Towards precision malnutrition screening: a contextual comparison of Malnutrition Universal Screening Tool, Nutrition Risk Screening 2002, Indian Malnutrition Self-Screening Tool, and a modified nutritional screening tool in Indian clinical settings

Background: Malnutrition in hospital settings requires prompt intervention. Nutritional screening tools like the Malnutrition Universal Screening Tool (MUST) and Nutrition Risk Screening 2002 (NRS 2002) are widely used, but their efficacy in Indian hospital settings remains poorly documented. This study aimed to evaluate and compare the diagnostic performance of the MUST, NRS 2002, and the Indian Malnutrition Self-Screening Tool (IMSST) with a context-specific modified nutritional screening tool developed for Indian inpatients. It was hypothesized that the modified tool would offer improved contextual relevance and balanced accuracy, supporting precision-based nutritional risk assessment in clinical settings. Methods: A cross-sectional study was conducted in a tertiary care hospital, involving 200 patients aged 30 to 60 years admitted to various wards. Nutritional risk screening was performed within 24 to 48 hours of admission using MUST, NRS 2002, IMSST, and the modified tool. Agreement between tools was assessed using Cohen’s κ, and diagnostic performance was evaluated through sensitivity, specificity, predictive values, and receiver operating characteristic (ROC) analysis. Results: Among 200 inpatients (mean age 47.6 ± 11.1 years; 64% male), the modified tool and IMSST identified the highest proportion at risk (63.5% and 71.0%). The modified tool showed excellent agreement with IMSST ( κ = 0.80; 91.0%), high sensitivity (87.9%), specificity (98.3%), and the highest accuracy (91.0%) among all tools. MUST demonstrated moderate sensitivity (63.6%), while NRS 2002 had the lowest (40.8%) but high specificity (94.8%). The modified tool achieved the highest average area under the ROC curve AUC (0.809), indicating strong discriminative performance across body mass index (BMI) groups and clinical settings. Conclusions: The context-specific modified screening tool, aligned with Global Leadership Initiative on Malnutrition (GLIM) criteria, exhibited enhanced diagnostic precision, overall performance and contextual adaptability, as compared to MUST, NRS 2002, and IMSST. Its high sensitivity positions it as a reliable tool for early nutritional intervention. Findings affirm the study hypothesis and highlight its value in precision nutrition care. Further validation in larger cohorts is recommended.