Common Nutritional Screening Tools for Adults
Nutritional screening is a quick, systematic process to identify individuals who are malnourished or at risk of malnutrition. This process is different from a comprehensive nutritional assessment, which is a more in-depth evaluation typically conducted by a registered dietitian. Several validated screening tools are available for use in adult populations across various healthcare settings. The choice of tool depends on the clinical setting and patient population, with some tools being more appropriate for specific groups, such as the elderly.
The Malnutrition Universal Screening Tool (MUST)
The Malnutrition Universal Screening Tool (MUST) is a widely used and validated tool for adults, particularly effective in various healthcare settings. It involves a simple, five-step process that assesses three key components:
- Body Mass Index (BMI): Assesses BMI using height and weight.
- Unintentional Weight Loss: Evaluates the percentage of unplanned weight loss over the past 3 to 6 months.
- Acute Disease Effect: Considers the impact of acute illness on nutritional intake.
These components are scored and combined to determine the overall risk of malnutrition (low, medium, or high), guiding the appropriate management plan.
Mini Nutritional Assessment-Short Form (MNA-SF)
The Mini Nutritional Assessment-Short Form (MNA-SF) is designed for older adults (aged 65 and above). This quick tool includes six questions covering aspects like food intake decline, weight loss, mobility, stress/illness, neuropsychological issues, and BMI (or calf circumference). The scoring categorizes individuals as normal, at risk of malnutrition, or malnourished, prompting further assessment or intervention. A score between 8 and 11, for instance, indicates risk of malnutrition.
Subjective Global Assessment (SGA)
The Subjective Global Assessment (SGA) is a clinical method using patient history and physical examination to diagnose malnutrition, often considered a 'gold standard'. It evaluates weight change, dietary intake, gastrointestinal symptoms, functional capacity, and physical signs of malnutrition. A trained professional classifies patients as well-nourished (A), moderately malnourished (B), or severely malnourished (C). While effective for diagnosis, SGA is less sensitive to short-term nutritional changes.
Comparison of Common Screening Tools
| Feature | MUST | MNA-SF | SGA |
|---|---|---|---|
| Target Population | General adults across all care settings | Older adults (>65 years) | General adults, often used for diagnosis |
| Components | BMI, Unintentional Weight Loss, Acute Disease Effect | Appetite, Weight Loss, Mobility, Stress/Illness, Neuropsychological Problems, BMI/Calf Circumference | Weight Change, Dietary Intake, GI Symptoms, Functional Capacity, Physical Examination |
| Speed & Ease | Quick and simple, based on mostly objective data | Fast (approx. 5 min), simple, requires some subjective input | Comprehensive, requires clinical judgment, can be more time-consuming |
| Output | Low, medium, or high risk score | Normal, at risk, or malnourished score | Classifies as A, B, or C (well-nourished, moderately malnourished, severely malnourished) |
| Best for | Widespread screening in general hospital/community settings | Screening older adults for early risk detection | Diagnosing malnutrition and triaging patients for specific interventions |
Choosing and Interpreting Results
Selecting the appropriate tool depends on the patient and setting. MUST is often used for general screening due to its objective nature, while MNA-SF is standard for older adults. SGA provides detailed diagnostic information for those flagged by other screens. Interpreting results is crucial: medium or high risk on MUST, 'at risk' or 'malnourished' on MNA-SF, or B/C on SGA necessitate further action, typically a referral to a dietitian for a full assessment. Early detection helps prevent complications, reduce costs, and improve outcomes. Results should be integrated with other clinical data and monitored.
Conclusion
Several validated tools, including MUST, MNA-SF, and SGA, are available for identifying nutritional risk in adults. Each tool is suited for different populations and provides varying levels of detail. MUST is good for general screening, MNA-SF for the elderly, and SGA for diagnosis. Effective screening is key to patient care, enabling early identification of risks and timely interventions to counter negative health outcomes associated with malnutrition. Proper use and interpretation of these tools, followed by appropriate action, ensure patients receive necessary nutritional support.
Lists
Best Practices for Nutrition Screening
- Screen all adults on hospital admission and then regularly based on risk.
- Use a validated tool suitable for the patient population and setting.
- Ensure staff are trained in using the selected tool correctly.
- Communicate screening results to the healthcare team.
- Refer at-risk or malnourished individuals to a dietitian for comprehensive assessment.
- Document all results, interventions, and follow-up plans.
Common Risk Factors for Adult Malnutrition
- Chronic illnesses like cancer, kidney disease, or COPD.
- Advanced age, potentially reducing appetite and absorption.
- Gastrointestinal issues such as nausea, vomiting, or malabsorption.
- Medication side effects impacting appetite or nutrient absorption.
- Limited mobility affecting food access and preparation.
- Psychosocial factors including isolation, depression, or low income.
Signs and Symptoms of Malnutrition in Adults
- Unintentional weight loss (e.g., 5-10% in 3-6 months).
- Low Body Mass Index (BMI < 18.5).
- Decreased appetite.
- Lethargy and fatigue.
- Visible muscle wasting.
- Skin changes like dryness or slow wound healing.
