What are the type of nutritional screening?

  Nutritional diagnosis and screening

Due to lack of definition of malnutrition the health professional face difficulties in diagnosis or grade or malnutrition among patients. A timely and precise diagnosis will help to improve the outcome of treatment and prevent further complications.

 Conversely lack of diagnosis will lead to longer stay at hospitals and frequent readmissions. Therefore one undernutrition is diagnosed it has to be treated by the multi-disciplinary sport team of nutritionist according to in initialized care plan.

Nutritional diagnosis is generally carried out by looking at BMI alone or weight loss combined with other BMI or fat free match index. An ideal care plan starts by immediately s upon admission at hospital is followed by through assessment screening patient of nutritional status.

 Patient screened at risk undergo appropriate nutritional interventions. Does nutritional screening is the process of identifying individual or groups who are marked restore are vulnerable to malnutrition.

 It is 3 and to mention that apart from increasing Healthcare post undernutrition has drastic impact on the tolerance and efficacy of certain treatments for example chemotherapy radiotherapy and antibiotics full stop there for early diagnosis of breast is helpful to prevent onset of Nutrition related problems and design intervention to curb the menace of malnutrition in its infancy.

More oven early detection and treatment are cost-effective and may prevent lifetime complications. Screening is usually Rapid procedure and is carried out prior comprehensive nutritional assessment.

 Only patients identified at risk screening is aim to  identify risks factors for malnutrition while assessment provides nutritional diagnosis.

Alternative; A

BMI <18.5 KG / m2

Alternative; B

Involuntary weight loss >10% indefinite of time, or >5% over

the past 3 month.

couple with either

BMI <20 kg /m2 if <70 years of age , or <22 kg/m2 if> 70 year of age

OR

FFMI<15 and 17 kg/m2 in women and men , respectively

Interplay of nutritional screening and assessment:

Nutritional screening:

Identify risk factors. 

Simple and Quicker. 

Can be carried out by the patient or family. 

May provide nutritional related outcomes.

Nutritional assessment:

Provide diagnosis.

Relatively Complex and takes long time.

Can be performed by professional dietitian.

Nutrition related outcomes are visible.

Components of nutritional screening:

Dietary intake, protein intake.

BMI or weight loss. 

Diseases and their related complications.

Presence of inflammation.

Muscle function.

Nutritional screening tools:

Several screening tools are used to identify characteristics attributed to dietary or nutritional insufficiency and differentiate individuals who are at risk from those who have developed a poor nutritional status. There is a consensus that nutritional screening be formed within the first 24 to 72 hours of hospital admission for all the patients.

Training is the first step in the nutrition care and includes information on dietary history, nutritional intake, anthropometry , biochemical measurements, physiological and clinical parameters, physiological or disease status as well as functional and behavioral aspects.

Screening tools currently suggested by European society for clinical nutrition and metabolism address some of the basic questions including.

Recent weight change;

Recent food intake

Current BMI

Current severity

Guidelines on the use of nutritional screening tools in different settings for example community hospitals and care institutions are based on their reliability and practicability. Following are some of the screening tools recommended by the ESPEN.

Community: malnutrition Universal screening tool MUST. 

Hospital: Nutrition screening tool NST. 

Elderly: Mini Nutritional assessment MNA. 

MUST : a community screening tool:

It was developed by the British Association for antiviral and enteral nutrition and used to detect nutritional problems by secondly BMI weight loss and diseases.

MUST is a simple quick and valid tool for Rapid screening of the community to get an estimate of the grade celebrity of undernutrition. 

However it does not account for recent food intake and percentage weight loss. More over BMI calculation may cause problem in some units. MUST is a universally used 5 step tool to identify these and adults or those who are at risk. It relies on three indicators with scores assigned to each grade.

1. BMI score

2. Weight loss score for last 3 to 6 month

3. Acute disease effects score or there has been or likely to be no nutritional intake for more than 5 days. 

MUST  ( Malnutrition universal screening tool )

Step ;4

Overall risk of malnutrition

Add a score together to calculate overall risk of malnutrition

Score 0 low risk                  Score 1 medium risk               Score 2 or more high risk

Step 5

Management guideline

             0 = Low risk routine clinical care   

             *Repeat screening , Hospital - weekly
               Care homes - monthly, Community- annually  
                      for specials groups e.g. those 75 years 

       

               1= Medium risk observe

          
             * Document dietary intake for 3days if subject in hospital
                or care home.
             *If improve or adequate intake - little clinical concern;
               If no improvement -clinical concern -follow local policy
             *Repeat screening 
               Hospital- weekly , Care home-at least monthly, community
               at least 2-3 month.

        

                2= Or more high risk treat

              *Refer to dietitian, nutritional support team or implement

                local policy.

              *Improve and increase overall nutritional intake .

              *Monitor and review care plan hospital- weekly 

                care home - monthly , community-monthly

              *Unless detrimental or no benefit is expected from       

                 nutritional support e.g. imminent death

           

                 All risk categories;

               *Treat underlying condition and provide help and advice

                 on food choice, eating and drinking when necessary.

