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🍽️Nutrition Assessment

Nutrition Screening Tools

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Why This Matters

Nutrition screening tools aren't just checklists—they're the frontline defense against malnutrition going undetected. You're being tested on your ability to select the right tool for the right population, whether that's a frail elderly patient in the community, a critically ill adult in the ICU, or a hospitalized child. Understanding why each tool was developed and what parameters it measures will help you answer questions about clinical decision-making, not just tool identification.

These tools demonstrate core principles of sensitivity vs. specificity, population-specific validation, and the balance between thoroughness and clinical practicality. Don't just memorize which tool has how many questions—know what makes each tool appropriate for its target population and setting. When you understand the underlying rationale, you can confidently tackle any scenario-based question thrown your way.


Tools for Older Adults

Geriatric populations face unique nutritional challenges: decreased appetite, social isolation, polypharmacy, and functional decline. These tools are specifically validated for age-related factors that standard adult screens might miss.

Mini Nutritional Assessment (MNA)

  • Gold standard for geriatric nutrition screening—specifically designed and validated for adults 65 and older
  • Two-part structure with a 6-item screening section (MNA-SF) that can stand alone or trigger the full 18-item assessment
  • Multidimensional approach evaluates dietary intake, weight loss, mobility, psychological stress, and cognitive status—capturing the complexity of geriatric malnutrition

Geriatric Nutritional Risk Index (GNRI)

  • Objective laboratory-based tool—combines serum albumin with body weight relative to ideal weight, reducing subjective bias
  • Predictive validity for hospital outcomes including length of stay, complications, and mortality in elderly patients
  • Formula-based scoring using GNRI=(1.489×albumin)+(41.7×actual weightideal weight)GNRI = (1.489 \times albumin) + (41.7 \times \frac{actual\ weight}{ideal\ weight})—requires calculation but provides quantifiable risk stratification

NSI DETERMINE Checklist

  • Self-administered screening tool—designed for older adults to complete independently in community settings
  • Mnemonic-based format covering Disease, Eating poorly, Tooth loss, Economic hardship, Reduced social contact, Multiple medications, Involuntary weight loss, Needs assistance, and Elder years
  • Public health focus promotes awareness and encourages proactive help-seeking rather than clinical diagnosis

Compare: MNA vs. GNRI—both target elderly patients, but MNA uses comprehensive subjective and objective measures while GNRI relies on just two objective parameters (albumin and weight). Choose MNA for thorough initial assessment; use GNRI when you need quick, reproducible data for outcome prediction.


Quick Screens for General Adult Populations

When time is limited and patient volume is high, these tools prioritize speed and simplicity. They sacrifice comprehensiveness for practicality, making them ideal for initial triage across diverse healthcare settings.

Malnutrition Universal Screening Tool (MUST)

  • Three-parameter approach—evaluates BMI, unintentional weight loss over 3-6 months, and acute disease effect on nutritional intake
  • Stepwise scoring system generates low, medium, or high risk categories with corresponding management guidelines
  • Versatility across settings—validated for hospitals, community care, and outpatient clinics, making it one of the most widely adopted tools internationally

Malnutrition Screening Tool (MST)

  • Ultra-brief two-question format—asks only about recent unintentional weight loss and appetite changes
  • High sensitivity despite minimal time investment—takes less than 5 minutes to complete
  • Low barrier to implementation—requires no calculations, measurements, or laboratory values, making it accessible for any staff member to administer

Short Nutritional Assessment Questionnaire (SNAQ)

  • Three focused questions—addresses unintentional weight loss, decreased appetite, and use of nutritional supplements or tube feeding
  • Rapid administration ideal for busy clinical environments where comprehensive screening isn't feasible
  • Action-oriented scoring directly links to intervention recommendations based on risk level

Compare: MUST vs. MST—both are quick adult screening tools, but MUST incorporates BMI and provides more detailed management pathways, while MST's two-question format offers maximum speed with slightly less specificity. If an exam question emphasizes efficiency in high-volume settings, MST is your answer; if it asks about evidence-based management guidance, choose MUST.


