Nutritional Risk Screening and Assessment

Emilie Reber, Filomena Gomes, Maria F Vasiloglou, Philipp Schuetz, Zeno Stanga, Emilie Reber, Filomena Gomes, Maria F Vasiloglou, Philipp Schuetz, Zeno Stanga

Abstract

Malnutrition is an independent risk factor that negatively influences patients' clinical outcomes, quality of life, body function, and autonomy. Early identification of patients at risk of malnutrition or who are malnourished is crucial in order to start a timely and adequate nutritional support. Nutritional risk screening, a simple and rapid first-line tool to detect patients at risk of malnutrition, should be performed systematically in patients at hospital admission. Patients with nutritional risk should subsequently undergo a more detailed nutritional assessment to identify and quantify specific nutritional problems. Such an assessment includes subjective and objective parameters such as medical history, current and past dietary intake (including energy and protein balance), physical examination and anthropometric measurements, functional and mental assessment, quality of life, medications, and laboratory values. Nutritional care plans should be developed in a multidisciplinary approach, and implemented to maintain and improve patients' nutritional condition. Standardized nutritional management including systematic risk screening and assessment may also contribute to reduced healthcare costs. Adequate and timely implementation of nutritional support has been linked with favorable outcomes such as a decrease in length of hospital stay, reduced mortality, and reductions in the rate of severe complications, as well as improvements in quality of life and functional status. The aim of this review article is to provide a comprehensive overview of nutritional screening and assessment methods that can contribute to an effective and well-structured nutritional management (process cascade) of hospitalized patients.

Keywords: malnutrition; nutritional assessment; nutritional risk screening.

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Compartment models of body composition. FFM: fat-free mass, FM: fat mass, BCM: body cell mass, ECM: extracellular cell mass. Modified after [40].

References

    1. Sorensen J., Kondrup J., Prokopowicz J., Schiesser M., Krahenbuhl L., Meier R., Liberda M., EuroOOPS Study Group EuroOOPS: An international, multicentre study to implement nutritional risk screening and evaluate clinical outcome. Clin. Nutr. 2008;27:340–349. doi: 10.1016/j.clnu.2008.03.012.
    1. Dupertuis Y.M., Kossovsky M.P., Kyle U.G., Raguso C.A., Genton L., Pichard C. Food intake in 1707 hospitalised patients: A prospective comprehensive hospital survey. Clin. Nutr. 2003;22:115–123. doi: 10.1054/clnu.2002.0623.
    1. Schwegler I., von Holzen A., Gutzwiller J.P., Schlumpf R., Muhlebach S., Stanga Z. Nutritional risk is a clinical predictor of postoperative mortality and morbidity in surgery for colorectal cancer. Br. J. Surg. 2010;97:92–97. doi: 10.1002/bjs.6805.
    1. Sun Z., Kong X.J., Jing X., Deng R.J., Tian Z.B. Nutritional Risk Screening 2002 as a predictor of postoperative outcomes in patients undergoing abdominal surgery: A systematic review and meta-analysis of prospective cohort studies. PLoS ONE. 2015;10:e0132857. doi: 10.1371/journal.pone.0132857.
    1. Imoberdorf R., Meier R., Krebs P., Hangartner P.J., Hess B., Staubli M., Wegmann D., Rühlin M., Ballmer P.E. Prevalence of undernutrition on admission to Swiss hospitals. Clin. Nutr. 2010;29:38–41. doi: 10.1016/j.clnu.2009.06.005.
    1. Studley H.O. Percentage of weight loss: A basic indicator of surgical risk in patients with chronic peptic ulcer. 1936. Nutr Hosp. 2001;16:141–143.
    1. Meguid M.M., Debonis D., Meguid V., Hill L.R., Terz J.J. Complications of abdominal operations for malignant disease. Am. J. Surg. 1988;156:341–345. doi: 10.1016/S0002-9610(88)80182-X.
    1. Pikul J., Sharpe M.D., Lowndes R., Ghent C.N. Degree of preoperative malnutrition is predictive of postoperative morbidity and mortality in liver transplant recipients. Transplantation. 1994;57:469–472. doi: 10.1097/00007890-199402150-00030.
    1. Soeters P.B., Schols A.M. Advances in understanding and assessing malnutrition. Curr. Opin. Clin. Nutr. Metab. Care. 2009;12:487–494. doi: 10.1097/MCO.0b013e32832da243.
