COURSE CODE: SHS 406

COURSE NAME: COMMUNITY

NUTRITION
LECTURE 3
Nutrition Screening and Assessment
 Learning Outcomes

Students will be able to

• Know about different Screening and Assessment

Tools used in Nutrition Care Process.

 Community Assessment
• Process of critically thinking about a community
by getting to know and understanding the
community as a client

• Evaluate the nutritional status

• Through measurement of food and nutrient
intake
• Evaluation of nutrition-related health
indicators.
Factors affecting Nutritional Status
• The nutritional status of an individual is often the

result of many inter-related factors.

• It is influenced by food intake, quantity & quality, &

physical health.

• The spectrum of nutritional status spread from

obesity to severe under-nutrition

 Importance
• Helps identify
– Community needs,
– Clarify problems,
– Identify strengths and resources
Identifying Target Population
The steps in identifying target populations includes,
but are not limited to:
1. Assessing the scale of food and nutrition problems
and their causes in the general population.
2. Identifying the population groups at nutrition risk.
3. Generating problem list and prioritizing the
situations according to
• The severity of the problems
• The population groups effected and
• The availability of resources
• After completing the assessment, the data analysis
will reveal the
Screening for Community Health
• Nutrition screening is defined as “the process of

identifying patients, clients, or groups who may

have a nutrition diagnosis and benefit from

nutrition assessment and intervention by a

registered dietitian nutritionist (RDN).”

• Screening is an attempt to detect unrecognized or
subclinical health conditions among individuals.
• Its purpose is to identify individuals who have a high
risk of developing or having a specific health condition
so they can be referred for definitive diagnosis and
treatment.
• It also identifies individuals who may actually have an
illness.
• Key considerations for nutrition screening include:

1. Tools should be quick, easy to use, and able to be

conducted in any practice setting.
2. Tools should be valid and reliable for the patient
population or setting.
3. Tools and parameters are established by RDNs, but the
screening process may be performed by dietetic
technicians, registered, or other trained personnel.
4. Screening and rescreening should occur within an
appropriate time frame for the setting
The most common screening criteria includes

• History of weight loss

• Current need for nutrition support

• Presence of skin breakdown

• Poor dietary intake and

• Chronic use of modified or unusual diets.

 GOAL

• Regardless of the information gathered, the goal of

screening is to identify individuals

• Who are at nutritional risk,

• Those likely to become at nutritional risk, and

• Those who need further assessment.

 Nutrition Screening Tools

1. Malnutrition Screening Tool (MST)

• by Ferguson (1999).
2. Malnutrition Universal Screening Tool (MUST)
• developed by Stratton and colleagues (2004)
3. The Nutrition Risk Screening (NRS 2002)
4. The Mini Nutritional Assessment (MNA) Short
Form
Malnutrition Screening Tool (MST)

• The parameters include recent weight loss and

recent poor dietary intake.

• The tool is useful for the acute hospitalized adult

population
Malnutrition Universal Screening
Tool (MUST)

• To assess for malnutrition rapidly and completely

• It is designed to be used by professionals of

different disciplines.

⮚ https://www.bapen.org.uk/pdfs/must/must_full.pdf
The Nutrition Risk Screening (NRS
2002)

• Is a screening tool that is useful for medical-surgical

hospitalized patients.

• This tool contains the nutritional components of the

MUST and a grading of disease severity as reflected by

increased nutritional requirements.

• http://espen.info/documents/screening.pdf
Screening parameters for this tool include

• Recent weight loss percentage,

• Body mass index (BMI)

• Severity of disease

• Consideration of "70 years of age

• and food intake/eating problems and skipping of

meals.
 The Mini Nutritional Assessment
(MNA) Short Form
is a rapid and reliable screening method for the sub-
acute and ambulatory elderly populations.

Nutrition screening parameters include

• Recent dietary intake,
• Recent weight loss,
• Mobility,
• Recent acute disease or
• Psychological stress, neuropsychological problems,
• Body mass index
NUTRITIONAL ASSESSMENT
• Nutrition assessment is a comprehensive evaluation

carried out by an RDN using medical and health,

social, dietary and nutritional, medication, and

supplement and herbal use histories; physical

examination; anthropometric measurements; and

laboratory data.
• Nutrition assessment interprets data from the

nutrition screen and incorporates additional

information.

• It is the first step in the nutrition care process.

• The purpose of assessment is to gather adequate

information in which to make a professional judgment

about nutrition status.

• The nutrition assessment is defined as a systematic

approach to collect, record, and interpret relevant

data from patients, clients, family members,

caregivers, and other individuals and groups.

• It is an ongoing, dynamic process that involves

initial data collection and continued reassessment

and analysis of nutritional status in comparison to

specific criteria.
Tools for Assessment of Nutritional
Status
• Several tools are available for the assessment of
nutritional status.

The Subjective Global Assessment (SGA) is a tool

that uses
• weight history,
• diet history data,
• stress level,
• primary diagnosis along with physical symptoms to
assess nutritional status.
The Mini Nutrition Assessment (MNA) Long Form tool
evaluates

• Independence,
• Medication therapy,
• Pressure sores,
• Number of full meals consumed per day, protein
intake, consumption of fruits and vegetables, fluid
intake,
• Mode of feeding,
• Self-view of nutritional status,
• Comparison with peers,
• Mid-arm and calf circumferences
 Histories
• The information collected about individuals or

populations is used as part of the nutrition status

assessment.

