Original article Risk of malnutrition (over and under-nutrition): Validation of the JaNuS screening tool Lorenzo M. Donini a, * , Laura Maria Ricciardi b , Barbara Neri a , Andrea Lenzi a , Giulio Marchesini b a Department Experimental Medicine, Medical Physiopathology, Food Science and Endocrinology Section, Food Science and Human Nutrition Research Unit, Sapienza University of Rome, 00185 Roma, Italy b Department of Medicine and Surgery, Unit of Metabolic Diseases & Clinical Dietetics, “Alma Mater Studiorum” University of Bologna, Italy article info Article history: Received 9 July 2013 Accepted 5 December 2013 Keywords: Malnutrition Overnutrition Undernutrition Screening tool JANUS summary Background & aims: Malnutrition (over and under-nutrition) is highly prevalent in patients admitted to hospital and it is a well-known risk factor for increased morbidity and mortality. Nutritional problems are often misdiagnosed, and especially the coexistence of over and undernutrition is not usually recognized. We aimed to develop and validate a screening tool for the easy detection and reporting of both undernutrition and overnutrition, specifically identifying the clinical conditions where the two types of malnutrition coexist. Methods: The study consisted of three phases: 1) selection of an appropriate study population (esti- mation sample) and of the hospital admission parameters to identify overnutrition and undernutrition; 2) combination of selected variables to create a screening tool to assess the nutritional risk in case of undernutrition, overnutrition, or the copresence of both the conditions, to be used by non-specialist health care professionals; 3) validation of the screening tool in a different patient sample (validation sample). Results: Two groups of variables (12 for undernutrition, 7 for overnutrition) were identified in separate logistic models for their correlation with the outcome variables. Both models showed high efficacy, sensitivity and specificity (overnutrition, 97.7%, 99.6%, 66.6%, respectively; undernutrition, 84.4%, 83.6%, 84.8%). The logistic models were used to construct a two-faced test (named JaNuS e Just A Nutritional Screening) fitting into a two-dimension Cartesian coordinate graphic system. In the validation sample the JaNuS test confirmed its predictive value. Internal consistency and testeretest analysis provide ev- idence for the reliability of the test. Conclusion: The study provides a screening tool for the assessment of the nutritional risk, based on parameters easy-to-use by health care personnel lacking nutritional competence and characterized by excellent predictive validity. The test might be confidently applied in the clinical setting to determine the importance of malnutrition (including the copresence of over and undernutrition) as a risk factor for morbidity and mortality. Ó 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved. 1. Introduction The health status is intimately connected with the nutritional status; the maintenance of health status corresponds to the maintenance of the structural and functional body entirety (body composition and body function, respectively) through energy (en- ergy balance) and substance exchange (energy and non-energy nutrients) with the environment. 1 Any alteration of this fragile balance generates malnutrition, a term which encompasses un- dernutrition, overnutrition, or the copresence of both the condi- tions, as in sarcopenic obesity. 2 Malnutrition is highly prevalent in patients admitted to hospital and it is a well-known risk factor for increased morbidity and mortality, specifically in frail populations and in the elderly. 3,4 Although studies continue to highlight the high incidence of undernutrition in patients, the increasing incidence of obesity in the general population suggests that an ever increasing number of obese patients will be admitted to hospital. Several studies have also revealed an increased risk of complications in obese * Corresponding author. Tel.: þ39 064991 0996, þ39 3385926464 (mobile); fax: þ39 06 4991 0699. E-mail address: lorenzomaria.donini@uniroma1.it (L.M. Donini). Contents lists available at ScienceDirect Clinical Nutrition journal homepage: http://www.elsevier.com/locate/clnu 0261-5614/$ e see front matter Ó 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved. http://dx.doi.org/10.1016/j.clnu.2013.12.001 Clinical Nutrition xxx (2013) 1e8 Please cite this article in press as: Donini LM, et al., Risk of malnutrition (over and under-nutrition): Validation of the JaNuS screening tool, Clinical Nutrition (2013), http://dx.doi.org/10.1016/j.clnu.2013.12.001