    1. Guo W., Ou G., Li X., Huang J., Liu J., Wei H. Screening of the nutritional risk of patients with gastric carcinoma before operation by NRS 2002 and its relationship with postoperative results. J. Gastroenterol. Hepatol. 2010;25:800–803. doi: 10.1111/j.1440-1746.2009.06198.x.
    1. Lieffers J.R., Bathe O.F., Fassbender K., Winget M., Baracos V.E. Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery. Br. J. Cancer. 2012;107:931–936. doi: 10.1038/bjc.2012.350.
    1. Schiesser M., Kirchhoff P., Muller M.K., Schafer M., Clavien P.A. The correlation of nutrition risk index, nutrition risk score, and bioimpedance analysis with postoperative complications in patients undergoing gastrointestinal surgery. Surgery. 2009;145:519–526. doi: 10.1016/j.surg.2009.02.001.
    1. Schiesser M., Muller S., Kirchhoff P., Breitenstein S., Schafer M., Clavien P.A. Assessment of a novel screening score for nutritional risk in predicting complications in gastro-intestinal surgery. Clin. Nutr. 2008;27:565–570. doi: 10.1016/j.clnu.2008.01.010.
    1. Sungurtekin H., Sungurtekin U., Balci C., Zencir M., Erdem E. The influence of nutritional status on complications after major intraabdominal surgery. J. Am. Coll. Nutr. 2004;23:227–232. doi: 10.1080/07315724.2004.10719365.
    1. Donini L.M., Savina C., Rosano A., Cannella C. Systematic review of nutritional status evaluation and screening tools in the elderly. J. Nutr. Health. Aging. 2007;11:421–432.
    1. Foley N.C., Salter K.L., Robertson J., Teasell R.W., Woodbury M.G. Which reported estimate of the prevalence of malnutrition after stroke is valid? Stroke. 2009;40:E66–E74. doi: 10.1161/STROKEAHA.108.518910.
    1. Bauer J.M., Kaiser M.J., Sieber C.C. Evaluation of nutritional status in older persons: Nutritional screening and assessment. Curr. Opin. Clin. Nutr. Metab. Care. 2010;13:8–13. doi: 10.1097/MCO.0b013e32833320e3.
    1. Schindler K., Pernicka E., Laviano A., Howard P., Schutz T., Bauer P., Grecu I., Jonkers C., Kondrup J., Ljungqvist O., et al. How nutritional risk is assessed and managed in European hospitals: A survey of 21,007 patients findings from the 2007–2008 cross-sectional nutritionDay survey. Clin. Nutr. 2010;29:552–559. doi: 10.1016/j.clnu.2010.04.001.
    1. Van Bokhorst-de van der Schueren M.A.E., Guaitoli P.R., Jansma E.P., de Vet H.C.W. Nutrition screening tools: Does one size fit all? A systematic review of screening tools for the hospital setting. Clin. Nutr. 2014;33:39–58. doi: 10.1016/j.clnu.2013.04.008.
    1. Kondrup J., Allison S.P., Elia M., Vellas B., Plauth M. ESPEN guidelines for nutrition screening 2002. Clin. Nutr. 2003;22:415–421. doi: 10.1016/S0261-5614(03)00098-0.
    1. Kondrup J., Rasmussen H.H., Hamberg O., Stanga Z. Nutritional risk screening (NRS 2002): A new method based on an analysis of controlled clinical trials. Clin. Nutr. 2003;22:321–336. doi: 10.1016/S0261-5614(02)00214-5.
    1. Schuetz P., Fehr R., Baechli V., Geiser M., Gomes F., Kutz A., Tribolet P., Bregenzer T., Braun N., Hoess C., et al. Individualized nutritional support in medical inpatients at nutritional risk: A randomized clinical trial. Lancet. 2019;393:2312–2321. doi: 10.1016/S0140-6736(18)32776-4.
    1. Weekes C.E., Elia M., Emery P.W. The development, validation and reliability of a nutrition screening tool based on the recommendations of the British, Association for Parenteral and Enteral Nutrition (BAPEN) Clin. Nutr. 2004;23:1104–1112.
