Early Malnutrition Risk Detection for Quality Patient Care: An Analysis of Nutrition Risk Screening Tools in Kenyan Referral Hospitals

Systematic reviews and original research articles should have a structured abstract of Background & objectives: Malnutrition is a prevalent condition linked to increased morbidity and mortality among hospitalized adult patients. This study assessed the effectiveness of three Nutrition Risk Screening (NRS) tools i.e. NRS-2002, Malnutrition Universal Screening Tool (MUST), and Malnutrition Screening Tool (MST) across Kenyatta National Hospital, Moi Teaching and Referral Hospital, and Kisii National Teaching and Referral Hospital in Kenya. Materials and Methods: A cross-sectional analytical design involved 420 adult inpatients screened within 24 hours of admission, using body mass index (BMI) as the reference standard. Results: Among hospitalized adults in three Kenyan referral hospitals, participants were predominantly middle-aged (median = 35.5 years). The NRS-2002 identified the highest malnutrition risk prevalence (85.7%), followed by MST (71.7%) and MUST (51.0%), whereas BMI classified only 23.8% as at risk. Both NRS-2002 and MUST showed perfect sensitivity (1.000) but MUST demonstrated higher specificity (0.65) and superior diagnostic accuracy (AUC = 0.82). Agreement with BMI was low across all tools, though MUST showed the best overall consistency and balance between sensitivity and specificity. Conclusion: The study revealed significant variation in malnutrition risk detection across NRS tools. While NRS-2002 was highly sensitive, it tended to overestimate risk. The MUST demonstrated the best overall balance of sensitivity, specificity, and diagnostic accuracy. Adoption of the MUST as the standard screening tool in Kenyan referral hospitals is recommended to enhance early malnutrition detection and improve patient care outcomes.