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NCP

This issue of Nutrition in Clinical Practice focuses on nutrition screening and assessment. The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Clinical Guidelines address the issue of screening and assessment and state: "Nutrition screening identifies individuals who are malnourished or who are at risk for malnutrition. The purpose of the nutrition screening is to determine if a more detailed nutrition assessment is necessary."¹ Furthermore, practice guidelines are available for both nutrition screening and assessment in adult and pediatric populations.

	Practice Guidelines Nutrition Screening—Adults

Top Practice Guidelines Nutrition... Practice Guidelines Nutrition...

 

1. A nutrition screening incorporating objective data such as height, weight, weight change, primary diagnosis, and presence of comorbidities should be a component of the initial evaluation of all patients in ambulatory, hospital, home, or alternate site care settings. (C)
   
2. The health care organization should determine who will perform the screen and the elements to be included in the screen. (C)
   
3. A procedure for periodic nutrition re-screening should be implemented. (C)
   

	Practice Guidelines Nutrition Assessment—Adults

Top Practice Guidelines Nutrition... Practice Guidelines Nutrition...

 

1. A formal nutrition assessment should be carried out in any patient, independent of the care setting, who is identified by a nutrition screen as nutritionally at risk. (C)
   
2. In the absence of an outcomes validated approach to nutrition assessment, a combination of clinical (history and physical exam) and biochemical parameters should be used to assess the presence of malnutrition. (C)
   
3. A written summary should be created and made available to the patient's care providers, which includes the following: The objective and subjective data collected for the nutrition assessment; the explicit nutrition risk stratification; and the specific recommendations to be incorporated into the nutrition care plan (protein, calorie, and micronutrient requirements, route of administration, and treatment goals and monitoring parameters). (C)
   

The strength of evidence rating of "C" denotes that expert opinion and editorial consensus form the basis of the recommendations. Even though screening and assessment are the foundation of any nutrition intervention, a rating of "C" suggests the need for additional research.

The first article in this issue by Dr Charney compares nutrition screening with assessment noting the similarities and differences. Next, Pat Anthony delves further into the types of validated screening tools that are available; she reviews the Malnutrition Universal Screening Tool (MUST), Nutrition Risk Screening 2002 (NRS 2002), Mini Nutritional Assessment (MNA), Short Nutritional Assessment Questionnaire (SNAQ), Malnutrition Screening Tool (MST), and the Subjective Global Assessment (SGA). Dr Thomas' article specifically evaluates nutrition assessment as it applies to patients in long-term care settings. He discusses the regulatory issues surrounding nutrition assessment in this population as well as 2 tools: the Nutrition Screening Initiative for nutrition screening as well as the MNA designed for nutrition assessment of this population. The MNA is further discussed in the paper by Dr Bauer and colleagues. Their paper examines the development and validation of the MNA, the results of using the tool in various populations, and strengths and shortcomings of the MNA. A specific, objective measurement is waist circumference and waist-to-hip ratio; Ness-Abramof and Apovian analyze the data surrounding the use of this measurement to determine cardiometabolic risk. The SGA has become widely known as a useful and valid nutrition assessment tool. Makhija and Baker review the characteristics of the tool and the populations in which it has been used. It is interesting to note that Dr Baker was one of the authors of an original publication about SGA in the 1980s. This paper is the subject of this issue's Pivotal Paper: in 1987, Detsky, McLaughlin, Baker, Johnston, Mendelson, and Jeejeebhoy published a JPEN paper on SGA.² In this issue, Dr Keith summarizes the history of SGA and how this paper transformed our practice.

We also have 2 unsolicited clinical research papers that evaluate nutrition screening and assessment. The first, by Chima et al, summarizes a survey that was conducted among clinical nutrition managers to identify nutrition screening practices. The second, by Luft, describes a unique measurement tool for determining body height in recumbent adult subjects.

This issue includes 2 additional unsolicited papers, both dealing with long-term parenteral nutrition (PN). The first is a case report of a single patient with short-bowel syndrome receiving home PN. When the lipid emulsion was changed from a soy-based lipid to an olive oil-based lipid, serum plant sterol and liver enzyme levels were reduced. Finally, a paper from Casey and colleagues at Stollery Children's Hospital in Alberta reviews their experience with children with intestinal failure and the relationship between patient variables and outcomes.

Closing out this issue, we have 3 Current Literature reviews and 1 Book Review.

We hope that this issue will be one that you keep aside as a reference for your library on the important issue of nutrition screening and assessment.

1 A.S.P.E.N. Board of Directors and the Clinical Guidelines Task Force. Guidelines for the Use of Parenteral and Enteral Nutrition in Adult and Pediatric Patients. JPEN J Parenter Enteral Nutr. 2002;26(Suppl):1SA-138SA. Available at: http://www.nutritioncare.org/wcontent.aspx?id=1616. Accessed 6/29/08.

Nutrition in Clinical Practice, Vol. 23, No. 4, 363-364 (2008)
DOI: 10.1177/0884533608323045

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