of alternative versus direct anthropometric measurements for evaluating the risk for malnutrition in older individuals living in nursing homes (NHs).MethodsWe conducted a cross-sectional survey in 67 NHs in Tuscany, Italy. We measured the weight, standing height (SH), knee height (KH), ulna length (UL), and middle-upper-arm circumference of 641 NH residents. Correlations between the different methods for calculating body mass index (BMI; using direct or alternative measurements) were evaluated by the intraclass correlation coefficient and the Bland-Altman method; agreement in the allocation of participants to the same risk category was assessed by squared weighted kappa statistic and indicators of internal relative validity.ResultsThe intraclass correlation coefficient for BMI calculated using KH was 0.839 (0.815-0.861), whereas those calculated by UL were 0.890 (0.872-0.905). The limits of agreement were ±6.13 kg/m(2) using KH and ±4.66 kg/m(2) using UL. For BMI calculated using SH, 79.9% of the patients were at low risk, 8.1% at medium risk, and 12.2% at high risk for malnutrition. The agreement between this classification and that obtained using BMI calculated by alternative measurements was "fair-good."ConclusionWhen it is not possible to determine risk category by using SH, we suggest using the alternative measurements (primarily UL, due to its highest sensitivity) to predict the height and to compare these evaluations with those obtained by using middle-upper-arm-circumference to predict the BMI.Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

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