8.4 Nutrition Risk Screening (NRS-2002)

Nutrition Risk Screening (NRS-2002) is a vital tool for assessing malnutrition risk in hospitalized adults. It helps healthcare professionals quickly identify patients who need nutritional support, using a simple scoring system based on nutritional status and disease severity.

The NRS-2002 consists of initial and final screening steps, evaluating factors like BMI, weight loss, and illness severity. Scores range from 0 to 7, with higher scores indicating greater nutritional risk. This tool guides interventions and ensures timely nutritional care for at-risk patients.

Target Population and Setting for NRS-2002

Adult Inpatients in Hospital Settings

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• The NRS-2002 screens adult patients in the hospital setting for malnutrition risk within the first 48 hours of admission
• Applies to most adult inpatients, but certain groups may need specialized screening (critically ill patients, obese individuals, or those with fluid overload)

Populations Not Validated for NRS-2002

• The tool is not validated for use in pediatric patients, outpatients, or long-term care residents
• These populations require alternative screening methods tailored to their specific needs and settings
• Using NRS-2002 in non-validated populations may lead to inaccurate risk assessments and inappropriate interventions

Components and Scoring System of NRS-2002

Initial and Final Screening Steps

• The NRS-2002 consists of an initial screening and a final screening
• Initial screening assesses four criteria:
  • BMI < 20.5 kg/m²
  • Weight loss in the past 3 months
  • Reduced dietary intake in the preceding week
  • Presence of severe illness
• If "Yes" to any initial screening question, the final screening is performed

Final Screening: Impaired Nutritional Status and Disease Severity

• Final screening evaluates impaired nutritional status and severity of disease as a reflection of increased nutritional requirements
• Impaired nutritional status is scored from 0 (absent) to 3 (severe) based on:
  • Percent weight loss
  • BMI
  • General condition
• Severity of disease is scored from 0 (absent) to 3 (severe) based on:
  • Patient's medical condition
  • Nutritional requirements
• An additional point is added for patients aged ≥70 years to represent elderly frailty

Total NRS-2002 Score Calculation

• The final NRS-2002 score is the sum of:
  • Impaired nutritional status score (0-3)
  • Severity of disease score (0-3)
  • Age adjustment (0 or 1)
• Total scores range from 0 to 7, with higher scores indicating greater nutritional risk

Assessing Nutritional Risk with NRS-2002

Proper Application by Trained Professionals

• NRS-2002 should be completed by trained healthcare professionals (nurses or dietitians) within 48 hours of hospital admission
• Requires accurate anthropometric measurements (height and weight) and thorough medical history

Assessing Weight Loss and Dietary Intake Changes

• Weight loss history should be obtained from patient, relatives, or medical records
  • Severity evaluated as percentage of usual body weight
• Dietary intake changes assessed compared to patient's normal pre-hospitalization intake
  • Significant reductions may indicate impaired nutritional status

Scoring Disease Severity and Special Considerations

• Disease severity scoring requires knowledge of primary diagnosis, comorbidities, and anticipated nutritional requirements
  • Examples of severe diseases: head injury, bone marrow transplantation, intensive care patients (APACHE score > 10)
• Special considerations for patients with altered body composition or fluid balance (obese, edema, ascites)
  • May require adjustments to BMI interpretation or weight loss assessment

Interpreting NRS-2002 Scores for Intervention

Identifying Patients at Nutritional Risk

• NRS-2002 score ≥3 indicates nutritional risk, requires intervention and weekly rescreening
  • Score of 3: moderate risk
  • Scores ≥4: high risk
• Patients with score <3 should be rescreened weekly during hospitalization to monitor changes

Guiding Nutritional Intervention Based on Score

• Higher scores indicate greater need for prompt, aggressive nutritional therapy
  • Scores ≥5 may require intensive interventions (enteral or parenteral nutrition)
• Interventions should be tailored to individual patient based on:
  • Specific nutritional deficits
  • Disease state
  • Tolerance
• NRS-2002 score alone does not dictate the type of nutritional therapy required

Collaborative Care Planning and Monitoring

• Nutritional care plans should be developed with a registered dietitian and interdisciplinary medical team
• Regular monitoring and reassessment crucial to:
  • Evaluate effectiveness of interventions
  • Adjust care plans as needed
• Ongoing communication and documentation ensure continuity of care and optimal outcomes