Common nutritional screening and assessment tools_
| Tool | Element | Forms of assessment | Efficiency assessment |
|---|---|---|---|
| NRS-2002 | Impaired nutritional status (weight loss, BMI, and food intake) and disease severity | Marking Scheme | Very effective |
| MUST | BMI, weight loss in the past 3–6 months, and acute illness of >5 days duration | Marking Scheme | Very effective |
| NMA | BMI, recent weight loss status, diet, nutrient absorption status, physical health status | Marking Scheme | Effective |
| SGA | Medical history (weight change, dietary intake, gastrointestinal symptoms, functional capacity, and metabolic stress) and physical examination (subcutaneous fat loss, muscle wasting, edema, and ascites). | Questionnaire | Effective |
| PG-SGA | Subjective patient assessment: weight, food intake, symptoms, activities, and body functions + Medical staff assessment: relationship between disease and nutritional needs, metabolic needs, physical examination | Questionnaire | Effective |
| PNI | 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (cells/mm3) | Formula | Simple and fast, but requires lab parameters |
| NRI | 1.489 × serum albumin (g/L) + 41.7 × (current weight/usual weight) | Formula | Simple and fast, but requires lab parameters |
| NRS | Unintentional weight loss in the past 3 months, BMI, appetite, ability to eat or retain food, and severity of disease | Marking Scheme | Very effective |
| COUNT | Serum albumin level (Ag/dL), total lymphocyte count (n/mm3), total cholesterol concentration (mg/dL) | Marking Scheme | Simple and fast, but requires lab parameters |
Indications and contraindications of PN and EN_
| Nutritional support pathway and indication | Contraindication |
|---|---|
| Enteral Nutrition | |
| Preoperative and postoperative supportive care for malnourished patients | Complete mechanical intestinal obstruction, paralytic intestinal obstruction |
| Difficulty in swallowing or chewing | Gastrointestinal bleeding and perforation |
| Disorders of consciousness and coma | Abdominal or intestinal infection |
| Stable stage of digestive tract disease | Early stage and shock state of severe infection, trauma and other stress states |
| High catabolic state | Early stage of short bowel syndrome, high flow intestinal fistula |
| chronic wasting disease | Severe vomiting, diarrhea, malabsorption |
| Parenteral nutrition | |
| Mechanical obstruction and paralytic intestinal obstruction caused by EN | Patients with normal gastrointestinal function or indications for EN |
| Short bowel syndrome | Cardiovascular dysfunction or severe metabolic disorder |
| Absorptive dysfunction | High intestinal fistula, congenital malformation of gastrointestinal tract, and excessive gastrointestinal reaction during radiotherapy |
| Severe vomiting and diarrhea | Severe burns and severe infections |
| Severe malnutrition | Ulcerative colitis, localized enteritis, long-term diarrhea |
| Hyperemesis gravidarum | Necrotizing pancreatitis, acute renal failure, liver failure |
| High risk of aspiration | Brain death or irreversible coma |