Diagnosis of Malnutrition (Undernutrition) PDF

Diagnosis of mal nutrition (undernutrition) Fig. 3 Nutritional Screening and Assessment - ,:Screening should be a simple and rapid process. which can be carried out by busy acimittinq nursing and medical staff, It sh...

Diagnosis of mal nutrition (undernutrition) Fig. 3 Nutritional Screening and Assessment - ,:Screening should be a simple and rapid process. which can be carried out by busy acimittinq nursing and medical staff, It should be sensitive enough to cletect all or trearly all patients at nutritional risk. Methods of nutritional screeninq slroLrlcl bc 'raliclatcrj irr r.lirrir;rl tri.rls (l,/). So"eer,in-c1sl'roultl lre perforrnecl withirr fhe lirst.i-1 4tl lr iil-lci'tltc fir:;i cr-rrrl;.lci:irrri i.lrere:;,il:i:i- at regLllar intervals. Patients icientilied as'at riskt rreecl to undergo nr,rtritiorr;r! a).ssessnrr:rrt. - Nutritional assessment shr:uld be more detailed and done in those patients found on screening to be at risk or when metabolic or functional problerns prevent a standard plan being carried out (16). Nutritional assessment also provides the basis for the formal diagnosis of malnutrition. 3.1. Methods for Screening Several validated screening tools are available and recommended by the European Society for Clinical Nutrition and Metabolism (ESPEN) (17). The screerring tools address several basic questrons:.. 1! Recent weight loss;. '! Current body mass index; Recent food intake; ir. Disease severity. ESPEN has published guidelines for nLrtrition screening in the community, it-l the lrospital and among the elderly in institutions. -l'he usefulness of the screening nrethods recomnretrded is based on predictive validity, content valirlity, reliahrility and practlcability ( 17), Screening tools recommended by ESPEN are: - Community: Malnutrition Universal Screenirrg Tool (MUST) (18); - Hospital; Nutritional Risk Screening (NRS) (19); - Elderly: Mini Nutritional Assessment (MNA) (20,21)..J "i" i , t-r:ri'rrnliirii:'.v: ivl;rlrrr.riritiorr l.iri;i/ti'ii;iri :::ir:i r:u:rrin..11 l'r:*l {MtJ:i'i J For a general screening of the community, lhe MUST is a useful tool for a rapid estimate of the grade of undernutrition (Fig. 4) (18). Its main disadvantage is that the recent foocl intake is not included, and calculations of the percentage weight loss, and of the BMI, have caused problems in some units, Copyright O by ESPEN t"LL Progranrme 2021  * Q,13:$. :J'=* \rlf-rl -. tr-:! (is**o,..Th ' o. ' Uf i*lt] i*jjly,'J -!r * i\\{ie4l, *at,r'fi4\ * tl' $tep BMI score 1 + Step 2 + Step 3 !kt'*Y" h ''* WeiEht loss score Aor:te disoase eflect score t' *+{ Unplanned vreight loss l, paiient is acutely ill anrJ ' BMI kg/nrr in past 3*6 monlhg. {.1 '"aLxr*x*X > 20i>- 30 Obese) *0 Yo Score there has baen or is likely t-':-' " to be no nutritioni.rl 18.5-20 ". I 5o/o in 2 rnonths Moderate Major abdominal surgery or Stroke BMI 18.5 - 20.5 + impaired general condition Severe pneumonia, haematological malignancy, or Food intake 25-50o/o of normal requirement in Score 2 precedinq ureek Score 2 Severe Wt loss >5Yo in 1 months Severe Head injury (>15% in 3 months) Bone marrow transplantation or lntensive care patients (ApACHE>10). 