    1. Anthony P.S. Nutrition screening tools for hospitalized patients. Nutr. Clin. Pract. 2008;23:373–382. doi: 10.1177/0884533608321130.
    1. Raslan M., Gonzalez M.C., Dias M.C., Nascimento M., Castro M., Marques P., Segatto S., Torrinhas R.S., Cecconello I., Waitzberg D.L., et al. Comparison of nutritional risk screening tools for predicting clinical outcomes in hospitalized patients. Nutrition. 2010;26:721–726. doi: 10.1016/j.nut.2009.07.010.
    1. Charney P. Nutrition screening vs. nutrition assessment: How do they differ? Nutr. Clin. Pract. 2008;23:366–372. doi: 10.1177/0884533608321131.
    1. Detsky A.S., McLaughlin J.R., Baker J.P., Johnston N., Whittaker S., Mendelson R.A., Jeejeebhoy K.N. What is subjective global assessment of nutritional status? 1987. Classical article. Nutr. Hosp. 2008;23:400–407.
    1. Koom W.S., Ahn S.D., Song S.Y., Lee C.G., Moon S.H., Chie E.K., et al. Nutritional status of patients treated with radiotherapy as determined by subjective global assessment. Radiat. Oncol. J. 2012;30:132–139. doi: 10.3857/roj.2012.30.3.132.
    1. National Kidney Foundation KDOQI Clinical Practice Guidelines for Nutrition in Chronic Renal Failure 2000. [(accessed on 24 June 2019)]; Available online: .
    1. British Dietetic Association . Parenteral and Enteral Nutrition Group. A Pocket Guide to Clinical Nutrition. 4th ed. Parenteral and Enteral Nutrition Group of the British Dietetic Association; Birmingham, UK: 2011.
    1. Han T.S., Lean M.E. Lower leg length as an index of stature in adults. Int. J. Obes. Relat. Metab. Disord. 1996;20:21–27.
    1. Reeves S.L., Varakamin C., Henry C.J. The relationship between arm-span measurement and height with special reference to gender and ethnicity. Eur. J. Clin. Nutr. 1996;50:398–400.
    1. Maastricht UMC+ Nutritional Assessment Body Composition Skinfold Measurements 2019. [(accessed on 12 July 2019)]; Available online: .
    1. Bosy-Westphal A., Kromeyer-Hausschild K., Pirlich M., Schlattmann A., Scholz G. Body composition analysis—What can be measured with practical value? Aktuel Ernahrungsmed. 2004;1:189–195.
    1. Kyle U., Bosaeus I., De Lorenzo A., Deurenberg P., Elia M., Gomez J., Heitmann B.L., Kent-Smith L., Melchior J.C., Pirlich M., et al. Bioelectrical impedance analysis—Part I: Review of principles and methods. Clin. Nutr. 2004;23:1226–1243. doi: 10.1016/j.clnu.2004.06.004.
    1. Kyle U., Bosaeus I., De Lorenzo A., Deurenberg P., Elia M., Manuel Gomez J., Lilienthal Heitmann B., Kent-Smith L., Melchior J.C., Pirlich M., et al. Bioelectrical impedance analysis—Part II: Utilization in clinical practice. Clin. Nutr. 2004;23:1430–1453. doi: 10.1016/j.clnu.2004.09.012.
    1. Forbes G.B., Bruining G.J. Urinary creatinine excretion and lean body mass. Am. J. Clin. Nutr. 1976;29:1359–1366. doi: 10.1093/ajcn/29.12.1359.
    1. Stratton R.J., Green C.J., Elia M. Disease-Related Malnutrition: An Evidence-Based Approach to Treatment. CABI Publishing; Wallingford, UK: 2003.
    1. MacDonald A.J., Greig C.A., Baracos V. The advantages and limitations of cross-sectional body composition analysis. Curr. Opin. Support Palliat. Care. 2011;5:342–349. doi: 10.1097/SPC.0b013e32834c49eb.
    1. Pirlich M., Norman K. Bestimmung des Ernährungszustands (inkl. Bestimmung der Körperzusammensetzung und ernährungsmedizinisches Screening) in Biesalski, rnährungsmedizin. Georg Thieme Verlag KG; Stuttgart, Germany: 2018.
    1. Leuenberger M.S., Joray M.L., Kurmann S., Stanga Z. How to assess the nutritional status of my patient. Praxis (Bern 1994) 2012;101:307–315. doi: 10.1024/1661-8157/a000857.