• Frequently the information is in the form of

histories—health and medical, social, medication and

herbal use, and dietary and nutritional.

 Medical or Health History
The medical or health history usually includes the

following information:

• Chief complaint present and past illness

• Current health

• Allergies

• Past or recent surgeries

• Family history of disease

• Psychosocial data and a review of problems—by

body system—from the patient’s perspective.

• These histories usually provide much insight into

nutrition related problems.

• Alcohol and drug use, increased metabolic needs,

increased nutritional losses, chronic disease, recent

major surgery or illness, disease or surgery of the

gastrointestinal tract, and recent significant weight

loss may contribute to malnutrition.

• In older patients, additional review is

recommended to detect mental deterioration,

constipation, poor eyesight, hearing or taste

sensation, slowed reactions, major organ

diseases, effects of prescription and over-the

counter drugs, and physical disabilities.

Medication and Herbal Use History

• Various foods, medications, and herbal

supplements can interact in many ways that affect

nutrition status and drug therapy effectiveness

• Thus a medication and herbal history is an important

part of any nutrition assessment.

• Those who are older, are chronically ill, have a

history of marginal or inadequate nutritional intake, or

are receiving multiple drugs for a long time are

susceptible to drug-induced nutritional deficiencies.

The effects of medication therapy can be

altered by

• Specific foods,

• The timing of food and

• Meal consumption, and

• Use of herbal products

 Social History

• Socioeconomic status may add to the risks for

inadequate nutrition intake.

• Knowledge of various cultures is also important in

assessing diverse groups of clients.

• Cultural factors include religious beliefs, rituals,

symbols, language, dietary practices, education,

communication style, views on health, wellness, and

illness, and racial identity

 Nutrition or Diet History

• A diet history is perhaps the best means of obtaining

dietary intake information and refers to a review of

an individual’s usual patterns of food intake and the

food selection variables that dictate the food intake

• Dietary intake data may be assessed either by

collecting retrospective intake data (e.g., a 24- hour

recall or food frequency questionnaire) or by

summarizing prospective intake data (e.g., a food

record kept for a number of days by an individual or

the caretaker).

• Each method has specific purposes, strengths, and

weaknesses.
• Any self-reported method of obtaining data can be

challenging because it is difficult for people to

remember what they ate, the content, and the

amounts.

• The choice of data collection depends on the purpose

and setting, but the goal is to determine the food and

nutrient intake that is typical for that individual.

• A daily food record, or food diary, involves

documenting dietary intake as it occurs and is

often used in outpatient clinic settings.

• The food diary is usually completed by the

individual client.
• A food diary or record is usually most accurate if the

food and amounts eaten are recorded at the time of

consumption, minimizing error from incomplete

memory or attention.
• The individual’s nutrient intake is then calculated and

averaged at the end of the desired period, usually 3

to 7 days, and compared with dietary reference

intakes (DRIs), government dietary guidelines as in

the MyPlate guide, or personalized dietary

recommendations for disease management or

prevention.
• The food frequency questionnaire is a retrospective

review of intake based on frequency (i.e., food

consumed per day, per week, or per month).

• For ease of evaluation, the food frequency chart

organizes foods into groups that have common

nutrients.
• Because the focus of the food frequency

questionnaire is the frequency of consumption

of food groups without portion sizes, the

information obtained is general, not specific, and

cannot be applied to certain nutrients.

• During illness, food consumption patterns can

change, depending on the stage of illness.

• Therefore it is helpful to complete food frequency

questionnaires for the period immediately before

hospitalization or before illness to obtain a complete

and accurate history.

 24 Hours Recall
• The 24-hour recall method of data collection requires

individuals to remember the specific foods and amounts

of foods they consumed in the past 24 hours.

• The nutrition professional asks the person to recall his

or her intake using a specific set of questions to gain as

much detailed information as possible.

• Problems commonly associated with this method of

data collection include

(1) An inability to recall accurately the kinds and amounts

of food eaten

(2) Difficulty in determining whether the day being

recalled represents an individual’s typical intake or was

exceptional
(3) The tendency for persons to exaggerate low intakes

and underreport high intakes of foods.

 Nutrient Intake Analysis
• A nutrient intake analysis (NIA) also may be referred

to as a nutrient intake record analysis or calorie

count, depending on the information collected and

the analysis done.

• The NIA is a tool used in various inpatient settings

to identify nutritional inadequacies by monitoring

intakes before deficiencies develop.

• Information about actual intake is collected

through direct observation or an inventory of

foods eaten based on observation of what

remains on the individual’s tray or plate after a

meal.
• A NIA should be recorded for at least 72 hours to

reflect daily variations in intake.

• Complete records for this period usually

accurately reflect an average intake for most

individuals.

• If the record is incomplete, it may be necessary to

extend the duration of the recorded intake.

• Eating habits or meals consumed during the

weekend and during the week may differ, so

ideally a week day is included.