Malnutrition Screening Tools

We know how detrimental malnutrition can be in regards to infection and illness. For hospitalized patients, nutrition status must be carefully monitored to support the recovery process and health of the patients.

Unfortunately, 1 in 3 patients admitted into the hospital are malnourished. These patients are twice as likely to develop a pressure ulcer and three times more likely to develop a surgical site infection. Because malnutrition is so prevalent, it is important that useful tools are being used to diagnose and treat it early to promote health and a quicker recovery. Upon admittance to the hospital, all patients undergo malnutrition screening which is used to identify any sign of malnutrition quickly and accurately. There are multiple screening tools in place.

One of which is the Malnutrition Screening Tool (MST) which is a three question tool assessing recent weight and appetite loss. It identifies malnutrition on a scoring scale (shown to the right) indicating whether the patient is mildly, moderately, or severely malnourished. Another screening tool is the malnutrition Universal Screening Tool (MUST). This was developed to detect malnourishment and obesity in adults and the elderly. The MUST (shown below) produces a score based on BMI, unplanned weight loss, and presence or absence of serious disease.

It gives accurate, reliable results, however, it is not able to be used to assess children due to their variable BMI and rapid growth. The Mini Nutritional Assessment (MNA) was developed specifically for the elderly population. Individuals over 65 years old are assessed through anthropometrics, medical records, lifestyle, dietary intake, and psycho-social factors to determine if they are at risk or suffering from malnutrition. Lastly, the most common assessment for malnutrition is the Subjective Global Assessment (SGA). It is a questionnaire that includes data on weight change, dietary intake change, gastrointestinal symptoms, assessment of fat and muscle stores, along with the presence or absence of edema. Once the test is completed, patients will be classified as well nourished, and mildly, moderately, or severely malnourished. The SGA has become the most common screening tool due to its ability to detect subtle changes, like weight, that can be a red flag for malnourishment.

For more information about these screening tools, please visit this site:

https://www.nestlenutrition-institute.org/Education/practical-tools/Pages/default.aspx

In the event that a patient is deemed at risk or suffering from malnutrition, that patient is referred to a dietitian for further assessment. This is known as The Nutrition Care Process (NCP). It is a four-component procedure to identify, diagnose, treat, and monitor nutritional complications. The first part is Nutrition Assessment. This is a comprehensive approach to defining nutritional status through physical examination, anthropometric measurements, laboratory data, dietary intake, and patient/client personal history. During assessment, the dietitian wants to know all the information that could potentially affect the patient's or client's nutritional status. After assessment, the next stage is Nutrition Diagnosis. During this stage, the dietitian will accurately diagnose their specific nutritional problem with its causes and signs and symptoms through a PES statement. This statement includes standardized language to address the Problem, Etiology, and Signs and Symptoms in order to go about nutrition treatment properly. Once the PES statement is established, the dietitian will progress into the next stage, Nutrition Intervention. During intervention, the dietitian and patient can implement an agreed upon plan to treat the patient and return their health status to normal. The dietitian will follow up with an evaluation of their treatment plan and identify if a different plan must be implemented or, the dietitian will encourage the patient to continue with the current plan if they are making progress with it. This stage is known as nutrition Monitoring and Evaluation. If the plan needs to be altered, the Nutrition Care Process cycles back through and is repeated as necessary.