Nutrition Screening and Assessment

Nutrition Screening and Assessment

• Nutrition screening is the process of identifying individuals who are malnourished or at risk for malnutrition to determine if a detailed nutrition assessment is needed.
• The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) defines nutrition screening.
• The Joint Commission mandates nutrition screening within 24 hours of admission to an acute care center in the United States.

Nutrition Assessment

• Nutrition assessment is a comprehensive approach to diagnosing nutrition problems that uses a combination of medical, nutrition, and medication histories; physical examination; anthropometric measurements; and laboratory data.
• A.S.P.E.N. defines nutrition assessment.
• Nutrition assessment provides the basis for a nutrition intervention.
• A nutrition support clinician performs a nutrition assessment, which includes obtaining diet and medical history, current clinical status, anthropometric data, laboratory data, physical assessment information, and often functional and economic information.

Malnutrition

• Malnutrition is an acute, subacute, or chronic state of nutrition, in which varying degrees of overnutrition or undernutrition with or without inflammatory activity have led to a change in body composition and diminished function.
• Parameters used to diagnose malnutrition in screening and assessment processes reflect both nutrition intake and severity and duration of disease.
• An International Consensus Guideline Committee has proposed an approach to diagnosing malnutrition in adults based on etiology, integrating the present understanding of inflammatory responses to disease and trauma.
• The committee proposed three nutrition diagnoses: starvation-related malnutrition, chronic disease–related malnutrition, and acute disease or injury–related malnutrition.

Inflammation and Metabolic Alterations

• Inflammation and related compensatory mechanisms associated with disease or injury cause anorexia and alterations in body composition and stress metabolism.
• Metabolic alterations associated with inflammation are predominantly cytokine mediated and persist as long as the inflammatory stimulus is present.
• These metabolic alterations include elevated energy expenditure, lean tissue catabolism (proteolysis), fluid shift to the extracellular compartment, acute phase protein changes, and hyperglycemia.

Nutrition Support Guideline Recommendations

• Screening for nutrition risk is suggested for hospitalized patients.
• Nutrition assessment is suggested for all patients who are identified to be at nutrition risk by nutrition screening.
• Nutrition support intervention is recommended for patients identified by screening and assessment as at risk for malnutrition or malnourished.

This quiz covers the importance of nutrition screening, assessment, and intervention in patients with malnutrition, as defined by A.S.P.E.N. and mandated by the Joint Commission.