Nutritional Risk Screening | Clinical Nutrition LAM Initiative

Nutritional Risk Screening

The First Step in the Fight Against Disease-Related Malnutrition

Proper screening is the initial step in the more complex nutritional assessment process. While severe malnutrition is more easily identified, less severe cases tend to become clear only in later stages of treatment.1

A study revealed that only 50 percent of malnourished patients are typically recognized by regular clinical practice in European health care settings.2 To avoid unnecessary nutrient depletion, all patients should be screened for a potential nutritional risk as defined by the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.)3 and the European Society for Clinical Nutrition and Metabolism (ESPEN).4

The roles and responsibilities of health care professionals who are accountable for risk screening may vary depending on the country and whether it is a public or private hospital, as well as the resources that are available. The information contained in this article is meant to serve as a general guide.

Nutritional Risk Screening for Effective Management

To counteract malnutrition and its consequences, timely identification of impaired nutritional status and quick start of effective treatment are crucial for patients in nutritional risk groups.5

Clinical trials have convincingly demonstrated that adequate clinical nutrition enhances outcomes.5,6,7,8,9,10,11,12,13,14,15,16

To read more about the benefits of nutritional risk screening, click here.

Good Nutritional Care Starts with Patient Screening

Various screening tools have been designed to detect patients with or at risk of malnutrition.

Appropriate validation of a screening tool is crucial.17 Screening tools can predict if under-nutrition is likely to develop and/or worsen.

  • 1. Kruizenga HM, de Jonge P, Seidell JC et al. Are malnourished patients complex patients? Health status and care complexity of malnourished patients detected by the Short Nutritional Assessment Questionnaire (SNAQ). Eur J Intern Med 2006;17(3):189-194.
  • 2. Kruizenga HM, Van Tulder MW, Seidell JC et al. Effectiveness and cost-effectiveness of early screening and treatment of malnourished patients. Am J Clin Nutr 2005;82(5):1082-1089.
  • 3. Mueller C, Compher C, Ellen DM et al. A.S.P.E.N. Clinical Guidelines: Nutrition Screening, Assessment, and Intervention in Adults. JPEN 2011;35(1):16-24.
  • 4. Kondrup J, Allison SP, Elia M et al. ESPEN Guidelines for Nutrition Screening 2002. Clin Nutr 2003;22(4):415-421.
  • 5. a. b. Detsky AS, McLaughlin JR, Baker JP et al. What is subjective global assessment of nutritional status? JPEN 1987;11(1):8-13.
  • 6. Waitzberg DL. Efficacy of nutritional support: evidence-based nutrition and cost-effectiveness. Nestle Nutr Workshop Ser Clin Perform Programme 2002;7:257-271.
  • 7. Correia MI, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr 2003;22(3):235-239.
  • 8. Jie B, Jiang ZM, Nolan MT et al. Impact of nutritional support on clinical outcome in patients at nutritional risk: a multicenter, prospective cohort study in Baltimore and Beijing teaching hospitals. Nutrition 2010;26(11-12):1088-1093. 
  • 9. Kennedy JF, Nightingdale JM. Cost savings of an adult hospital nutrition support team. Nutrition 2005;21(11-12):1127-1133.
  • 10. Heidegger CP, Berger MM, Graf S et al. Optimisation of energy provision with supplemental parenteral nutrition in critically ill patients: a randomized controlled clinical trial. Lancet 2013;381(9864):385-393. 
  • 11. Alberda C, Gramlich L, Jones N et al. The relationship between nutritional intake and clinical outcomes in critically ill patients: results of an international multicententer observational study. Int Care Med 2009;35(10):1728-1737.
  • 12. Martin CM, Doig GS, Heyland DK et al. Multicentre, cluster-randomized clinical trial of algorithms for critical-care enteral and parenteral therapy (ACCEPT). CMAJ 2004;170(2):197-204.
  • 13. Weijs PJ, Stapel SN, de Groot SD et al. Optimal protein and energy nutrition decreases mortality in mechanically ventilated, critically ill patients: a prospective observational cohort study. JPEN 2012;36(1):60-68.
  • 14. Strack van Schijndel RJ, Weijs PJ, Koopmans RH et al. Optimal nutrition during the period of mechanical ventilation decreases mortality in critically ill, long-term acute female patients: a prospective, observational cohort study. Crit Care 2009;13(4):R132.
  • 15. Bozzetti F, Forbes A. The ESPEN clinical practice guidelines on Parenteral Nutrition: Present status and perspectives for future research. Clin Nutr 2009;28(4):359-364.
  • 16. Norman K, Pichard C, Lochs H et al. Prognostic impact of disease-related malnutrition. Clin Nutr 2008;27(1):5-15.
  • 17. Van Bokhorst-de van der Schueren MA, Guaitoli PR, Jansma EP et al. Nutrition screening tools: does one size fit all? A systematic review of screening tools for the hospital setting. Clin Nutr 2014;33(1):39-58.

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Dr. Roger Riofrio sitting in front of a United for clinical nutrition roll-up during ESPEN Congress.

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