Defining Nutritional Screening
Nutritional screening is a quick and simple process to identify individuals who are malnourished or at risk of malnutrition. Unlike a comprehensive nutritional assessment performed by a dietitian, screening is designed for rapid risk identification and can be performed by various healthcare workers. Early detection is paramount because malnutrition can lead to numerous adverse health consequences, including a weakened immune system, prolonged hospital stays, increased complications, and higher mortality rates.
Screening is particularly vital in healthcare settings where malnutrition rates are often high, such as in hospitals, nursing homes, and outpatient clinics. It helps to initiate the nutrition care process, which includes a more detailed assessment and the development of a nutrition care plan for at-risk patients.
Key Nutritional Screening Tools for Adults
Several validated and reliable tools are used globally to screen for nutritional risk in adults. The selection of a tool often depends on the clinical setting and the patient population. Some of the most widely recognized tools include:
Malnutrition Universal Screening Tool (MUST)
The Malnutrition Universal Screening Tool (MUST) is a widely used five-step tool designed for all care settings. It assesses BMI, unintentional weight loss over 3–6 months, and the effect of acute disease on nutritional intake over 5 days. These factors contribute to an overall risk score (low, medium, or high), which guides a care plan.
Nutritional Risk Screening (NRS-2002)
Recommended by ESPEN for hospital settings, especially for acutely ill patients, the NRS-2002 identifies those likely to benefit from nutritional support. A pre-screening questionnaire assesses BMI, weight loss, reduced intake, and severity of illness. If any apply, a detailed assessment scores illness severity and nutritional status impairment, with an additional point for patients over 70. A score of 3 or higher indicates high risk.
Mini Nutritional Assessment - Short Form (MNA-SF)
The MNA-SF is a quick tool for patients aged 65 and older. It assesses changes in food intake and weight loss over 3 months, mobility, psychological stress or acute disease, and neuropsychological problems. It also includes BMI, or calf circumference as an alternative.
Subjective Global Assessment (SGA)
The Subjective Global Assessment (SGA) is a validated clinical method using patient interview and physical examination. It evaluates changes in weight, intake, GI symptoms, functional capacity, and signs of muscle and fat wasting to classify patients as well-nourished, moderately, or severely malnourished. The Patient-Generated SGA (PG-SGA) is a scored version useful for oncology patients.
The Role and Importance of Nutritional Screening
Routine nutritional screening is crucial in healthcare as it's the first step in the nutrition care process, enabling proactive intervention. Screening helps prevent the worsening cycle of disease and malnutrition. Its benefits include targeted care for those most in need, improved patient outcomes like faster recovery and fewer complications, cost savings through reduced hospital stays, and ensuring continuous care.
Comparing Nutritional Screening Tools
| Feature | MUST (Malnutrition Universal Screening Tool) | NRS-2002 (Nutritional Risk Screening 2002) | MNA-SF (Mini Nutritional Assessment - Short Form) | SGA (Subjective Global Assessment) |
|---|---|---|---|---|
| Target Population | General adults across all settings, including those who are obese. | Hospitalized adults, particularly those with acute illnesses. | Geriatric patients (65 and older). | Adult patients, especially in hospital settings. |
| Primary Setting | Hospital, community, care homes. | Hospital. | Community, hospital, nursing homes for elderly. | Hospital, but also validated for other settings. |
| Key Criteria | BMI, unintentional weight loss, acute disease effect. | Initial questions on BMI, weight loss, dietary intake, plus scoring for illness severity and age. | Changes in intake, weight loss, mobility, stress, neuropsychological issues, BMI (or calf circumference). | Weight history, intake changes, GI symptoms, functional capacity, physical exam. |
| Scoring | Total score (0, 1, ≥2) for low, medium, or high risk. | Total score (0–7), with ≥3 indicating high risk. | Total score (0–14), with a score ≤11 indicating malnutrition risk. | Categorical: Well-nourished (A), Moderately (B), or Severely (C) malnourished. |
| Usability | Simple, quick, and can be completed by any trained care worker. | Requires some clinical judgment for scoring illness severity, but simple pre-screening exists. | Quick and easy, with optional calf circumference measurement for immobile patients. | Requires a trained healthcare professional, more subjective than other tools. |
How to Implement Nutritional Screening
Implementing nutritional screening effectively involves choosing the right tool for the setting and population (e.g., MUST for community, NRS-2002 for hospitals, MNA-SF for elderly). Screening should occur routinely, such as on hospital admission or during check-ups for at-risk groups. Accurate data collection, including BMI or alternatives like calf circumference, is essential. The risk score should be interpreted correctly, and at-risk patients should be referred for a full nutritional assessment and care plan. Regular re-screening is important as nutritional status can change.
Conclusion
Nutritional screening is a vital initial step in addressing malnutrition risk in adults across various healthcare settings. Using validated tools like MUST, NRS-2002, or MNA-SF allows for rapid identification of patients at risk, facilitating timely assessment and intervention. This proactive approach improves patient outcomes, shortens hospital stays, and reduces healthcare costs. Integrating standardized nutritional screening ensures that nutritional care is a key component of comprehensive patient management.
For more detailed information on specific screening protocols, the full MUST guide is available on the British Association for Parenteral and Enteral Nutrition (BAPEN) website.
