Nutrition Risk Screening (NRS-2002)

Evaluates risk of malnutrition in hospitalized patients.

Refer to the text below the calculator for more information on this nutrition screening and its usage.


The Nutrition Risk Screening (NRS-2002) was designed as a 2-part screening for malnutrition, to be used risk stratifying hospitalized patients and in devising what profilactic measures are to be applied.

The initial screening consists in 4 criteria (BMI<20.5, weight loss within 3 months, reduced dietary intake in the last week and ICU patient) and rules out patients that are low risk.

The final screening consists in 3 items where answer choices are scored from 0 to 3. The sum of the scores is then used to provide the final score which classifies the patient in one of the risk categories.


NRS-2022 interpretation

NRS-2002 result Risk Group Intervention
0 - 3 Low risk Re-screen at weekly intervals
4 At risk Initiate nutritional care plan (food, oral supplements, tube feeding, and/or parenteral nutrition as appropriate)
5 - 7 High risk Initiate early intervention nutritional care plan

1

Initial Screening

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The Nutrition Risk Screening Explained

The NRS-2002 predicts risk of malnutrition in critically-ill hospitalized patients, based on the Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.).

It consists in an initial screening with four criteria:

  • BMI <20.5 kg/m²
  • Weight loss within the last 3 months
  • Reduced dietary intake in the last week
  • Is the patient severely ill (ICU)?

If none of the above is present, then the patient is considered at low risk of malnutrition but if at least one of the above is present, the final screening is applied.

The final screening evaluates nutritional impairment (under 4 classes: absent, mild, moderate and severe), evaluates severity of disease (under same 4 classes as previous item) and also takes into account the patient’s age.

Scores for the final screening range from 0 to 7, where the higher the score, the more severe the risk of malnutrition:

NRS-2002 result Risk Group Intervention
0 - 3 Low risk Re-screen at weekly intervals
4 At risk Initiate nutritional care plan (food, oral supplements, tube feeding, and/or parenteral nutrition as appropriate)
5 - 7 High risk Initiate early intervention nutritional care plan
 

About the original study

Kondrup et al. have designed a system for screening nutritional risk following a number of 128 randomized trials.

In each trial, the group of patients was classified with respect to nutritional status and severity of disease, and it was determined whether the effect of nutritional intervention on clinical outcome was positive or absent.

In 75 of the cases, patients where classified as being nutritionally at-risk and 43 of them showed a positive effect of nutritional support on clinical outcome. In 53 of the cases of patients not considered to be nutritionally at-risk, 14 showed a positive effect.

The NRS-2002 is deemed to be able to distinguish between trials with a positive effect vs no effect and so can identify patients who are likely to benefit from nutritional support.

 

References

Original reference

Kondrup J, Rasmussen HH, Hamberg O, Stanga Z. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003;22(3):321-36.

Validation

Borek P, Chmielewski M, Małgorzewicz S, Dębska Ślizień A. Analysis of Outcomes of the NRS 2002 in Patients Hospitalized in Nephrology Wards. Nutrients. 2017;9(3).

Other references

Kondrup J, Johansen N, Plum LM, et al. Incidence of nutritional risk and causes of inadequate nutritional care in hospitals. Clin Nutr. 2002;21(6):461-8.

Mcclave SA, Dibaise JK, Mullin GE, Martindale RG. ACG Clinical Guideline: Nutrition Therapy in the Adult Hospitalized Patient. Am J Gastroenterol. 2016;111(3):315-34.

Mcclave SA, Taylor BE, Martindale RG, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2016;40(2):159-211.


Specialty: Nutrition

Objective: Risk Screening

Year Of Study: 2002

Abbreviation: NRS

Article By: Denise Nedea

Published On: May 8, 2020

Last Checked: May 8, 2020

Next Review: May 8, 2025