Understanding Nutritional Screening
Nutritional screening is a rapid, systematic process designed to identify individuals who are malnourished or at risk of malnutrition. It is distinct from a comprehensive nutritional assessment, which is a more in-depth evaluation performed once a risk is identified. Screening tools are crucial for ensuring timely and appropriate nutritional support, which can significantly improve patient outcomes and reduce healthcare costs. The choice of screening tool often depends on the patient's age, clinical setting, and specific health status. Here, we'll explore some of the most widely used tools.
Mini Nutritional Assessment (MNA)
The Mini Nutritional Assessment (MNA) is designed for older adults (age 65 and above) and is used in clinical, hospital, and nursing home settings to identify those at risk of malnutrition. It has a short form (MNA-SF) for quick screening and a full form for more detailed assessment. The MNA-SF includes six questions, and if risk is indicated, the full 18-item MNA is recommended. The MNA is known for its effectiveness in its target population.
Malnutrition Universal Screening Tool (MUST)
Developed by BAPEN, the Malnutrition Universal Screening Tool (MUST) is applicable to all adults across all care settings. It identifies malnutrition, risk of malnutrition, and obesity. MUST involves a five-step process: calculating BMI, assessing weight loss, evaluating the effect of acute disease, determining an overall risk score (low, medium, or high), and providing management guidelines. It is widely used due to its ease of use and broad applicability.
Nutritional Risk Screening (NRS-2002)
Recommended by ESPEN for hospitalized adults, the Nutritional Risk Screening (NRS-2002) identifies patients who will benefit from nutritional support. It starts with a four-question pre-screening. If risk is indicated, a full screening scores impaired nutritional status and illness severity, with an additional point for patients aged 70 or older. A score of 3 or higher indicates nutritional risk, prompting a care plan. NRS-2002 is validated and can predict outcomes like mortality and length of stay.
Comparison of Common Nutritional Screening Tools
| Feature | Mini Nutritional Assessment (MNA) | Malnutrition Universal Screening Tool (MUST) | Nutritional Risk Screening (NRS-2002) |
|---|---|---|---|
| Target Population | Elderly (age 65+) | All adults | Hospitalized adults |
| Setting | Hospital, long-term care, community | All care settings (hospital, care home, community) | Primarily hospital setting |
| Primary Criteria | Food intake, weight loss, mobility, psychological stress, BMI/calf circumference | BMI, unintentional weight loss, acute disease effect | BMI, weight loss, reduced food intake, disease severity, age |
| Speed & Complexity | Short Form is quick (under 5 min); Full Form is more detailed (10-15 min) | Simple 5-step process, easily completed by various staff | Quick pre-screening, followed by a more detailed scoring if necessary |
| Other Considerations | Has a specialized form for self-screening by patients | Also screens for obesity; very common in UK | Includes disease severity in scoring, which affects metabolic requirements |
Other Screening Tools
Beyond MNA, MUST, and NRS-2002, other tools include the Malnutrition Screening Tool (MST), Subjective Global Assessment (SGA), and Patient-Generated Subjective Global Assessment (PG-SGA).
How Screening Tools Drive Action
Identifying risk is the first step. A high-risk score necessitates a comprehensive nutritional assessment by a dietitian, leading to interventions like dietary changes or nutritional support. Early nutritional care improves outcomes, reducing hospital stays and complications. The NIH provides resources on nutrition.
Conclusion
Selecting the appropriate nutritional screening tool depends on the patient and setting. MNA is ideal for the elderly, NRS-2002 for hospitalized adults, and MUST for all adults across various settings. Effective screening enables timely interventions, improving patient care and outcomes.