Hospital-Specific Tools

Hospitalized patients face acute stressors that compound nutritional risk. These tools incorporate disease severity and clinical parameters that community-based screens don't capture.

Nutritional Risk Screening 2002 (NRS-2002)

  • ESPEN-recommended tool for hospitalized adults—endorsed by the European Society for Clinical Nutrition and Metabolism
  • Dual-component scoring combines nutritional status (BMI, weight loss, food intake) with disease severity to capture how illness amplifies nutritional needs
  • Age adjustment adds one point for patients over 70, acknowledging increased vulnerability in older hospitalized adults

Subjective Global Assessment (SGA)

  • Clinician-administered comprehensive evaluation—integrates patient history with physical examination findings
  • Five key domains assessed: weight change pattern, dietary intake changes, GI symptoms, functional capacity, and physical signs of malnutrition (muscle wasting, fat loss, edema)
  • Three-tier classification rates patients as well-nourished (SGA-A), moderately/suspected malnourished (SGA-B), or severely malnourished (SGA-C)—no numerical score, just clinical judgment

Compare: NRS-2002 vs. SGA—NRS-2002 generates a numerical score ideal for research and standardized protocols, while SGA provides a holistic clinical impression requiring trained assessor judgment. For FRQ questions about tool selection, NRS-2002 fits protocol-driven settings; SGA fits scenarios emphasizing clinical expertise and individualized assessment.


Critical Care and Specialized Populations

Standard screening tools may underperform in extreme clinical situations. These specialized tools address the unique metabolic demands and prognostic factors of ICU patients and pediatric populations.

Nutrition Risk in Critically Ill (NUTRIC) Score

  • ICU-specific design—the only major tool validated specifically for critically ill adult patients
  • Six variables assessed: age, APACHE II score, SOFA score, number of comorbidities, days in hospital before ICU admission, and IL-6 level (when available)
  • Identifies benefit from aggressive nutrition support—high NUTRIC scores predict patients most likely to benefit from early, adequate nutritional intervention

Pediatric Nutritional Risk Score (PNRS)

  • Pediatric-specific parameters—accounts for growth patterns, developmental considerations, and childhood disease presentations
  • Growth-based assessment incorporates weight-for-age, recent weight changes, and underlying conditions affecting nutritional status
  • Guides intervention intensity—helps clinicians prioritize which hospitalized children need immediate dietitian consultation

Compare: NUTRIC vs. NRS-2002 in hospitalized patients—while NRS-2002 works across general hospital populations, NUTRIC specifically predicts which ICU patients will have improved outcomes with nutritional intervention. If the question involves critical illness or mechanical ventilation, NUTRIC is the appropriate choice.


Quick Reference Table

ConceptBest Examples
Geriatric-specific screeningMNA, GNRI, NSI DETERMINE
Rapid adult triageMST, SNAQ, MUST
Hospitalized adult assessmentNRS-2002, SGA, MUST
Critical care populationsNUTRIC Score
Pediatric populationsPNRS
Objective/laboratory-basedGNRI (albumin + weight)
Subjective/clinical judgmentSGA
Self-administered community toolsNSI DETERMINE

Self-Check Questions

  1. A 78-year-old patient is admitted to the hospital. Which two screening tools specifically incorporate age as a factor in their scoring, and how do they handle it differently?

  2. You need to screen 50 outpatients in a busy clinic with minimal staff training available. Compare MST and MUST—which would you choose and why?

  3. What distinguishes SGA from all other tools on this list in terms of how the final assessment is determined?

  4. A critically ill patient has been in the ICU for 5 days. Why would NUTRIC be more appropriate than NRS-2002 for assessing nutritional risk, and what unique information does it provide?

  5. Compare and contrast MNA and GNRI for elderly patients: What types of malnutrition risk factors does MNA capture that GNRI cannot, and when might GNRI's approach be advantageous?