Food science and Nutrition

1. CLINICAL
ASSESSMENT TOOLS
IN HOSPITALS
Ms. NIRUPAMA MAHANTA, MSc
(FOOD SCIENCE & NUTRITION)

2. CLINICAL ASSESSMENT :
 Nutritional assessment has been defined by the American
society of enteral and parenteral nutrition (ASPEN) as “a
comprehensive approach to diagnosing nutrition problems that
uses a combination of the following: medical, nutrition and
medication histories; physical examination; anthropometric
measurements and laboratory data.”
 It is a continuous, nonlinear and dynamic procedure that includes initial data gathering as well as
recurrent reassessment and analysis of the individual’s status compared to identified standards.
 It not only identifies risks but also measures the effectiveness of treatment.
 The purpose of a nutritional assessment is to acquire, validate and interpret data needed to
identify nutrition related problems, their root causes and the relevance to overall health status

3. COMPONENTS OF NUTRITIONAL
ASSESSMENT :
•Anthropometric measurements
•Biochemical analysis
•Clinical evaluation
•Dietary history

4. GOALS OF NUTRITIONALASSESSMENT :
to identify those who require aggressive nutritional
support to restore or maintain nutritional status.
to identify appropriate medical nutrition therapies
to monitor their efficacy
to design nutrition care plans

5. NUTRITIONALASSESSMENT TOOLS:
The most commonly used nutritional assessment tools
in hospitals include:
 MNA
 MUST
 SGA
 NRS-2002
 MST

6. MNA
 Mini nutritional assessment
 Designed to provide a rapid assessment of the nutritional status of frail elderly people in order to facilitate
nutrition intervention.
 It is composed of simple measurements and brief questions that can be completed in about 10 min
 The revised MNA-SF is a short form of the MNA that takes less than 5 minutes to complete.
 Currently, the MNA-SF is the preferred form of the MNA for clinical practice in community, hospital, or long-
term care settings, due to its ease of use and practicality.
 MNA consists of 18 self-reported questions derived from the four parameters of assessment: anthropometric,
general, diet and food history and self-assessment.
 The screen is performed as a two-step process. The MNA-SF can be completed as a first step screening tool to
determine if further evaluation is needed. The first six items on the MNA makes op the MNA-SF(part 1-
screening). If the MNA-SF shows the individual to be at nutritional risk, then the full MNA (part 2 – assessment)
can be completed.

8. MUST
 Malnutrition universal screening tool
 The MUST is a five-step tool to identify adults
who are malnourished, at risk of malnutrition or
obese.
 It can be used in healthcare settings as well as in
the community.

9. SGA
 Subjective global assessment
 SGA is a valid assessment tool in older adults, clinical and surgical hospital patients,
rehabilitation centre patients, critical care patients and children
 The tool involves evaluating five components of a patient’s medical history (weight status and
dietary intake changes, gastrointestinal symptoms, functional capacity and metabolic stress
from disease) and three components of physical examination (muscle wasting, fat depletion and
nutrition related oedema)
 To make the SGA more sensitive in detecting small changes in nutrition status, the tool was
expanded to a seven-point scale.
 Patient generated subjective global assessment (PG-SGA) – specifically designed for patients
with cancer.

11. NRS - 2002
 Nutritional Risk Screening
 The purpose of the NRS-2002 system is to detect the presence of undernutrition and the risk of
developing undernutrition in the hospital setting.
 This tool includes an assessment of recent weight loss (%), food intake or eating problems, BMI,
severity of disease, and age.
 Score 0-3 for each parameter
 Total score: >3 = start nutrition support

12. MST
 The MST is a validated tool to
screen patients for risk of
malnutrition. The tool is
suitable for a residential aged
care facility or for adults in
the inpatient/outpatient
hospital setting.
 Nutrition screen parameters
include weight loss and
appetite.
 Total score ≥2 = at risk for
malnutrition

13. REVIEW ARTICLE 1: Comparison of tools for nutritional assessment and screening at
hospital admission: A population study
This study aimed to test the sensitivity and specificity of nutritional risk index
(NRI), malnutrition universal screening tool (MUST) and nutritional risk screening tool 2002 (NRS-
2002) compared to subjective global assessment (SGA). Sensitivity, specificity and predictive values
were calculated to evaluate NRI, MUST and NRS-2002 compared to SGA. The sensitivity was 62%, 61%
and 43% and specificity was 93%, 76% and 89% with the NRS-2002, MUST and NRI, respectively.
NRS-2002 had higher sensitivity and specificity than the MUST and NRI, compared to SGA.

14. REVIEW ARTICLE 2 : Comparison of five malnutrition screening tools in one hospital inpatient
sample
Neelemaat, Floor & Meijers, Judith & Kruizenga, Hinke & Van Ballegooijen, Hanne & De van der
Schueren, Marian A.E.. (2011). Comparison of five malnutrition screening tools in one hospital inpatient
sample. Journal of clinical nursing. 20. 2144-52. 10.1111/j.1365-2702.2010.03667.x.
The study compares five commonly used malnutrition screening tools against an acknowledged definition of
malnutrition(low BMI and unintentional weight loss) in one hospital inpatient sample. They compared quick-and
easy screening tools [Malnutrition Screening Tool (MST), Short Nutritional Assessment Questionnaire (SNAQ) and
Mini-Nutritional Assessment Short Form (MNA-SF)] and more comprehensive malnutrition screening tools
[Malnutrition Universal Screening Tool (MUST) and Nutritional Risk Screening 2002 (NRS-2002)]. Sensitivity,
specificity, positive predictive value and negative predictive value were determined. A sensitivity and specificity
of ≥70% was set as a prerequisite for adequate performance of a screening tool. The MNA-SF showed excellent
sensitivity, but poor specificity for the older subpopulation, hence should not be applied to hospital inpatients. The
quick-and-easy malnutrition screening tools (MST and SNAQ) are suitable for use in an hospital inpatient setting.

15. REFERENCES:
1. Bruce R.Bistrian.(2012). Nutritional assessment. Goldman's Cecil Medicine. 24(2):1384-1388
https://www.sciencedirect.com/science/article/pii/B9781437716047002219
2. Neelemaat F, Meijers J, Kruizenga H, Ballegooijen H, Bokhorstde M, Schueren V.(2011). Comparison of five malnutrition screening
tools in one hospital inpatient sample. Journal of Clinical Nursing
3. Malnutrition screening tools. National council on aging. Retrieved from https://www.ncoa.org/center-for-healthy-
aging/resourcehub/community-orgs-and-professionals/professional-resources/malnutrition-screening-tools/
4. Ursula G. kyle, Kossovsky M, Karsegard V, Pichard C.(2006). Comparison of tools for nutritional assessment and screening at hospital
admission: A population study. Clinical nutrition. 25(3): 409-417
https://www.clinicalnutritionjournal.com/article/S0261-5614(05)00208-6/fulltext
5.Vellas B, Guigoz Y, Garry PJ, Nourhashemi F, Bennahum D, Lauque S , Albarede JL.(1999). The Mini Nutritional Assessment (MNA)
and its use in grading the nutritional state of elderly patients. Nutrition. 15(2):116-22.
https://www.ncbi.nlm.nih.gov/pubmed/9990575
6. Paul Insel, Don Ross, Kimberley McMahon, Melissa Bernstein. Nutrition(5th edition)
7. L. Kathleen Mahan, Sylvia Escott Stump. Krause’s Food Nutrition & Diet therapy(9th edition)