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Nutritional Screening and Assessment Tools

Use a validated screening tool to identify nutritional risk, then assess the cause, severity and treatment needs. Screening, malnutrition diagnosis and sarcopenia assessment are different steps. Choose a tool suited to the population and local workflow.[1][2][3]

Screening Tools by Setting​

ToolTypical settingCore informationInterpretation
MSTAdult hospital or outpatient careUnintentional weight loss and reduced appetiteScore ≥2 prompts comprehensive nutritional assessment
MUSTAdult community or hospital careBMI, weight loss, acute disease effect0 low, 1 medium, ≥2 high risk; act according to the associated care pathway
NRS-2002Hospitalized adultsNutritional impairment, illness severity and age≥3 indicates nutritional risk; ≥5 denotes high risk in the ESPEN surgical framework
MNA-SFAdults ≥65 yearsIntake, weight, mobility, acute illness/stress, neuropsychological status, BMI or calf circumference12–14 normal, 8–11 at risk, 0–7 malnourished by this instrument
PG-SGA Short FormAdult oncology outpatientsPatient-reported weight, intake, symptoms and activityUse the validated screening version and its threshold; do not substitute a full PG-SGA intervention score
mNUTRICCritically ill adultsAge, APACHE II, SOFA, comorbidity count, hospital-to-ICU interval5–9 high nutrition risk; not a diagnosis of malnutrition. ESPEN 2023 recommends general clinical malnutrition assessment until an ICU-specific tool is validated (GPP, strong consensus).[20]

The Academy of Nutrition and Dietetics recommends MST for adult screening across settings. Other validated tools remain useful in setting-specific pathways. One tool is used consistently, and a positive result leads to assessment and a care plan.[1]

The MST has two questions, on recent weight loss and reduced appetite.[1]

Comparative accuracy​

A 2024 meta-analysis of hospitalized adults pooled the following estimates. Study quality varied greatly, and the reference standards differ.[2]

ToolReference standardPooled sensitivityPooled specificity
MSTSGA0.810.79
MUSTSGA0.840.85
MUSTESPEN criteria0.970.80
NRS-2002SGA0.760.86
MNA-SFESPEN criteria0.990.60

MUST​

BAPEN's tool scores BMI, unintentional weight loss over 3–6 months, and the acute disease effect. The latter applies when the patient is acutely ill and has had, or is likely to have, no nutritional intake for more than five days. BMI scoring is 0 above 20, 1 at 18.5–20 and 2 below 18.5 kg/m²; weight-loss scoring is 0 below 5%, 1 at 5–10% and 2 above 10%. Use the original tool and management pathway.[4]

A 2024 systematic review found pooled MUST sensitivity and specificity of 84% and 85%, respectively, against SGA, with accuracy varying by reference standard and study quality.[2] In a 2025 prospective cohort of 1,649 patients undergoing major gastrointestinal surgery (58% colorectal; SGA reference; 562/1,649 malnourished), MNA-SF (AUC 0.83) and MUST (AUC 0.79; 1,614 evaluable) had the best discrimination, and only MUST had sensitivity and specificity close to 80%.[5] The authors concluded that MUST was the most valid screening tool in that setting.[2][5]

NRS-2002​

Initial screening asks about BMI below 20.5, recent weight loss, reduced intake and severe illness. If indicated, complete the nutritional impairment and disease-severity scoring, adding one point at age ≥70. A score ≥3 identifies risk. The ESPEN 2025 surgical guideline includes NRS ≥5 among high metabolic-risk criteria; this score meets that risk criterion, while operative timing also requires the broader assessment and attention to disease urgency.[6][7] For severe malnutrition and/or high metabolic risk, ESPEN recommends preoperative nutrition therapy even if surgery is postponed (grade A, strong consensus) and considering 10–14 days (grade B).[7]

MNA-SF​

The six-item form was developed for older adults and permits calf circumference when BMI cannot be obtained. The instrument's categories should trigger an appropriate assessment and intervention pathway. Sensitivity and specificity depend on population and comparator. Obtain the current MNA-SF form and guide.[8]

Oncology Screening​

ASPEN's 2024 systematic review identified six validated screening tools, including MST, MUST, NRS-2002, NUTRISCORE, the Mini Nutritional Assessment and PG-SGA Short Form. It did not select PG-SGA Short Form as the only acceptable option. ASPEN's expert panel recommends screening adult oncology outpatients with a tool validated for the intended oncology population after diagnosis and every 4–8 weeks during treatment, with additional screening when the treatment stage or clinical situation changes.[9]

The full scored PG-SGA includes clinician assessment and an intervention-triage score. Its ≥9 urgent-intervention threshold must not be applied to the patient-only short-form screen; validated short-form thresholds differ by study and version.[9]

Assessment and Diagnosis​

Subjective Global Assessment​

SGA combines weight and intake history, gastrointestinal symptoms, function, disease burden and examination for muscle or fat loss or fluid accumulation. Categories are A (well nourished), B (moderate or suspected malnutrition) and C (severe malnutrition). Classification requires trained clinical judgment; a particular weight-loss percentage does not independently assign the category.[10][11]

SGA and GLIM are related assessment approaches and are not interchangeable numerical scores. Use the diagnostic framework required by the clinical service and document the actual findings; a screening result alone does not establish a GLIM diagnosis.