    1. Esper D.H. Utilization of nutrition-focused physical assessment in identifying micronutrient deficiencies. Nutr. Clin. Pract. 2015;30:194–202. doi: 10.1177/0884533615573054.
    1. Norman K., Stobaus N., Gonzalez M.C., Schulzke J.D., Pirlich M. Hand grip strength: Outcome predictor and marker of nutritional status. Clin. Nutr. 2011;30:135–142. doi: 10.1016/j.clnu.2010.09.010.
    1. Studenski S., Perera S., Wallace D., Chandler J.M., Duncan P.W., Rooney E., Fox M., Guralnik J.M. Physical performance measures in the clinical setting. J. Am. Geriatr. Soc. 2003;51:314–322. doi: 10.1046/j.1532-5415.2003.51104.x.
    1. Food and Agriculture Organization of the United Nations . Dietary Assessment: A Resource Guide to Method Selection and Application in Low Resource Settings. Food and Agriculture Organization of the United Nations; Rome, Italy: 2018.
    1. Forster H., Walsh M.C., Gibney M.J., Brennan L., Gibney E.R. Personalised nutrition: The role of new dietary assessment methods. Proc. Nutr. Soc. 2016;75:96–105. doi: 10.1017/S0029665115002086.
    1. Gemming L., Utter J., Ni Mhurchu C. Image-assisted dietary assessment: A systematic review of the evidence. J. Acad. Nutr. Diet. 2015;115:64–77. doi: 10.1016/j.jand.2014.09.015.
    1. Illner A.K., Freisling H., Boeing H., Huybrechts I., Crispim S.P., Slimani N. Review and evaluation of innovative technologies for measuring diet in nutritional epidemiology. Int. J. Epidemiol. 2012;41:1187–1203. doi: 10.1093/ije/dys105.
    1. Stumbo P.J. New technology in dietary assessment: A review of digital methods in improving food record accuracy. Proc. Nutr. Soc. 2013;72:70–76. doi: 10.1017/S0029665112002911.
    1. Archundia Herrera M.C., Chan C.B. Narrative Review of New Methods for Assessing Food and Energy Intake. Nutrients. 2018;10:1064. doi: 10.3390/nu10081064.
    1. Martin C.K., Correa J.B., Han H., Allen H.R., Rood J.C., Champagne C.M., Gunturk B.K., Bray G.A. Validity of the Remote Food Photography Method (RFPM) for estimating energy and nutrient intake in near real-time. Obesity (Silver Spring) 2012;20:891–899. doi: 10.1038/oby.2011.344.
    1. Dong Y., Hoover A., Scisco J., Muth E. A new method for measuring meal intake in humans via automated wrist motion tracking. Appl Psychophysiol. Biofeedback. 2012;37:205–215. doi: 10.1007/s10484-012-9194-1.
    1. Kawano Y., Yanai K. FoodCam: A real-time food recognition system on a smartphone. Multimed. Tool. Appl. 2015;74:5263–5287. doi: 10.1007/s11042-014-2000-8.
    1. Anthimopoulos M., Dehais J., Shevchik S., Ransford B.H., Duke D., Diem P., Mougiakakou S. Computer vision-based carbohydrate estimation for type 1 patients with diabetes using smartphones. J. Diabetes Sci. Technol. 2015;9:507–515. doi: 10.1177/1932296815580159.
    1. Bally L., Dehais J., Nakas C.T., Anthimopoulos M., Laimer M., Rhyner D., Rosenberg G., Zueger T., Diem P., Mougiakakou S., et al. Carbohydrate Estimation Supported by the GoCARB System in Individuals With Type 1 Diabetes: A Randomized Prospective Pilot Study. Diabetes Care. 2017;40:e6–e7. doi: 10.2337/dc16-2173.
    1. Dehais J., Anthimopoulos M., Shevchik S., Mougiakakou S. Two-view 3D reconstruction for food volume estimation. IEEE Trans. Multimed. 2017;19:1090–1099. doi: 10.1109/TMM.2016.2642792.
