SKRINING GIZI

AMALIA RAHMA, S.Gz., M.Si

OUTLINE
 Background
 Pengertian skrining gizi
 Tujuan skrining gizi
 Manfaat skrining gizi
 Macam-macam skrining gizi
BACKGROUND
 In 1859, Florence Nightingale noted cases of
under‑nutrition in soldiers who were hospitalised in
the Crimea, also writing about the importance of
nutrition to their overall wellbeing
 Over a century later, evidence of malnutrition in
hospital patients is a focus of attention because,
despite informed practices, malnutrition may still be
the skeleton in the hospital cupboard (Weinsler et al
1979) and its treatment unresolved
BACKGROUND
 In developed countries, malnutrition is known to
afflict between 20‑50% of adults in hospital also
co‑existing with other disease processes.
 There are clear correlations between parameters
reflecting poor nutrition such as low body
mass index or decreased serum albumin
and rate of in‑hospital complications,
readmissions and mortality (Correia and
Waitzberg 2003).
BACKGROUND
 Prevalence of disease related malnutrition is
reported to vary from 25-40% in hospital
inpatients to 15-25% in home care units and
20-25% in nursing homes
 It is well recognised that malnourished patients
recover more slowly from illness(poor wound
healing or altered immune function.
 PROSES ASUHAN RAWAT INAP MENCEGAH
GIZI STANDAR TERJADINYA
RAWAT JALAN MASALAH
GIZI
GAWAT DARURAT (MALNUTRIT
ION)
SKRINING GIZI/PENAPISAN GIZI

Intervensi Gizi yang tepat akan memperbaiki

hasil terapi pasien  PASIEN LEBIH CEPAT
KELUAR RS
PENGERTIAN
Malnutrition screening is a quick and easy
procedure using a valid malnutrition
screening tool, designed to identify those who
are malnourished or at risk of malnutrition and
may benefit from nutritional intervention froma
registered dietitian or expert clinician
PENGERTIAN
Skrining gizi merupakan proses identifikasi
masalah gizi yang cepat, sederhana, efisien,
mampu dilakukan, murah, tidak beresiko
kepada individu yang diskrining, valid dan
reliable dan dapat dilakukan oleh tenaga
kesehatan yang lain
TUJUAN
1. Mengidentifikasi pasien yang beresiko
mengalami masalah gizi (malnutrition), tidak
beresiko malnutrition atau kondisi khusus
(kelainan metabolik, hemodialisa, geriatrik,
dengan kemoterapi atau radiasi, luka bakar,
pasien dengan imunitas ↓, sakit kritis)
2. Ketepatan dalam intervensi gizi sehingga dapat
mencegah malnutrisi di rumah sakit dan
mempercepat proses penyembuhan
MANFAAT
Skrining gizi  Membantu
mengidentifikasi asuhan gizi secara
spesifik yang bermanfaat sebagai tahap
awal asuhan gizi.
PELAKSANAAN
Rekomendasi ESPEN (European Society
For Parenteral and Enteral Nutrition),
menetapkan bahwa skrining dilakukan
pada awal pasien masuk rumah awal
sakit (1 x 24 jam setelah pasien masuk
rumah sakit) untuk mengidentifikasi
pasien yang beresiko masalah gizi
ALUR
SKRINING
TOOLS
Malnutrition screening tools are 1. MST
generally of questionnaire 2. MUST
format, addressing risk factors 3. NRS 2002
for malnutrition (e.g. poor appetite
4. SGA
or functional limitations), and
5. MNA
indicators of malnutrition (e.g.
recent involuntary weight loss), and 6. SNAQ
are most often administered by 7. DETERMINE
staff other than dietitians, such as 8. NUFFE
nursing staff.
 MALNUTRITION SCREENING
TOOL (MST) Interpretasi :
MST : 0-1  tidak beresiko
MST : > 2  beresiko

