Table 1.
Nutrition risk screening (NRS) 2002
| Step 1: Initial screening | Yes | No | |
|---|---|---|---|
| 1 | Is BMI <20.5? | ||
| 2 | Has the patient lost weight within the last 3 mo? | ||
| 3 | Has the patient had a reduced dietary intake in the last wk? | ||
| 4 | Is the patient severely ill? (eg, in intensive therapy) | ||
| Yes: If the answer is “Yes” to any question, the screening in step 2 is performed. | |||
|
No: If the answer is “No” to all questions, the patient is rescreened at weekly intervals. If the patient, eg, is scheduled for a major operation, a preventive nutritional care plan is considered to avoid the associated risk status. | |||
|
Step 2: Final screening | |||
| Impaired nutritional status | Severity of disease (≈ increase in requirements) | ||
| Absent score 0 | Normal nutritional status A | Absent score 0 | Normal nutritional requirements |
| Mild score 1 | Weight loss >5% in 3 mo or Food intake below 50%–75% of normal requirement in preceding wk |
Mild score 1 | Hip fracturea Chronic patients, in particular with acute complications: cirrhosis,a COPDaChronic hemodialysis, diabetes, oncology |
| Moderate score 2 | Weight loss >5% in 2 mo or BMI 18.5–20.5 + impaired general condition or Food intake below 25%–50% of normal requirement in preceding wk |
Moderate score 2 | Major abdominal surgerya StrokeaSevere pneumonia, hematologic malignancy |
| Severe score 3 | Weight loss >5% in 1 mo (>15% in 3 mo) or BMI <18.5 + impaired general condition or Food intake below 0%–25% of normal requirement in preceding wk |
Severe score 3 | Head injurya Bone marrow transplantationaIntensive care patients (APACHE > 10) |
| Score: | + | Score: | = Total score: |
| Age | if ≥70 y: add 1 to total score above | = age–adjusted total score | |
| Score ≥3: the patient is nutritionally at risk, and a nutritional care plan is initiated | |||
| Score <3: weekly rescreening of the patient. If the patient, eg, is scheduled for a major operation, a preventive nutritional care plan is considered to avoid the associated risk status. | |||
Notes: NRS 2002 is based on an interpretation of available randomized clinical trials. Nutritional risk is defined by the present nutritional status and risk of impairment of present status, due to increased requirements caused by stress metabolism of the clinical condition.
A nutritional care plan is indicated in all patients who are (1) severely undernourished (score = 3), (2) severely ill (score = 3), (3) moderately undernourished + mildly ill (score 2 + score 1), or (4) mildly undernourished + moderately ill (score 1 + score 2).
Diagnoses shown in italics are based on the prototypes for severity of disease given below:
1. Score = 1: a patient with chronic disease, admitted to hospital due to complications. The patient is weak but out of bed regularly. Protein requirement is increased, but can be covered by oral diet or supplements in most cases.
2. Score = 2: a patient confined to bed due to illness, eg, following major abdominal surgery. Protein requirement is substantially increased, but can be covered, although artificial feeding is required in many cases.
3. Score = 3: a patient in intensive care with assisted ventilation etc. Protein requirement is increased and cannot be covered even by artificial feeding. Protein breakdown and nitrogen loss can be significantly attenuated.
a trial directly supports the categorization of patients with that diagnosis.
Abbreviations: BMI, body mass index; COPD, chronic obstructive pulmonary disease; APACHE, acute physiology and chronic health evaluation.