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Nutrition Screening Adults

NSA: Tool Descriptions (2018)

Six tools designed to screen adults for malnutrition (undernutrition) were evaluated for validity, reliability and agreement. Descriptions of the tools are as follows.

Modified MNA-SF (MNA-SF-BMI and MNA-SF-CC). In 2009, Kaiser et al proposed modifications to the Mini Nutrition Assessment–Short Form (MNA-SF) and validated the tool against the MNA for use by geriatric health care professionals. Like the original MNA-SF, the modified tool consists of six screening criteria: Changes in appetite over the past three months, weight loss, mobility, psychological stress and acute disease in the past three months, neuropsychological problems, and BMI. However, the scoring system was expanded from two to three categories: “malnourished,” “at risk of malnutrition” and “well-nourished,” as in the MNA. The modified version of the MNA-SF includes two different variants: the MNA-SF-BMI (body mass index) and the MNA-SF-CC (calf-circumference). When height and weight is unavailable, the MNA-SF-CC replaces the BMI question with calf-circumference and modifies the scores (0 or 3, instead of 0 or 1). Both variants of the modified MNA-SF have identical cut-off points and total scores (Garcia-Meseguer and Serrano-Urrea, 2013; Kaiser et al, 2009; Kaiser et al, 2011; Lera et al, 2016; Martin et al, 2016).

Short Nutritional Assessment Questionnaire (SNAQ) is a nutrition screening tool created by Dutch dietitians (Dutch Malnutrition Screening Group) to identify risk for malnutrition in hospitalized patients. The tool was developed in response to changes in European Society for Parenteral and Enteral Nutrition (ESPEN) guidelines and incorporated data from 26 questions, including items concerning eating, drinking, pain, stooling, and clinical condition. The tool consists of the three most highly predictive questions related to presence and degree of unintentional weight loss, changes in appetite and use of supplemental drinks or tube feeding. Responses to each question are given a score of zero to three based on severity. Patients with a score of two or more are classified as moderately malnourished and patients with a score of three or more are identified as severely malnourished (Kruizenga et al, 2005).

Malnutrition Screening Tool (MST) is a simple, quick, valid, and reliable tool developed for use in adult hospitalized patients, now used to identify patients at risk for malnutrition in many developed countries. It consists of two questions: Decreased intake due to poor appetite and amount of recent unintentional weight loss. The sum of these parameters is obtained to result in a score between zero and five. Patients are considered to be at risk for malnutrition if they receive a score of two or more (Ferguson et al, 1999).

Nutritional Risk Screening 2002 (NRS 2002) was developed by ESPEN as a system for screening hospitalized patients for the presence of undernutrition and the risk of developing undernutrition in the hospital. It is composed of two main sections. The first section contains four criteria, including BMI, weight loss within the last 3 months, decreased intake in the last week, and severity of illness; a positive response to any one of these items prompts the completion of section two, which classifies patients by severity according to a combination of nutritional markers (weight loss, BMI, and/or decreased intake) and severity of disease. An additional point is added for advanced age.  Patients with a score of three or more are identified at risk for malnutrition. NRS 2002 is recommended for use in hospitalized patients by ESPEN (Kondrup et al, 2003).

Malnutrition Universal Screening Tool (MUST), originally created by the British Association for Parenteral and Enteral Nutrition (BAPEN), is a five-step screening tool to identify adults who are malnourished, at risk of malnutrition (undernutrition), or obese, recommended for use in the community setting by ESPEN. Three criteria are used: BMI, severity of unintentional weight loss, and acute disease effect, which describes the predicted impact on nutritional intake based on an acute condition. The severity of each criterion is given a score between 0 and 2. Patients with a score of zero are deemed at low risk for malnutrition, a score of 1 is identified as medium risk for malnutrition, while a score of 2 or greater is classified as high risk for malnutrition.  Management guidelines on developing a care plan are included. This is the most widely used screening tool in all care settings in the United Kingdom. (Bapen)

Mini Nutrition Assessment–Short Form (MNA-SF) is an abbreviated version of the Mini Nutrition Assessment (MNA) and was designed to screen patients 65 years of age and older in clinics, nursing homes, and hospitals for malnutrition in less than five minutes. The MNA-SF includes six screening criteria: changes in appetite over the past three months, weight loss, mobility, psychological stress and acute disease in the past three months, neuropsychological problems, and BMI.  Each criterion is assigned a score of zero to three based on severity; a score of 11 or below indicates risk of malnutrition. The results strongly correlate with results of the MNA and clinical judgment. The MNA-SF has been validated in a wide variety of study settings and has demonstrated similar validity and accuracy as the full MNA (Cohendy et al, 2001; Rubenstein et al, 2001).

British Association for Parenteral and Enteral Nutrition (BAPEN). Screening and Malnutrition Universal Screening Tool (MUST). (Last Updated 25 April 2016) Accessed online May 23, 2018 https://www.bapen.org.uk/screening-and-must/must.

Cohendy R, Rubenstein LZ, Eledjam JJ. The Mini Nutritional Assessment-Short Form for pre-operative nutritional evaluation of elderly patients. Aging Clin Exp Res. 2001 Aug; 13 (4): 293-297.

Ferguson M, Capra S, Bauer J, Banks M. Development of a valid and reliable malnutrition screening tool for adult acute hospital patients. Nutrition. 1999 Jun; 15 (6): 458-464.

Garcia-Meseguer M, Serrano-Urrea R. Validation of the revised mini nutritional assessment short-forms in nursing homes in Spain. J Nutr Health Aging. 2013; 17: 26-29.

Kaiser MJ, Bauer JM, Ramsch C, Uter W, Guigoz Y, Cederholm T, Thomas DR, Anthony P, Charlton KE, Maggio M, Tsai AC, Grathwohl D, Vellas B, Sieber CC; MNA-International Group. Validation of the Mini Nutritional Assessment short-form (MNA-SF): A practical tool for identification of nutritional status. J Nur Health Aging 2009; 13: 782-788.

Kaiser MJ, Bauer JM, Uter W, Donini LM, Stange I, Volkert D, Diekmann R, Drey M, Bollwein J, Tempera S, Guerra A, Ricciardi LM, Sieber CC. Prospective validation of the modified mini nutritional assessment short-forms in the community, nursing home, and rehabilitation setting. J Am Geriatr Soc. 2011; 59: 2,124-2,128. 

Kondrup J, Allison SP, Elia M, Vellas B, Plauth M; Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). Clin Nutr. 2003 Aug; 22 (4): 415-421. PMID: 12880610.

Kruizenga HM, Seidell JC, de Vet HC, Wierdsma NJ, van Bokhorst-de van der Schueren MA. Development and validation of a hospital screening tool for malnutrition: the short nutritional assessment questionnaire (SNAQ). Clin Nutr. 2005 Feb; 24 (1): 75-82.
Lera L, Sánchez H, Ángel B, Albala C. Mini Nutritional Assessment Short-Form: Validation in Five Latin American Cities. SABE Study. J Nutr Health Aging. 2016; 20: 797-805.

Martín A, Ruiz E, Sanz A, García JM, Gómez-Candela C, Burgos R, Matía P, Ramalle-Gomera E. Accuracy of Different Mini Nutritional Assessment Reduced Forms to Evaluate the Nutritional Status of Elderly Hospitalised Diabetic Patients. J Nutr Health Aging. 2016; 20: 370-375.

Rubenstein LZ, Harker JO, Salvà A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: Developing the short-form mini-nutritional assessment (MNA-SF). J Gerontol A Biol Sci Med Sci. 2001 Jun; 56 (6): M366-M372.