BACKGROUND & AIMS: Malnutrition in the elderly is a multifactorial problem, more prevalent in hospitals and care homes. The absence of a gold standard in evaluating nutritional risk led us to evaluate the efficacy of six nutritional screening tools used in the elderly. METHODS: Two hundred forty eight elderly patients (129 men, 119 female women, aged 75.2 ± 8.5 years) were examined. Nutritional screening was performed on admission using the following tools: Nutritional Risk Index (NRI), Geriatric Nutritional Risk Index (GNRI), Subjective Global Assessment (SGA), Mini Nutritional Assessment - Screening Form (MNA-SF), Malnutrition Universal Screening Tool (MUST) and Nutritional Risk Screening 2002 (NRS 2002). A combined index for malnutrition was also calculated. RESULTS: Nutritional risk and/or malnutrition varied greatly, ranging from 47.2 to 97.6%, depending on the nutritional screening tool used. MUST was the most valid screening tool (validity coefficient = 0.766, CI 95%: 0.690-0.841), while SGA was in better agreement with the combined index (κ = 0.707, p = 0.000). NRS 2002 although was the highest in sensitivity (99.4%), it was the lowest in specificity (6.1%) and positive predictive value (68.2%). CONCLUSIONS: MUST seem to be the most valid in the evaluation of the risk for malnutrition in the elderly upon admission to the hospital. NRS 2002 was found to overestimate nutritional risk in the elderly.