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In the Emergency Department (ED) actual body weight (ABW) is essential for accurate drug dosing. Frequently, the ABW is unknown and direct measurement troublesome. A method using the mid-arm circumference (MAC) to estimate ABW has been developed and validated in the United States of America (USA). This study aimed to validate the MAC-formula for estimating ABW in the Dutch population and compare its performance within the American population.Data were obtained from the Dutch National Institute for Public Health and the Environment (RIVM) and extracted from the American National Health and Nutrition Examination Survey (NHANES) datasets. We included all subjects' ≥70 years whose MAC and weight were recorded and obtained additional anthropometric data. We used the equation: kg = 4 × MAC-50 to estimate the ABW of all subjects and compared results.We retrieved 723 and 972 subjects from the Dutch and American dataset, respectively. The MAC is better correlated with ABW in the American dataset when compared with the Dutch dataset (Pearson r = 0.84 and 0.68, respectively). Bland-Altman bias was -7.49 kg (Limits-of-Agreement [LOA] -27.5 to 12.27 kg) and -0.50 kg (LOA -20.99 to 19.99 kg) in the Dutch and American datasets, respectively.The MAC based formula to estimate ABW is a promising tool for the elderly American population. However it is not accurate within the Dutch elderly ED population. Consequently, it is not applicable to Dutch EDs. This study highlights that the results of anthropometric studies performed within the USA are not per se generalizable to the European population.

Background/objectives: In order to identify critically ill patients with high nutritional risk the modified NUTrition Risk in the Critically ill (mNUTRIC)-score was developed. This score aims to identify patients that will benefit from nutritional interventions. Few data are available on its validity. In The Netherlands, the MUST-score, a nutritional assessment tool for non-ICU patients, is commonly used in the ICU. To validate the mNUTRIC-score in Dutch ICU patients and compare its prognostic performance with the MUST-score., Subjects/methods: A single-center retrospective cohort study among 475 mechanically ventilated patients. Prognostic performance of the mNUTRIC and MUST-scores were assessed and compared for discriminative abilities for 28-day mortality and prolonged mechanical ventilation (>2 days)., Results: The discriminative ability of the mNUTRIC-score for 28-day mortality is (ROC-AUC) 0.768 (95% CI 0.722-0.814) with an associated LR+ of 1.73 (95% CI 1.53-1.95) and LR- of 0.24 (95% CI 0.14-0.39) when comparing low with high (>4) scores. Comparing low with high MUST-scores (>1) a ROC-AUC of 0.513 (95% CI 0.445-0.587) and LR+ of 1.05 (95%CI 0.77-1.45) and LR- of 0.97 (95% CI 0.71-1.17) for mortality were found. The discriminative ability for prolonged ventilation was 0.666 (95% CI 0.616-0.716) and 0.532 (95% CI 0.469-0.594) for the mNUTRIC and MUST-scores, respectively., Conclusions: The prognostic performance of the mNUTRIC-score for 28-day mortality is fair and comparable to other validation studies. The association with prolonged ventilation was not confirmed by our results. The mNUTRIC-score has better performance than the commonly used MUST-score. Therefore, we suggest abandoning use of the MUST-score and to recommend introduction of the mNUTRIC-score for the nutritional risk assessment of critically ill patients.