What Is Malnutrition and Why Is Screening Important?
Malnutrition involves deficiencies or excesses in energy, protein, and other nutrients, which can negatively impact the body's function. Undernutrition specifically can heighten the risk of infection, extend hospital stays, and increase mortality rates. Identifying malnutrition early is key to providing nutritional support. The NRS 2002 screening tool offers a structured way to do this, enabling timely intervention for at-risk individuals. This is particularly important for patients in hospitals, who may be more susceptible to nutritional issues due to their health conditions.
The Two-Step Process of the NRS 2002
The NRS 2002 is designed for adult hospital inpatients and uses a two-step approach to assess nutritional risk. This system allows for a quick initial assessment of all patients upon admission, with more thorough evaluations for those potentially at risk.
Step 1: Initial Screening
The first step involves four questions to see if a patient needs further assessment. These questions look at potential nutritional problems:
- Is BMI < 20.5 kg/m²? (For adults under 70)
- Has the patient lost weight recently (within 3 months)?
- Has the patient eaten less in the last week?
- Is the patient severely ill? (e.g., in intensive therapy)
If all answers are 'No', the patient is considered low-risk and should be checked again weekly. If any answer is 'Yes', the patient moves to the final screening.
Step 2: Final Screening and Scoring
The final screening quantifies nutritional risk by scoring the patient's nutritional status and their disease severity. These scores, along with an age adjustment, give the final NRS 2002 score.
Scoring Nutritional Status (0-3 points): Scores are based on recent weight loss, BMI, and changes in food intake.
Scoring Disease Severity (0-3 points): Scores reflect the patient's illness severity, from normal needs to critical conditions.
Age Adjustment (+1 point): Patients over 70 get an extra point because they are more vulnerable.
Total NRS 2002 Score:
- Score < 3: Low nutritional risk; re-screen weekly.
- Score ≥ 3: High nutritional risk; start a nutritional care plan.
NRS 2002 vs. Other Nutritional Screening Tools
The NRS 2002 is one of several available screening tools, with the choice depending on factors like the patient's setting and age. Below is a comparison with some common alternatives:
| Feature | NRS 2002 | MNA-SF (Mini Nutritional Assessment Short-Form) | MUST (Malnutrition Universal Screening Tool) |
|---|---|---|---|
| Primary Target Population | Hospitalized adults | Ambulatory elderly and those in long-term care facilities | All adults across various care settings (hospitals, community, care homes) |
| Key Assessment Factors | Nutritional status (BMI, weight loss, food intake), Disease severity, Age | Food intake, Weight loss, Mobility, Psychological stress, BMI | BMI, Unplanned weight loss, Effect of acute disease |
| Tool Complexity | Intermediate. Two-step process with scoring tables | Moderate. Six-item questionnaire | Relatively simple. Three steps based on BMI, weight loss, and disease effect |
| Validation | Strongly validated for hospitalized patients | Strong validation for geriatric populations | Well-validated for various settings |
| Output | Numerical score (0-7) indicating risk level | Numerical score (0-14) indicating nutritional status | Categorical risk (Low, Medium, High) |
| Key Advantage | High sensitivity and specificity for hospitalized patients, incorporates disease severity | Gold standard for non-hospitalized elderly | Versatile across settings and quick to administer |
Interpreting and Acting on the NRS 2002 Score
A score of 3 or higher on the NRS 2002 indicates nutritional risk, prompting a comprehensive nutritional care plan, often with a dietitian's input. This plan might involve diet changes, supplements, or more intensive feeding methods for higher scores. Patients scoring under 3 are low-risk but require weekly re-screening.
Conclusion
The NRS 2002 screening tool is an important, evidence-based method for identifying and managing malnutrition risk in hospitalized adults. Recommended by ESPEN, its two-step process efficiently assesses nutritional status, disease severity, and age. By providing a standard assessment, the NRS 2002 helps healthcare teams provide timely and appropriate nutritional support, potentially improving patient outcomes and reducing hospital stays. Its correct use is key to good nutritional care in hospitals.
More detailed guidance and scoring information can be found in the {Link: ESPEN guidelines https://www.espen.org/documents/Screening.pdf}.
