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Validated screening tools for the assessment of cachexia, sarcopenia, and malnutrition: a systematic review

Miller, Janice; Wells, Liz; Nwulu, Ugochinyere; Currow, David; Johnson, Miriam J.; Skipworth, Richard J.E.


Janice Miller

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Mrs Liz Wells
Lecturer in Nutrition and Dietetics

Ugochinyere Nwulu

David Currow

Richard J.E. Skipworth


Background: There is great overlap between the presentation of cachexia, sarcopenia, and malnutrition. Distinguishing between these conditions would allow for better targeted treatment for patients. Objectives: The aim was to systematically review validated screening tools for cachexia, sarcopenia, and malnutrition in adults and, if a combined tool is absent, make suggestions for the generation of a novel screening tool. Design: A systematic search was performed in Ovid Medline, EMBASE, CINAHL, and Web of Science. Two reviewers performed data extraction independently. Each tool was judged for validity against a reference method. Psychometric evaluation was performed as was appraisal of the tools' ability to assess the patient against consensus definitions. Results: Thirty-eight studies described 22 validated screening tools. The Cachexia score (CASCO) was the only validated screening tool for cachexia and performed well against the consensus definition. Two tools assessed sarcopenia [the Short Portable Sarcopenia Measure (SPSM) and the SARC-F (Strength, Assistance with walking, Rise from a chair, Climb stairs, and Falls)] and scored well against the 1998 Baumgartner definition. The SPSM required large amounts of equipment, and the SARC-F had a low sensitivity. Nineteen tools screened for malnutrition. The 3-Minute Nutrition Score performed best, meeting consensus definition criteria (European Society for Clinical Nutrition and Metabolism) and having a sensitivity and specificity of >80%. No tool contained all of the currently accepted components to screen for all 3 conditions. Only 3 tools were validated against cross-sectional imaging, a clinical tool that is gaining wider interest in body-composition analysis. Conclusions: No single validated screening tool can be implemented for the simultaneous assessment of cachexia, sarcopenia, and malnutrition. The development of a tool that encompasses consensus definition criteria and directs clinicians toward the underlying diagnosis would be optimal to target treatment and improve outcomes. We propose that tool should incorporate a stepwise assessment of nutritional status, oral intake, disease status, age, muscle mass and function, and metabolic derangement.


Miller, J., Wells, L., Nwulu, U., Currow, D., Johnson, M. J., & Skipworth, R. J. (2018). Validated screening tools for the assessment of cachexia, sarcopenia, and malnutrition: a systematic review. American Journal of Clinical Nutrition, 108(6), 1196-1208.

Journal Article Type Article
Acceptance Date Aug 16, 2018
Online Publication Date Dec 12, 2018
Publication Date Dec 1, 2018
Deposit Date Dec 14, 2018
Publicly Available Date Oct 27, 2022
Journal The American Journal of Clinical Nutrition
Print ISSN 0002-9165
Electronic ISSN 1938-3207
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 108
Issue 6
Pages 1196-1208
Keywords Nutrition and Dietetics; Medicine (miscellaneous)
Public URL
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