GLIM — 2025 Update​

Following risk screening, GLIM diagnosis requires at least one phenotype and one etiologic criterion. Assess all five criteria when feasible; severity is based on the phenotypic abnormalities. GLIM stage 2 (severe) malnutrition is defined by nonvolitional weight loss >10% within six months or >20% beyond six months, or BMI <18.5 kg/m² below age 70 or <20 kg/m² at age ≥70; muscle-mass severity cutoffs are unavailable.[3]

Phenotypic criteriaEtiologic criteria
Unintentional weight loss >5% within six months or >10% beyond six monthsIntake ≤50% of requirements for >1 week, any reduction for >2 weeks, or impaired assimilation
Low BMI: <20 if age <70 or <22 if ≥70; use appropriate regional thresholdsInflammation or disease burden
Reduced muscle mass assessed using a validated methodAt least one of the two etiologic criteria is required

Muscle strength is not a substitute for muscle mass. If technical body-composition assessment is unavailable, use validated anthropometry or trained examination with awareness of adiposity, edema and reference-population limits. An acute or chronic disease, infection or injury usually associated with inflammatory activity can satisfy the GLIM inflammation criterion; CRP helps resolve uncertain cases.[3]

A negative initial screen does not override substantial clinical concern. In a 328-patient hospitalized cohort that excluded cancer and intensive care, NRS-2002 missed 37 of 114 GLIM-defined cases. The finding supports further assessment when clinical findings conflict with the screen.[12]

ICU: NUTRIC and Modified NUTRIC​

The original NUTRIC combines age, APACHE II, SOFA, number of comorbidities, days from hospital admission to ICU admission, and IL-6. mNUTRIC omits IL-6 and uses the remaining five variables. Mechanical-ventilation days are not an input; replacing APACHE II with SAPS 3 produces a studied modification, not the standard score.[13][14]

The usual high-risk ranges are 6–10 for original NUTRIC and 5–9 for mNUTRIC. These scores incorporate illness severity and prognosis, and they do not measure muscle depletion or establish malnutrition. In a post hoc analysis of 1,199 ICU patients with multiorgan failure, each additional mNUTRIC point multiplied the odds of 28-day mortality by 1.4 (95% CI 1.3–1.5).[13] The association between nutritional adequacy and survival was strong at high scores and diminished at lower scores (interaction p = 0.029).[15][13] In a 2025 systematic review, randomized comparisons and secondary analyses of randomized trials in high-mNUTRIC ICU patients showed no statistically significant reduction in 28-day mortality (OR 1.09, 95% CI 0.74–1.60) or 90-day mortality (OR 1.03, 95% CI 0.87–1.23) with adequate versus lower energy delivery.[19]

Use the ICU nutrition pathway, including hemodynamic stability, feeding tolerance, refeeding risk and appropriate reassessment. Do not prescribe feeding intensity from mNUTRIC alone.

Sarcopenia Case-finding: SARC-F​

SARC-F asks about strength, walking assistance, rising from a chair, climbing stairs and falls. The conventional ≥4 result triggers further assessment. It does not establish probable sarcopenia by itself: in EWGSOP2, that stage requires measured low strength. Its low-to-moderate sensitivity means a negative result cannot reliably rule out sarcopenia when clinical suspicion remains.[16]

The AWGS 2025 update also retains SARC-F ≥4 among older-adult case-finding options, while emphasizing age-specific strength and muscle-mass assessment. See Handgrip Strength for the current frameworks.[17]

Reconstructive Workflow​

  1. Screen early enough to act using the institution's validated tool; review weight trajectory, intake and barriers to eating.
  2. Assess a positive screen or persisting concern, including nutrition-focused examination and an appropriate diagnostic framework.
  3. Assess strength and function separately when sarcopenia or frailty is suspected. Use existing suitable imaging when it adds useful information rather than ordering a scan automatically.
  4. Treat identified problems and reassess. For perioperative patients with malnutrition and/or metabolic risk, include refeeding precautions: ESPEN 2025 recommends starting standard enteral nutrition at 10–30 mL/h and increasing only with stable electrolytes while monitoring intestinal tolerance (GPP, strong consensus). In severe malnutrition, increase enteral tube feeding or PN slowly while monitoring phosphate, potassium and magnesium and assessing the need for thiamine replacement.[7] Nutrition support and operative timing depend on severity, urgency, expected benefit and multidisciplinary judgment. A positive screen is not a fixed surgical contraindication.[7]

Serum albumin and prealbumin should not be used as nutrition markers to diagnose malnutrition; albumin, prealbumin and transferrin should not guide changes in nutrition support.[18] They are affected by inflammation and disease physiology; see the nutritional assessment overview, albumin and prealbumin pages.[18]