MST merupakan instrumen skrining yang yang paling banyak digunakan

di rumah sakit di Australia.
MALNUTRITION SCREENING
TOOL (MST)
Kelebihan dari alat skrining MST adalah lebih
efisien (waktu 30 detik), pertanyaan lebih
sederhana, nilai sensitivitas dan spesifisitas 93-
95%, nilai keandalan 90-97%, tidak tergantung
pada nilai antropometri dan laboratorium.
MALNUTRITION UNIVERSAL
SCREENING TOOL (MUST)
‘MUST’ adalah alat skrining lima langkah untuk
mengidentifikasi orang dewasa yang memiliki
resiko masalah gizi (undernutrition/ obesitas).
MUST juga mencakup pedoman manajemen
yang dapat digunakan untuk mengembangkan
rencana perawatan.
PENGGUNAAN MUST
MUST dapat digunakan di rumah sakit,
komunitas dan asuhan gizi lainnya dan
dapat digunakan oleh semua pekerja
perawatan.
NUTRITION RISK
SCREENING (NRS 2002)
 NRS 2002 adalah instrumen yang sukses digunakan
di seluruh Eropa
 ESPEN merekomendasikan NRS 2002 untuk
mendeteksi adanya masalah gizi (undernutrition) dan
resiko berkembangnya masalah gizi di RS. NRS 2002
protokol /form berasal dari pengembangan MUST
dengan menambahkan tingkat keparahan penyakit,
penyesuaian usia (jika > 70 tahun), dan mencakup
semua kategori pasien yang mungkin di rumah sakit.
NRS 2002
NRS 2002 asks four pre-screening questions with regard to
adult patients:
1. Is the patient’s body-mass-index (BMI) less than 20.5? (BMI
= weight/height m2)
2. Has the patient lost weight within the last three months?
3. Has the patient had a reduced dietary intake in the last
week?
4. Is the patient severely ill (e. g. in intensive therapy)?
If the answer is “Yes” to any question during this initial pre-
screening, a final screening should be performed. If the answer
is “No” to all questions, then the patient should be re-screened
in weekly intervals to monitor nutritional status.
SUBJECTIVE GLOBAL
ASSESSMENT (SGA)
As an extended alternative to the NRS
2002 protocol, the SGA can be used to
identify patients with existing
malnutrition or who are at risk of
developing malnutrition, using a
bedside assessment.
SUBJECTIVE GLOBAL
ASSESSMENT (SGA)
SGA considers alterations in body
composition and changes in physiological
function.
Originally developed to assess surgical
patients, many studies have shown its
applicability in other clinical situations,
evaluating patients with renal failure, cancer,
hepatic diseases, as well as the elderly
and HIV-infected.
SGA
SGA criteria take into account the following patient factors:
1. Weight loss
2. Dietary intake
3. Gastrointestinal (GI) symptoms
4. Functional capacity
5. Disease-related effects
6. Physical signs of malnutrition (loss of subcutaneous fat or
muscle mass, edema, ascites)
If a patient receives an SGA “A” rating, they are considered well
nourished. An SGA “B” rating indicates a moderately
malnourished patient; an SGA “C” rating indicates a severely
malnourished patient.
SUBJECTIVE GLOBAL
ASSESSMENT (SGA)
Kelebihan: Teknik SGA lebih komprehensif,
terdiri dari terdiri dari dua tahap dan
menggunakan pendekatan klinis terstruktur,
terdiri dari anamnesis dan pemeriksaan fisik
yang mencerminkan perubahan metabolik dan
fungsional.
SUBJECTIVE GLOBAL
ASSESSMENT (SGA)
Anamnesis terdiri dari keterangan mengenai
perubahan berat badan, perubahan asupan gizi,
gejala saluran cerna, gangguan kemampuan
fungsional, dan penyakit yang dialami pasien
 mencari etiologi malnutrisi apakah akibat
penurunan asupan makanan, malabsorbsi,
maldigesti atau peningkatan kebutuhan.
SUBJECTIVE GLOBAL
ASSESSMENT (SGA)
Pemeriksaan fisis menilai kehilangan massa
otot dan lemak serta adanya asites
 bermanfaat untuk mengidentifikasi
perubahan komposisi tubuh akibat efek
malnutrisi atau pengaruh proses penyakit
PATIENT-GENERATED
SUBJECTIVE GLOBAL
ASSESSMENT(PG-SGA)
Pada 1994 Ottery telah mengembangkan Patient-
Generated (PG) -SGA, yang dibuat untuk penilaian gizi
pasien kanker. Selain format asli, PG-SGA ini mencakup
pertanyaan tambahan tentang adanya gejala masalah gizi
dan penurunan berat badan jangka pendek.

Skor PG-SGA ini dimodifikasi lebih lanjut dan sistem skor

numerik diperkenalkan yang memberikan peringkat global
kepada pasien yang mengalami gizi baik, kurang gizi
sedang atau dicurigai kurang gizi atau kurang gizi
PATIENT-GENERATED
SUBJECTIVE GLOBAL
ASSESSMENT(PG-SGA)
PATIENT-GENERATED
SUBJECTIVE GLOBAL
ASSESSMENT(PG-SGA)
PATIENT-GENERATED
SUBJECTIVE GLOBAL
ASSESSMENT(PG-SGA)
PATIENT-GENERATED
SUBJECTIVE GLOBAL
ASSESSMENT(PG-SGA)
MINI NUTRITIONAL
NUTRITION (MNA)
The MNA  is a validated nutrition screening and assessment
 ®

