Why Are Screening and Assessment Important?
Benefits of Nutritional Risk Screening and Assessment
Early diagnosis of hospital malnutrition is the first step in effective management of this prevalent health care problem. In a comprehensive study, it was found that only 50 percent of malnourished patients were recognized in regular clinical practice.1 Severe malnutrition can be identified rather easily, whereas less severe states of malnutrition, particularly in patients with complex conditions, tend to become evident only in later stages of treatment.2 For this reason, mandatory screening using a validated nutritional risk screening tool is recommended for early identification and treatment of malnutrition.3,4
Patient Benefits of Nutritional Risk Screenings
When nutritional risk screening is performed, the deleterious effects of hospital malnutrition can be reduced or prevented. The benefits include:
- Support of wound healing5
- Fewer complications5,6,7,8
- Reduced number of infections5,7,8
- Shorter hospital stays6
- Faster mobilization9
- Better quality of life9
Early Detection is Critical to Enabling Good Clinical Nutrition
To counteract hospital malnutrition and its consequences, timely identification of impaired nutritional status and quick response to start treatment are crucial for patients in nutritional risk groups. Today, only 50 percent of hospital malnutrition cases worldwide were recognized in regular clinical practice.1,10
Good nutritional care is a vital part of patient management and includes11:
- Proper screening of nutritional condition
- Calculation of energy and nutrient requirements
- Decision on nutritional strategy
- Decision on route of administration
- Tight monitoring of the nutritional therapy
- Competent complication management
Recommended Patient Screening Tools
Various screening tools have been designed to detect protein and energy undernutrition in patients. These tools are also effective for predicting whether undernutrition is likely to develop and/or worsen. The European Society for Clinical Nutrition and Metabolism (ESPEN) has set guidelines for nutritional risk screening of hospitalized patients12suggesting the following tools to avoid unnecessary depletion:
- Nutritional Risk Screening 2002 (NRS 2002) for use in the hospital setting12
- Subjective Global Assessment (SGA) for use in the hospital setting13
- Malnutrition Universal Screening Tool (MUST) for use in the community12
- Mini-Nutritional Assessment (MNA) for use with elderly patients12
Each screening method has been recommended for different patient populations, care settings and age groups. Criteria for the selection of the appropriate tool also include validity and reliability of the method, predictive power, and simplicity of use.4
These tools consider weight loss, body mass index, physical signs of malnutrition, age, and disease severity among the signs of hospital malnutrition.14
Assessment is the second step of efficient nutritional management. It is a detailed, more specific and in-depth evaluation of the causes of malnutrition and the risk factors for nutrition and fluid deficiency.14
The assessment should be performed by a nutritional expert (e.g. a dietitian, a clinician interested in nutrition, or a nutrition nurse specialist) or by a nutritional support team. Clinical judgment is indispensable for the decision on the appropriate follow up. The completion of the assessment allows interventions which can lead to better outcomes.
- 1.Kruizenga HM, Wierdsma NJ, VanBokhorst-de van der Schueren MAE, et al. Screening of nutritional status in the Netherlands. Clin Nutr. 2003;22:147–52.
- 2.Kruizenga HM, de Jonge P, Seidell JC, et al. Are malnourished patients complex patients? Health status and care complexity of malnourished patients detected by the Short Nutritional Assessment Questionnaire (SNAQ). Eur J Intern Med. 2006;17(3):189-94.
- 3.Tappenden KA, Quatrara B, Parkhurst ML, et al. Critical role of nutrition in improving quality of care: an interdisciplinary call to action to address adult hospital malnutrition. JPEN. 2013;37(4):482-87.
- 4.Van Bokhorst-de van der Schueren MA, Guaitoli PR, Jansma EP, et al. Nutrition screening tools: does one size fit all? A systematic review of screening tools for the hospital setting. Clin Nutr. 2014;33(1):39-58.
- 5.Waitzberg DL. Efficacy of nutritional support: evidence-based nutrition and cost-effectiveness. Nestle Nutr Workshop Ser Clin Perform Programme. 2002;7:257-71.
- 6.Correia MI, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr. 2003;22(3):235-39.
- 7.Jie B, Jiang ZM, Nolan MT, et al. Impact of nutritional support on clinical outcome in patients at nutritional risk: a multicenter, prospective cohort study in Baltimore and Beijing teaching hospitals. Nutrition. 2010;26(11-12):1088-93.
- 8.Kennedy JF, Nightingale JM. Cost savings of an adult hospital nutrition support team. Nutrition. 2005;21(11-12):1127-33.
- 9.Ha L, Hauge T, Spenning AB, et al. Individual, nutritional support prevents undernutrition, increases muscle strength and improves QoL among elderly at nutritional risk hospitalized for acute stroke: a randomized, controlled trial. Clin Nutr. 2010;29(5):567-73.
- 10.NICE: National Collaborating Centre for Acute Care. Nutrition support in adults: Oral nutrition support, enteral tube feeding and parenteral nutrition. Methods, evidence and guidance. London 2006.
- 11.COUNCIL OF EUROPE COMMITTEE OF MINISTERS: Resolution ResAP(2003)3 on food and nutritional care in hospitals. https://wcm.coe.int/rsi/CM/index.jsp
- 12.Kondrup J, Allison SP, Elia M, et al. ESPEN Guidelines for Nutrition Screening 2002. Clin Nutr. 2003;22(4):415-21.
- 13.A.S.P.E.N. Board of Directors and the Clinical Guidelines Task Force. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric care. JPEN 2002;26:1SA-138SA.
- 14.Mueller C, Compher C, Ellen DA, et al. A.S.P.E.N. Clinical Guideline: Nutrition screening, assessment, and intervention in adults. JPEN. 2011;35(1):16-24.