Screening and diagnostics
Screening and diagnostics are essential for early recognition and treatment of (risk of) malnutrition. This can ensure that the seriousness and negative consequences for care complexity, care need and quality of life remain limited. If the outcome of the screening indicates an increased risk of malnutrition, diagnostics for establishing malnutrition is indicated. This is preferably performed by a dietitian.
Screening for the risk of malnutrition is indicated:
- Upon admission to a healthcare institution;
- In the case of the assessment by home care as part of the nursing anamnesis;
- In general practice;
- At the first visit to the outpatient clinic in the hospital.
A malnutrition screening instrument is available for every care sector. You can use some screening instruments in any healthcare sector.
|Screening tool (click to view)||Target group / sector|
|MUST / Malnutrition Universal Screening Tool||All sectors|
|PG-SGA-SF / Patient Generated Subjective Global Assessment – Short Form||All sectors|
|MNA(-SF) /Mini Nutritional Assessment (-Short Form)||For older people aged 65 and over in all sectors|
|SNAQ / Short Nutritional Assessment Questionaire||Clinical patients, in hospital|
|Voedingstoestandmeter with Addendum||Outpatients, hospital|
|SNAQ-65+ / Short Nutritional Assessment Questionaire-65+||Elderly ≥65 years, primary care and rehabilitation center|
|SNAQ-rc / Short Nutritional Assessment Questionaire-residential care||Nursing and care homes|
|NUTRIC Score||Intensive Care|
See also the library (under Knowledge Base) for the substantiation and literature of the various SNAQ variants. Translations of the various SNAQ screening instruments are also available, see www.fightmalnutrition.eu.
In 2018, global consensus criteria for diagnosing adult malnutrition (GLIM) were published. A Dutch translation has been published in the ‘Nederlands Tijdschrift voor Voeding & Dietetiek’ . The use of these diagnostic criteria for the determination of malnutrition by Dutch healthcare providers is recommended by the Knowledge Center Malnutrition. The diagnosis of malnutrition is made in 2 steps.
Step 1 screens for malnutrition using a validated instrument (eg SNAQ, MUST, SNAQ65+, MNA). If the outcome of the screening indicates that someone has an increased risk of malnutrition, proceed to step 2.
In step 2, it is determined whether there is malnutrition on the basis of characteristic (phenotypic) criteria and causal (etiological) criteria. The diagnosis of malnutrition is made if there is at least one characteristic criterion AND at least one causal criterion. It is then determined whether someone is moderately or severely malnourished (click on the image on the right).
When a question is answered with ‘yes’, a number of points are awarded. The total score (0-5 points) provides advice on follow-up interventions. During hospitalization, it is recommended to repeat this risk screening weekly. Click here fot the STRONGkids screening. STRONGkids has been developed for use in hospitals, but can also be used in primary care or other institutions. However, the use of the STRONGkids in these settings has not been validated.
A separate screening instrument has been developed for children with cerebral palsy. This screening instrument can be used in, for example, the rehabilitation sector. The screening tool consists of a questionnaire of 4 questions. A score of 3 or 4 points means that the child may have difficulties eating, drinking or swallowing and that these may affect his or her safety while eating and/or drinking. It can also mean that the child is having trouble gaining weight. If the child has 3 or 4 points, it is recommended that the parents discuss the eating difficulties and the associated weight with the attending physician. The child may benefit from a referral to a dietician or speech therapist for examination and advice.
For healthcare professionals:
The growth curve
To determine the nutritional status it is necessary to measure the height and weight of the child and to plot these data in a growth curve. This can be plotted in a growth curve on paper, or digitally in the Growth Analyzer.
Dutch clinical practice uses growth curves on which the SD score is indicated. The most commonly used cut-off point for malnutrition is the <-2 SD. The advantage of using the Growth Analyzer compared to growth curves on paper is that this program calculates the standard deviation score, which makes it immediately visible whether there is a growth delay or a deflection of growth. The Growth Analyzer contains different growth curves including weight by age, height by age and weight by height.
- Measure height and weight and plot the correct growth curve based on gender and ethnicity.
- Determine SD scores of weight and height and interpret the values found in the growth curve
- Acute and chronic malnutrition are an indication for further evaluation and treatment.
- Children >28 days and <1 year: weight by age <-2 SD
- Children > 1 year: weight to height <-2 SD
- All children: >1 SD bending growth curve in 3 previous months
- All children: height by age <-2 SD
- Children <4 years: height by age 0.5-1 SD deflection in 1 year
- Children >4 years: height by age 0.25 SD deflection in 1 year
The standard deviation describes the degree of dispersion around a mean. By definition, based on the normal distribution, 2.3% of children will have a weight or height below -2 SD. An SD score below -2 is therefore not always a sign of acute or chronic malnutrition and should be assessed in the patient’s context.
The above and more extensive information with literature references are described in the library.