    1. Rhyner D., Loher H., Dehais J., Anthimopoulos M., Shevchik S., Botwey R.H., Duke D., Stettler C., Diem P., Mougiakakou S., et al. Carbohydrate Estimation by a Mobile Phone-Based System Versus Self-Estimations of Individuals With Type 1 Diabetes Mellitus: A Comparative Study. J. Med. Int. Res. 2016;18:e101. doi: 10.2196/jmir.5567.
    1. Vasiloglou M.F., Mougiakakou S., Aubry E., Bokelmann A., Fricker R., Gomes F., Guntermann C., Meyer A., Studerus D., Stanga Z. A Comparative Study on Carbohydrate Estimation: GoCARB vs. Dietitians. Nutrients. 2018;10:741. doi: 10.3390/nu10060741.
    1. Ambrosini G.L., Hurworth M., Giglia R., Trapp G., Strauss P. Feasibility of a commercial smartphone application for dietary assessment in epidemiological research and comparison with 24-h dietary recalls. Nutr. J. 2018;17:5. doi: 10.1186/s12937-018-0315-4.
    1. Bucher Della Torre S., Carrard I., Farina E., Danuser B., Kruseman M. Development and Evaluation of e-CA, an Electronic Mobile-Based Food Record. Nutrients. 2017;9:76
    1. Bejar L.M., Sharp B.N., Garcia-Perea M.D. The e-EPIDEMIOLOGY Mobile Phone App for Dietary Intake Assessment: Comparison with a Food Frequency Questionnaire. JMIR Res. Protoc. 2016;5:e208. doi: 10.2196/resprot.5782.
    1. Poslusna K., Ruprich J., de Vries J.H., Jakubikova M., van’t Veer P. Misreporting of energy and micronutrient intake estimated by food records and 24 hour recalls, control and adjustment methods in practice. Br. J. Nutr. 2009;101:S73–85. doi: 10.1017/S0007114509990602.
    1. Beasley J., Riley W.T., Jean-Mary J. Accuracy of a PDA-based dietary assessment program. Nutrition. 2005;21:672–677. doi: 10.1016/j.nut.2004.11.006.
    1. Casperson S.L., Sieling J., Moon J., Johnson L., Roemmich J.N., Whigham L. A mobile phone food record app to digitally capture dietary intake for adolescents in a free-living environment: Usability study. JMIR Mhealth Uhealth. 2015;3:e30. doi: 10.2196/mhealth.3324.
    1. Ashman A.M., Collins C.E., Brown L.J., Rae K.M., Rollo M.E. Validation of a Smartphone Image-Based Dietary Assessment Method for Pregnant Women. Nutrients. 2017;9:73. doi: 10.3390/nu9010073.
    1. Recio-Rodriguez J.I., Rodriguez-Martin C., Gonzalez-Sanchez J., Rodriguez-Sanchez E., Martin-Borras C., Martinez-Vizcaino V., Arietaleanizbeaskoa M.S., Magdalena-Gonzalez O., Fernandez-Alonso C., Maderuelo-Fernandez J.A., et al. EVIDENT Smartphone App, a New Method for the Dietary Record: Comparison With a Food Frequency Questionnaire. JMIR Mhealth Uhealth. 2019;7:e11463. doi: 10.2196/11463.
    1. Carter M.C., Burley V.J., Nykjaer C., Cade J.E. ‘My Meal Mate’ (MMM): Validation of the diet measures captured on a smartphone application to facilitate weight loss. Br. J. Nutr. 2013;109:539–546. doi: 10.1017/S0007114512001353.
    1. Conrad J., Nothlings U. Innovative approaches to estimate individual usual dietary intake in large-scale epidemiological studies. Proc. Nutr. Soc. 2017;76:213–219. doi: 10.1017/S0029665116003025.
    1. Lemacks J.L., Adams K., Lovetere A. Dietary Intake Reporting Accuracy of the Bridge2U Mobile Application Food Log Compared to Control Meal and Dietary Recall Methods. Nutrients. 2019;11:199. doi: 10.3390/nu11010199.
    1. Harris J.A., Benedict F.G. A Biometric Study of Human Basal Metabolism. Proc. Natl. Acad. Sci. USA. 1918;4:370–373. doi: 10.1073/pnas.4.12.370.
    1. Druml W., Jadrna K. Recommendations for Enteral and Parenteral Nutrition in Adults. Austrian Society of Clinical Nutrition (AKE); Vienna, Austria: 2008. English Edition/Pocket Version.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit