Nutrition Assessment

Nutrition Screening and Assessment:

The first step in practice is to screen patients to know exactly who will benefit from a clinical nutrition intervention. Once patients are selected, a step-wise approach is taken to determine the patient needs.

The process of screening for malnourished patients utilizes a variety of tools including physical examination, anthropometric measurements, laboratory data and obtaining medical, drug and nutrition history. It is important to determine whether a malnourished patient is undernourished, overnourished (obese) or suffers malnutrition associated with disease or trauma. Alterations in metabolism and physiology caused by inflammatory mediators associated with severe illness and trauma accelerate loss of

But each has limitations and the validated effectiveness has not been established.(3) Screening parameters often utilize clinical judgment and are primarily subjective. The Subjective Global Assessment (SGA) score is considered to be one the best predictors for patients at nutritional risk. The parameters suggested are magnitude of weight loss and appetite.(4) Figure (()) below is an algorithm offered by ASPEN for screening and assessment.

History

It is the first tool in any nutritional assessment. The features of interest are recent weight changes; dietary habits and alteration in dietary intake whether drug induced or not; allergies and food intolerance; gastrointestinal functions and symptoms; current functional capacity, including recent limitations; and previous medical conditions.

Physical Examination

It relies on subjective and descriptive data. Although not quantitative, a physical examination is may still influence the nutritional management of a patient.

Objectives of physical

Board of Directors. Clinical Pathways and Algorithms for Delivery of Parenteral and Enteral Nutrition Support in Adults, Silver Spring, MD:

American Society for Parenteral and Enteral Nutrition; 1998:4.

Subjective Global Assessment

As a nutrition screening tool, SGA relies on history of weight and dietary change, gastrointestinal symptoms, functional capacity, effects of disease on nutritional requirements and physical appearance. Based on these parameters, patients are classified as; well nourished, moderate or suspected malnutrition or severe malnutrition.(6)

Figure: Subjective Global Assessment: ****** This was a quick review for a few of the assessment techniques that can be used……

Points that can be modified:

Anthropometric measurements

Weight measurements Enteral