                *Record malnutrition risk category.

                *Record need for special diets and follow local policy.

                 Obesity

          *Record presence of obesity for those with underlying

                  conditions, theses are generally controlled before the 

                  treatment of obesity.

b. NRS-2002 (nutritional risk screening) :

NRS-2002 is a simple and well validated nutritional screening tool used to identify patients who are severely malnourished and need increased dietary requirements.

 Nrs 2002 to start with 4 basic questions about BMI weight loss dietary intake and disease severity. If the answer of any of the questions  is yes indicating a deviation from normal.

 

The final screening records the grade of malnutrition or disease severity . Each of the parameter is assign a score of zero to 3 and a final score of greater than or equal to 3 would indicate the need of nutritional intervention for the patient.

Screening questions  Yes/No

1 ) Is BMI < 20.5?

2) Has the patients lose weight within the last 3 months?

3)the patient had a reduced dietary intake in the last week?

4)Is the patient severely ill? ( e.g. in intensive therapy)

Yes; If the answer is ' yes ' to any question , the final screening is performed.

No; If the answer is 'No to all question , the patient is rescreened at weekly intervals. If the patient is scheduled for a major operation, a

preventive nutritional care is considered to try avoid the associated risk.

Impaired nutritional status		Sererity of disease(=increase in
		requirement)
Absen; score 0	Normal nutrition status	Absent ;scoeo	Normal nutrition requirement
Mild	weight loss >5%in 3 month	Mild	Hip fracture chronic patient,
	OR		particular with acute
Score 0	Food intake below 50-75% of	Score 1	complication;
	normal requirements in		cirhosis, COFD chronic
	preceding week		hemodialysis,diabetes,oncology
Moderate	Weight loss >5%in 2 months	Moderate	Major abdominal surgery, stroke,
	OR		server pneumonia, hematologic
Score 2	BMI 18.5- 20.5% impaired		malignancy
	general condition	Score 2
	OR
	Food intake 25-50% of normal
	requirement preceding week
Sever	weight loss >5%in 1 months	Severe	Head injury, bone marrow
Score 3	(>15% in 3 months)		transplantation, intensive care
	OR		patients.
	BMI <18.5 + impaired general	Score 3	(APACHE>10)
	condition
	OR
	Food intake 0-25% of normal
	requirement in preceding week.

 Age if > 70 years ; add to total score above = age adjusted total score;

Score >3 ; The patient is nutritionally at risk and a nutritional care plan has to be initiated.

Score>3; Weekly re-screening of the patient. If the patient is scheduled for a major operation, a preventative nutritional care plan is considered in avoid the associated risk.

   

            Score                                            Nutritional status

          

            0-2                                                Well nourished

            3-4                                                 Medium risk

            5-6                                                 Nutritional status  

                     Elderly; MNA (Mini malnutritional assessment)

It is validated, highly specific and sensitive tool to identify patients at risk of malnutrition. its development started in 1989 at International Association of geriatrics and gerontology (IAG).

 MNA is not only screening tool but also an assessment tool to check malnutrition status of elderly patients is further divided into two classes I full emane and the shot from MN m s f the full and man has two component the first one is explaining which then difficult the purchase at rest and second one is a assessment of which is the carried out only for patients at risk.

 It comprises of 18 parameters including weight loss, anorexia, anthropometric measurements, during situation cognitive and mood disorders, acute diseases, dietary and subjective assessment, drug intake and mobility etc.

 It is pertinent to mention that MNA tool provide preliminary information about nutritional status of elderly ultimately providing early prognosis. 

More over, it is important to educate Health Care  professional about the practices of MNA for development of early intervention.

Mini nutrition assessment(MNA) -Screening adapted from MNA Société des proudest Nestle".

A

screening question with score and severity	Score assigned
Has food intake declined over the past 3 month due to loss of appetite
digestive problems, chewing or swallowing difficulties?
0= Sever loss of appetite
1= Moderate loss of appetite
2= No loss of appetite

B

Weight loss during last month

0= Weight loss greater than 3Kg

1= Does not know

2= Weight loss between 1 and 3 Kg

3= No weight loss

   

c

Mobility?

0= Bed or chair bound

1= Able to get out of bed/ chair but does not go out

2= Goes out

D

Has suffered physical stress or a cute diseases in the past 3 month?

0= YES

1= NO

E 

Neuropsychological problems?

0= Severe dementia or depression

1= Mild dementia

2=No psychological problem

F  

              

Body Mass Index (BMI)

0= BMI less than 19

1= BMI 19 to less than 21

2= BMI 21 to less than 23

3= BMI 23 or greater

Depending on scores assigned the patients are categorized into three groups:

0 score:   Low risk (routine clinical care) 

1 score :  Medium risk ( under observation) 

More than or equal to 2: High risk (treatment) 

What is nutritional screening?

What are the type of nutritional screening?

What is nutritional risk screening?