tool that can identify geriatric patients age 65 and above who
are malnourished or at risk of malnutrition.
 The MNA® was developed nearly 20 years ago and is the most
well validated nutrition screening tool for the elderly. Originally
comprised of 18 questions, the current MNA® now consists of 6
questions and streamlines the screening process.
 The current MNA® retains the validity and accuracy of the
original MNA® in identifying older adults who are malnourished
or at risk of malnutrition. The revised MNA® Short Form
 makes the link to intervention easier and quicker and is now
the preferred form of the MNA® for clinical use.
MINI NUTRITIONAL
ASSESSMENT – SHORT
FORM (MNA-SF)
The MNA-SF is a screening tool to help
identify elderly patients who are
malnourished or at risk of malnutrition.
The User Guide will assist you in
completing the MNA-SF accurately and
consistently. It explains each question and
how to assign and interpret the score.
MINI NUTRITIONAL
ASSESSMENT – SHORT
FORM (MNA-SF)
The MNA-SF version 1 consists of six
questions taken directly from the
MNA-FF (18-Q)
 Sensitivity ranging from 81 to 100%
and Specificity ranging from 82 to
100%
MNA FULL-FORM
MNA versi 1 dan MNA versi 2
 MNA_english.pdf
MNA-SF VERSI 2
 The MNA-SF version 1 was revised and revalidated in
2009, and includes calf circumference instead of BMI
for cases in which measurement of height and weight is
difficult, such as with bedridden older patients

 MNA-SF version 2 should only be used in cases where

body weight and body height cannot be measured
accurately, as it has been found to be less sensitive
and specific than the original MNA-SF
 MNA versi 2
MINI NUTRITIONAL
NUTRITION (MNA)
MNA
 SHORT NUTRITIONAL
ASSESSMENT
QUESTIONNAIRE (SNAQ-NL)

SNAQ is the screening tool

recommended by the Dutch
Malnutrition Steering Group for
use in the Netherlands

The SNAQ consisting of three

questions, has been validated
for the hospital inpatient
population against low BMI and/or
unintentionally weight loss.
 SHORT NUTRITIONAL ASSESSMENT
QUESTIONNAIRE (SNAQ-NL)
 The SNAQ malnutrition screening tool is a useful
instrument to assess patients’ nutritional status in a
quick, easy and valid way
 The SNAQ has been proven to be a valid and
reproducible screening tool for determining the risk
of malnutrition of hospitalized patients. The
recognition of disease-related malnutrition may
improve from 50% to 80% by using this malnutrition
screening tool
 SHORT NUTRITIONAL ASSESSMENT
QUESTIONNAIRE (SNAQ-NL)

This version of SNAQ is not acceptable for use with

older community-dwelling adults (sensitivity of
31% and specificity of 98%)
 Another version of the SNAQ-NL is the SNAQ-
Residential Care (SNAQ-RC) screening tool which
was developed for use in residential care, and has
evidence of good criterion validity (sensitivity
87%, specificity 82%)
DETERMINE YOUR HEALTH
CHECKLIST (DETERMINE)
The Determine your Health Checklist
(DETERMINE) was developed by the US Nutrition
Screening Initiative (NSI) in the early 1990s
DETERMINE was originally designed for the
purpose of screening for general nutritional
status (i.e. a ‘nutrition’ screening tool), it has
been validated as a malnutrition screening
tool in the community
DETERMINE YOUR HEALTH
CHECKLIST (DETERMINE)
 DETERMINE has high sensitivity (91%), but
low specificity (11%) in the community and
residential care, suggesting the tool
overestimates risk of malnutrition
DETERMINE YOUR HEALTH
CHECKLIST (DETERMINE)
NUTRITIONAL FORM FOR
THE ELDERLY (NUFFE)
 The NUFFE was designed with the purpose of
obtaining a simple, clinically useful tool to screen for
undernutrition in older rehabilitation patients in
Sweden
 The NUFFE could identify malnutrition as effectively
as clinical assessment by a trained nutrition
professional
 NUFFE is a simple, useful screening instrument for
identification of older nutritional at-risk patients
NUTRITIONAL FORM FOR
THE ELDERLY (NUFFE)
Cut off :
Low : 0-5
Medium : 6-12
High risk : > 13
TUGAS KELOMPOK
Bentuk 6 kelompok
Cari Screening tools lain yang belum tertera di at

1. Simplified nutritional appetite questionnaire (SNAQ) Kelompok 1 : 1-2

2. Council on Nutrition Appetite Questionnaire (CNAQ) Kelompok 2 : 3-4
3. Geriatric Nutritional Risk Index (GNRI) Kelompok 3 : 5-7
4. Seniors in the community: Risk Evaluation for eating and Kelompok 4 : 8-10
Nutrition Questionnaire (SCREEN-II) Kelompok 5 : 11-2
5. Malnutrition risk screening tool (MRST) Kelompok 6 : 13-14
6. Controlling Nutritional Status (CONUT)
7. Rapid Screen (RS)
8. Simple NST (Indonesia)
9. Canadian NST
10. Chinese Nutrition Screen (CNS)
11. Nutritional Risk Assessment Scale (NURAS)
12. Nutritional Risk Assessment Tool (NRAT)
13. Screening Tool for Malnutrition in Pediatrics (STAMP)
14. Pediatric Nutritional Risk Score (PNRS)