This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.
Why screen for malnutrition in hospital?
Between 20 and 50% of hospital patients are malnourished or at risk, and the problem is often missed. Malnutrition slows wound healing, weakens the immune system and muscles, and increases complications, length of stay and mortality. Nutritional Risk Screening 2002 (NRS-2002), developed by Jens Kondrup and colleagues for the European Society for Clinical Nutrition and Metabolism (ESPEN), is a quick tool to find patients who would benefit from nutrition support.
Step 1: initial screening
Four questions:
- Is the BMI below 20.5?
- Has the patient lost weight in the last 3 months?
- Has food intake fallen in the last week?
- Is the patient severely ill, for example in intensive care?
If all four answers are no, the patient is rescreened every week. If any answer is yes, the final screening below is completed.
Step 2: final screening
| Score | Impaired nutritional status | Severity of disease |
|---|---|---|
| 0 | normal | normal requirements |
| 1 | weight loss over 5% in 3 months, or intake 50 to 75% of needs | hip fracture, chronic disease with complications, hemodialysis, diabetes, cancer |
| 2 | weight loss over 5% in 2 months, BMI 18.5 to 20.5 with impaired condition, or intake 25 to 60% | major abdominal surgery, stroke, severe pneumonia, blood cancer |
| 3 | weight loss over 5% in 1 month, BMI below 18.5 with impaired condition, or intake 0 to 25% | head injury, bone marrow transplant, intensive care |
Add one point if the patient is 70 or older. The maximum is 7.
Interpretation
A total of 3 or more means the patient is at nutritional risk, and a nutrition care plan should be started. Below 3, the screening is repeated weekly, or before major surgery.
Worked example
A 72-year-old woman with COPD is admitted for an exacerbation. She weighs 143 lb at 5 feet 7 inches (BMI 22.4) and has eaten about two-thirds of her usual meals for a week. Her nutritional status scores 1, her disease (chronic disease with an acute complication) scores 1, and her age adds 1. The total of 3 puts her at nutritional risk, even though her BMI is normal.
What a nutrition plan includes
A dietitian estimates energy and protein needs, usually 25 to 30 kcal and 1.2 to 1.5 g of protein per kilogram per day in illness, and starts with food fortification and oral nutritional supplements. Tube feeding or intravenous nutrition is used when eating is not enough.