Identifying patients who are malnourished or at risk for malnutrition
An international consensus committee recommended the following criteria for the diagnosis of undernutrition if two of six are present3:
- Insufficient energy intake.
- Weight loss.
- Loss of muscle mass.
- Loss of subcutaneous fat.
- Localized or generalized fluid accumulation that may sometimes mask weight loss.
- Diminished functional status as measured by handgrip strength.
The joint commission requires that all patients admitted to acute care hospitals be screened for risk of malnutrition within 24 hours. The American College of Gastroenterologists recommends using a validated score to assess nutritional risk, such as the Nutritional Risk Score (NRS) 2002 or the NUTRIC (Nutrition Risk in the Critically Ill) Score, which use a combination of nutritional status and diet-related factors – weight loss, body mass index, and food intake – and also severity of illness measurements.4