6MI 3: the patierlt is nr"rtritionaliy at-risk and a nutritioni:l care plan is initiatecl score < 3l weekly re-screening ofthe patient. rfthe patient is (e,g.) scheduled for a major nutritional care plan is consiclered to try to avoid the associated r-isi. operation, a preventative 3,1.3I*Elclerly: Mini Nutritionat Assessment (MNA) _ p-3l'ult overili$yoars oF-"\ age, two specific arrcl welt-vatictated ::: i1). -i'he fui: t1l'i;\ irlci thc sl^to.r't (i'4i\i\-5I) toois are avsilerDte (20, i:10) forulr (;l l). i:i ;:t i.:r:riib;tr;.ition iif a T'hr:: lrlirt,.1, SCreet I il g al ii ai a :isi:il:ii'i i i' it I i:ool I. The full MNA has two parts: 1. ScreeBing and if the patients is at risk 2, Asses-sment The full |4NA has 18 questions and covers 4 domains. A score or,; iri'lnaicates an adequate nutritional status. A score between r7land,23.5;inclicates risk oi nialnutrition and r ';:r '-n a score of no need to complete assessment r 11 polnts or below Possible malnutrition -> continue assessment Copyright @ by ESPEN LLL Programme 2021  Table g b Mini N Assessment MIlA 1_,1$gsessment 0=no 1 =yes 1=no 0 -..1. tleals 1=2 rn(:als i) ::..1 n.r/)als su.trri*d**G@ At least one serving of dairy proclucts (milk, cheese, yoghurt) per Two or more servino of teoumes or egi per day yes? no? Meat, fish or poultry- -1' '-' weck "'"' ii-ri.lz yes? "u".iduy no? 0.0 = if 0 or l yes 0,5 * if two yes 1,0 = if 3 yes 0.0 = less than 3 cups 0.5=3to5cups 1,0 = more than 5 cups 0 = unable to eat wilhout assistance I = self-fed with some cJifficulty 2 = self-fed without any problems 0 = view self as being malnourished 1 = is rincertain of nutritional status 2 = views self as having no nutritional problenl In comparison with status? 0.0 = not as good 0.5 = does not know :1.0 = as good 2.0 = better Uja *."r r-.trsu -f.n;n*;l I', AaIrl;aJ li.C,* I"IAC.irr.;.tJh;irr ?1 0.i,. r,ij:,(-t rli r.,.:,i.l : :":Ai: i."' c;r.$rr:r;.r'il.rr..l ,t.l 0 = CC less than 31 1 = CC,31"_or greater Screening score (max. 14'poirrts) Assessment score (maxr'16 ipolnts) Total MNA score 1nrax. :O polnts; Copyright O by ESPEN LLL proqramme 2021 10 Interpretation: A score of I 24 indicates an adequate nutritional status Malnutrition Indicator Score: 17 to 23.s points -> at risk of malnutrition Less than 17 points -> malnourished The initial]opg vqqsion of the mini-nutritionalassessment (MNA) was followed by a simpler one. thett'l.NA SFlis derived from the original MNA and includes onty'olitems. Recently it was revised and the calf circumference was added if the BMI cannot be calculated. Tlre short form of the MNA has turned out to be as good as the iong version, ancl it is more rapidly done (Table 4). If the score is 11 or less tlre patients is regarded as at risk for malnutrition and the full MNA has to be done. L{urt -$ l"{t\"}i\ -rir 4 Table 4 (, Mini |iutritir:lnal ,&ssessi'nr.:nt $hol't Fai-rr (ivi i\l A-.5F Xi"t'las food int;rke rleclinerl over the past 3 ntonths, due to loss of appetite, digestive proble,lrs, chewing or swallowirrg difficrrlties? 0 = severe loss of appetite 1 = moderate loss of appetite 2 = no loss of appetite #{rveight loss during last 3 months? 0 = weight loss greater than 3 kg 1 = does not know 2 = weight loss between 1 and 3 kg 3 = no weight loss duouirty 0 = bed- or chair-bound 1 = able to get out of bed / chair but does not go out I = poes out diu*suffered psychologicat distress or acute disease in the past 3 {nonths? 0=yes 2=no Neuropsychological problertrs? 0 = i;evt)r'e. clcrT)cntia cr'