Nutrition evaluation in HIV seropositive patients using the Malnutrition Universal Screening Tool and Subjective Global Assessment in Ibadan, Nigeria

Abstract

Background: Early identification of nutritional risks in People Living With HIV/AIDS (PLWHA) in low-income settings depends onan awareness of the available and reliable tools.

Objectives: The study was designed to compare the nutritional status evaluation of PLWHA using the Malnutrition Universal Screening Tool (MUST) and Subjective Global Assessment (SGA) tool, and to also determine the cut-off values of MUST and SGA that corresponds to underweight with BMI (<18.5kg/m2) as the gold standard.

Methodology: The study reviewed records of HIV seropositive patients between May and October 2008 at the antiretroviral clinic, University College Hospital, Ibadan, Nigeria. Clinical symptoms and anthropometric data of 120 PLWHA were extracted from the hospital records for nutritional evaluation by the BMI, MUST, and SGA tools. Descriptive and inferential statistics were employed in data analysis.Cut-off values for MUST and SGA tools in identifying underweight (BMI<18.5) were determined using Receiver Operation Curve (ROC) analysis. Level of significance was placed at p<0.05.

Results: Prevalence of underweight was 5.8%(BMI), 75.8% were at high risk of malnutrition (MUST score ≥2) while 42.3% had suspected and severe malnutrition (SGA B&C) respectively. There is a significant difference between MUST and SGA risk of malnutrition χ2=17.331, p= 0.000. ROC curve for MUST was more accurate in identifying underweight compared with SGA (AUC=0.900, C.I=0.778 to 1.012, p=0.000 vs AUC=0.700, C.I=0.476 to 0.934, p=0.070). At a MUST score of 3.4 and SGA of 6.0, about 10% and 30% of the underweight respondents were not identified.

Conclusion: With the use of MUST and SGA tools, more PLWHA were at risk of malnutrition. Thus, combined use of MUST and SGA gives a better assessment than BMI.

Keywords: Nutritional assessment, MUST, SGA, PLWHA, Nutrition screening