See Also​

References​

1. Skipper A, Coltman A, Tomesko J, et al. "Position of the Academy of Nutrition and Dietetics: Malnutrition (Undernutrition) Screening Tools for All Adults." Journal of the Academy of Nutrition and Dietetics. 2020;120(4):709–713. doi:10.1016/j.jand.2019.09.011

2. Cortés-Aguilar R, Malih N, Abbate M, et al. "Validity of Nutrition Screening Tools for Risk of Malnutrition Among Hospitalized Adult Patients: A Systematic Review and Meta-Analysis." Clinical Nutrition. 2024;43(5):1094–1116. doi:10.1016/j.clnu.2024.03.008

3. Jensen GL, Cederholm T, Correia MITD, et al. "GLIM consensus approach to diagnosis of malnutrition: A 5-year update." JPEN. 2025;49:414–427. doi:10.1002/jpen.2756.

4. BAPEN. "The Malnutrition Universal Screening Tool (MUST)." Original tool and care pathway.

5. Petra G, Kritsotakis EI, Gouvas N, et al. "Multicentre Prospective Study on the Diagnostic and Prognostic Validity of Malnutrition Assessment Tools in Surgery." The British Journal of Surgery. 2025;112(2):znaf013. doi:10.1093/bjs/znaf013

6. Chrástecká M, Blanař V, Pospíchal J. "Risk of malnutrition assessment in hospitalised adults: A scoping review of existing instruments." Journal of Clinical Nursing. 2023;32(13–14):3397–3411. doi:10.1111/jocn.16470

7. Weimann A, Bezmarevic M, Braga M, et al. "ESPEN guideline on clinical nutrition in surgery — Update 2025." Clinical Nutrition. 2025;53:222–261. doi:10.1016/j.clnu.2025.08.029.

8. Mini Nutritional Assessment. Official MNA forms and user guides.

9. Trujillo EB, Kadakia KC, Thomson C, et al. "Malnutrition Risk Screening in Adult Oncology Outpatients: An ASPEN Systematic Review and Clinical Recommendations." JPEN. Journal of Parenteral and Enteral Nutrition. 2024;48(8):874–894. doi:10.1002/jpen.2688

10. Duerksen DR, Laporte M, Jeejeebhoy K. "Evaluation of Nutrition Status Using the Subjective Global Assessment: Malnutrition, Cachexia, and Sarcopenia." Nutrition in Clinical Practice. 2021;36(5):942–956. doi:10.1002/ncp.10613

11. Hummell AC, Cummings M. "Role of the Nutrition-Focused Physical Examination in Identifying Malnutrition and Its Effectiveness." Nutrition in Clinical Practice. 2022;37(1):41–49. doi:10.1002/ncp.10797

12. Trollebø MA, Skeie E, Revheim I, et al. "Comparison of Nutritional Risk Screening With NRS2002 and the GLIM Diagnostic Criteria for Malnutrition in Hospitalized Patients." Scientific Reports. 2022;12(1):19743. doi:10.1038/s41598-022-23878-3

13. Rahman A, Hasan RM, Agarwala R, et al. "Identifying critically-ill patients who will benefit most from nutritional therapy: Further validation of the modified NUTRIC nutritional risk assessment tool." Clinical Nutrition. 2016;35:158–162. PubMed. doi:10.1016/j.clnu.2015.01.015

14. Souza IAO, Ribeiro PC, Jonckheer J, De Waele E, Taniguchi LU. "Performance of NUTRIC Score to Predict 28-Day Mortality in Critically Ill Patients After Replacing APACHE II With SAPS 3." PLoS One. 2022;17(7):e0270455. doi:10.1371/journal.pone.0270455

15. McClave SA, Taylor BE, Martindale RG, et al. "Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: SCCM and ASPEN." JPEN. Journal of Parenteral and Enteral Nutrition. 2016;40(2):159–211. doi:10.1177/0148607115621863

16. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. "Sarcopenia: revised European consensus on definition and diagnosis." Age and Ageing. 2019;48:16–31. doi:10.1093/ageing/afy169. See also the published correction.

17. Chen LK, Hsiao FY, Akishita M, et al. "A focus shift from sarcopenia to muscle health in the Asian Working Group for Sarcopenia 2025 Consensus Update." Nature Aging. 2025;5:2164–2175. doi:10.1038/s43587-025-01004-y.

18. Evans DC, Corkins MR, Malone A, et al. "The Use of Visceral Proteins as Nutrition Markers: An ASPEN Position Paper." Nutrition in Clinical Practice. 2021;36:22–28. doi:10.1002/ncp.10588.

19. Bao L, Wang Y, Li Y, Zhang D, Li H. "Impact of nutritional support on mortality among critically ill patients with different nutritional risks: a systematic review with meta-analysis." Front Nutr. 2025;12:1667389. doi:10.3389/fnut.2025.1667389

20. Singer P, Reintam Blaser A, Berger MM, et al. "ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit." Clin Nutr. 2023;42(9):1671–1689. doi:10.1016/j.clnu.2023.07.011