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1. Nutritional Assessment
• Nutritional assessment is a formal assessment of the nutritional status of a patient by a
trained healthcare professional usually a dietician, and results in nutrition-related
diagnosis.
• Once a patient is identified as at risk from the screening tools detailed, nutritional
assessment should be performed.
• Indian Society of Critical Care Medicine (ISCCM) practice guidelines for nutrition in
critically ill patients recommend the nutritional assessment by Subjective Global
Assessment (SGA).
• Assessment by anthropometry like body mass index (BMI) is difficult to measure in
critical care setting.
• Measurement of serum albumin, transferrin, and prealbumin is not reliable in critically ill
patients

2. Subjective Global Assessment (SGA)
• Subjective Global Assessment (SGA) is a method for evaluating
nutritional status based on a practitioner's clinical judgment rather
than objective, quantitative measurements.
• SGA is a semi-quantitative tool to assess nutritional status based on the
history and physical examination.
• It is a subjective nutritional assessment tool initially developed for post-
gastrointestinal surgery patients.
The tool was later studied in critically ill patients.
• The SGA scale includes parameters to assess subcutaneous fat, muscle
wasting, fluid retention, weight change, recent food intake,
gastrointestinal symptoms, and functional capacity.

3. • Subjective Global Assessment class C includes severe malnutrition, SGA
class B includes moderate malnutrition, and SGA class A includes no
malnutrition..
• Besides the subjective assessment, it is also important to assess the
gastrointestinal tract with gastric residual volumes to assess the
nutritional status in critically ill patients.
• It is simple, non invasive, inexpensive, and quickly executable and can
be performed bedside by any skilled and trained health-care professional
after brief training.
• It helps in identifying malnutrition, predicting outcomes, and making
appropriate recommendations in hospitalized patients as well as in general
population.

4. • SGA has been used for malnutrition screening in a wide variety of health-
care settings, including transplantation, geriatric care, radiotherapy,
chronic liver disease, stroke, and pregnancy
• Although the SGA scores are determined in a subjective manner, it is the
only screening tool recommended in Clinical setting by the American
Society for Parenteral and Enteral Nutrition (ASPEN)

5. SGA form
Refer SGAAssessment Guide pdf for scoring**

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7. Mini Nutritional Assessment (MNA)
• The Mini Nutritional Assessment (MNA) has recently been
designed and validated to provide a single, rapid assessment of
nutritional status in elderly patients in outpatient clinics,
hospitals, and nursing homes.
• Validation studies demonstrated the strong capacity of the
MNA to reflect the nutritional status and the risk of
malnutrition in the older adult.
• A strong correlation between the MNA and biochemical
parameters was shown, particularly with albumin (p < 0.0001).

9. Mini Nutritional Assessment – Complete Form (MNA CF)
The Full MNA consists of 18 easily measurable items classified
into four categories:
1. Anthropometric measurements (4 questions on weight, height
and weight loss)
2. Dietary questionnaire (6 questions related to number of meals,
food and fluid intake, autonomy of feeding)
3. Global assessment (6 questions related to lifestyle, medication
and mobility)
4. Subjective assessment (2 questions on self-perception of health
and nutrition)

10. When to go for Complete form MNA?
 If the total score is 11 or less (from MNA SF), the patient is
considered at a risk of malnutrition / malnourished and hence
full form MNA should be performed.
(Refer the MNA complete form pdf for the form )

11. Mini Nutritional Assessment – Short Form (MNA-SF)
• The MNA-SF is a screening tool to help identify elderly patients
who are malnourished or at risk of malnutrition either in the
hospital or community setting, therefore MNA-SF allows
clinicians to intervene earlier to provide adequate nutritional
support, prevent further deterioration, and improve patient
outcomes.
• It identifies the risk of malnutrition before severe changes in
weight or serum protein levels occur.
• It is recommended to be done annually in the community, and
every 3 months in the hospital or long term care or with a
change in clinical condition

13. Note:
• In the elderly, weight and height are important because they
correlate with morbidity and mortality.
• Weight and height measurements are often available in the patient
record, and should be used as a priority.
• Only when unavailable, Calf Circumference (CC) can be used
instead of BMI.
(Refer Detailed MNA- SF pdf for the form)

15. ‘Malnutrition Universal Screening Tool’ (MUST)
• ‘MUST’ is a five-step screening tool to identify adults, who are
malnourished, at risk of malnutrition (undernutrition), or obese.
• It considers body mass index, weight change and acute disease
effect equally and determines a malnutrition risk score.
• It also includes management guidelines which can be used to
develop a care plan.
• It is for use in hospitals, community and other care settings and
can be used by all care workers.

16. This guide contains:
• A flow chart showing the 5 steps to use for screening and
management
• BMI chart
• Weight loss tables
• Alternative measurements when BMI cannot be obtained by
measuring weight and height.
(Refer MUST assessment pdf)

17. OTHER TOOLS
NRS 2002
(Refer NRS 2002
scoring guide pdf).