intro

• Nutrition screening


  The process of identifying patients, clients, or groups who may have a nutrition diagnosis and benefit from nutrition assessment and intervention by a registered dietitian nutritionist (RDN)
• Nutrition screening

  • It is a supportive task, which relies on tools that are quick and easy to use (<10 minutes to complete) and that require minimal training
  • The use of valid and reliable tools are important to avoid under-referral of patients or clients with malnutrition or over-referral of patients or clients without malnutrition
• Tools for identifying risk for malnutrition (undernutrition) with sufficient evidence for evaluation

  • Malnutrition Screening Tool (MST)
  • Malnutrition Universal Screening Tool (MUST)
  • Mini Nutrition Assessment – Short Form (MNA-SF)
  • Short Nutritional Assessment Questionnaire (SNAQ)
  • Mini Nutrition Assessment-Short Form-Body Mass Index (MNA-SF-BMI)
  • Nutrition Risk Screening (NRS-2002)
• Nutrition screening for pediatrics

  Nutrition screening exists as an important precursor to dietitian notification that a nutrition problem may exist, thus sending a patient into the first step of the Nutrition Care Process
• Pediatric nutrition screening tools to identify risk of malnutrition related to under- or over-nutrition

  • Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP)
  • Screening Tool for Risk on Nutritional status and Growth (STRONGkids)
  • Paediatric Yorkhill Malnutrition Score (PYMS)
• Nutrition assessment

  The interpretation of anthropometric, biochemical (laboratory), clinical and dietary data to determine whether a person or groups of people are well-nourished or malnourished (over-nourished or under-nourished)
• In research, nutrition assessments are important to determine the nutrition status of a community
• Nutrition Focused Physical Exam (NFPE)

  Includes detection of signs & symptoms of malnutrition
• Nutrition Focused Physical Exam (NFPE)


  • Provides physical factors that may impact the patient's ability to ingest or digest foods & fluids
  • Provides visual & physical signs of nutrition-related problems, including malnutrition & nutrient deficiencies
  • Dietitian is UNIQUELY TRAINED to identify & manage via intervention and/or referral
• Malnutrition identification tools

  • Subjective Global Assessment (SGA)
  • GLIM
  • Academy/ASPEN Malnutrition Framework
  • Malnutrition Screening Tool (MST)
  • Mini Nutritional Assessment (MNA); MNA-SF
  • ESPEN Consensus Statement
• Subjective Global Assessment (SGA)

  A diagnostic tool to differentiate between well-nourished, moderately (or at risk of being) malnourished, and severely malnourished individuals
• 2012 Academy/A.S.P.E.N. Consensus Statement on Adult Malnutrition


  • A diagnosis of malnutrition may be based on the presence of at least 2 of the following:
  • weight loss
  • inadequate energy intake
  • fluid accumulation (marker of inflammation)
  • loss in fat stores, loss in muscle stores
  • reduced functional status as measured by hand grip strength
• The 2012 Academy/A.S.P.E.N. Consensus Criteria

  • requires an alert patient or caregiver to provide accurate history
  • documentation of muscle, fat, and fluid require conduct of nutrition-focused physical exam (NFPE)
  • Micronutrient deficiencies are not captured
  • Not a complete NFPE
  • Need validation in different region and setting
• GLIM Phenotypic Criteria


  • Weight loss>5% within 6 months or >10% >6 months
  • Low BMI<20 if <70 years; <22 if >70 year (Asia: <18.5 if <70 years; <20 if >70 years)
  • Reduced muscle mass according to body composition assessment techniques
• GLIM Etiologic Criteria


  • Reduced food intake/assimilation<50% estimated needs for >1 week or any reduction for >2 weeks or any chronic gastrointestinal issue that could impact absorption or metabolism (i.e. Crohn's disease)
  • Inflammation - any disease/injury or chronic disease state
• Mini Nutritional Assessment (MNA)

  A validated screening tool for identifying malnutrition & risk of malnutrition in adults aged 65 years and older, useful in both inpatient and outpatient settings
• Versions of the MNA

  • MNA-SF (short form): a 6-item nutrition screening form
  • Full MNA: an 18-item nutrition screening and assessment form
  • Self MNA: a 6-item nutrition screening form designed for use by patients and their caregivers
• Nutrition Care Process (NCP)


  Designed to improve the consistency and quality of individualized care for patients/clients or groups and the predictability of the patient/client outcomes. It has four steps: Nutrition Assessment, Nutrition Diagnosis, Nutrition Intervention, and Nutrition Monitoring and Evaluation.
• NFPE :

  • detect sign and symptom of malnutrition
  • conduct physical exam
  • use information gathered from medical record
  • provide physical factor that affect patient's ability to ingest food and fluid
  • provide visual and physical sign of nutrition related problem
• NFPE reveal :

  • fluid status for edema and hydration
  • fat and muscle store
  • malnutrition
  • loss strength or functional ability
  • sign and symptom micronutrient deficiency
• NFPE :

  • orofacial
  • cranial nerve and dysphagia screening
  • dermatologic
  • fat and muscle exam
  • asses edema