Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials
Abstract
Background & aims A system for screening of nutritional risk is described. It is based on the concept that nutritional support is indicated in patients who are severely ill with increased nutritional requirements, or who are severely undernourished, or who have certain degrees of severity of disease in combination with certain degrees of undernutrition. Degrees of severity of disease and undernutrition were defined as absent, mild, moderate or severe from data sets in a selected number of randomized controlled trials (RCTs) and converted to a numeric score. After completion, the screening system was validated against all published RCTs known to us of nutritional support vs spontaneous intake to investigate whether the screening system could distinguish between trials with a positive outcome and trials with no effect on outcome. Methods The total number of randomized trials identified was 128. 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. Results Among 75 studies of patients classified as being nutritionally at-risk, 43 showed a positive effect of nutritional support on clinical outcome. Among 53 studies of patients not considered to be nutritionally at-risk, 14 showed a positive effect (P=0.0006). This corresponded to a likelihood ratio (true positive/false positive) of 1.7 (95% CI: 2.3-1.2). For 71 studies of parenteral nutrition, the likelihood ratio was 1.4 (1.9-1.0), and for 56 studies of enteral or oral nutrition the likelihood ratio was 2.9 (5.9-1.4). Conclusion The screening system appears to be able to distinguish between trials with a positive effect vs no effect, and it can therefore probably also identify patients who are likely to benefit from nutritional support.
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Intravenous fat emulsions based solely on soybean oil rich in 18 carbon omega-6 fatty acids have likely pro-inflammatory effects.
“From previous and recent recommendations(2,42), it is clear that the use of intravenous fat emulsions based solely on a soybean oil rich in 18 carbon omega-6 FA should be avoided due to their likely pro-inflammatory effects.”
From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [42]
Patients with low muscle mass found at admission have a higher length of stay and higher mortality.
“A very recent study showed that patients with low muscle mass found at admission have a higher length of stay and higher mortality (42).”
From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [42]
ESPEN recommended the use of the Malnutrition Universal Screening Tool (MUST) in community settings, the Nutritional Risk Screening tool (NRS-2002) in clinical settings, and the Mini Nutritional Assessment (MNA) for the elderly.
“ESPEN recommended the use of the Malnutrition Universal Screening Tool (MUST) in community settings (48), the Nutritional Risk Screening tool (NRS-2002) in clinical settings (49), and the Mini Nutritional Assessment (MNA) for the elderly (50).”
From Evolution of the diagnosis of malnutrition in adults: a primer for clinicians (2024) · cites this paper as [49]
A definition of acute critical illness-associated malnutrition still needs to be developed.
“A definition of acute critical illnessassociated malnutrition still needs to be developed [8].”
From ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit (2023) · cites this paper as [8]
The existing nutritional screening tools NRS 2002 and MUST have not been designed specifically for critically ill patients.
“The existing nutritional screening tools (nutritional risk screening (NRS) 2002 [8] and the malnutrition universal screening tool (MUST) score [9]) have not been designed specifically for critically ill patients.”
From ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit (2023) · cites this paper as [8]
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- Authors
- KONDRUP, J.
- Affiliations
- Rigshospitalet (DK)
- Corresponding author
- KONDRUP, J
- Venue
- Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2003-06
- Volume
- 22
- Issue
- 3
- Pages
- 321-336
- ISSN
- 0261-5614 (ISSN-L)
- OpenAlex
- W2052139208
- Cited by
- 3,063
- References
- 3
- Citations by year
- 2026: 262 · 2025: 285 · 2024: 310 · 2023: 252 · 2022: 262 · 2021: 227 · 2020: 231 · 2019: 147 · 2018: 141 · 2017: 151 · 2016: 133 · 2015: 140 · 2014: 119 · 2013: 82 · 2012: 71
- FWCI
- 10.58
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Bern Open Repository and Information System (University of Bern) (submittedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Keywords
- nutritional risk screening, NRS-2002, nutritional support, malnutrition, disease severity, nutritional status, parenteral nutrition, enteral nutrition, oral nutrition, likelihood ratios, screening validation, critically ill patients
- MeSH terms
- Enteral Nutrition, Humans, Mass Screening, Parenteral Nutrition, Risk Factors, ROC Curve, Sensitivity and Specificity, Severity of Illness Index, Meta-Analysis as Topic, Nutrition Assessment, Likelihood Functions, Logistic Models, Randomized Controlled Trials as Topic, Outcome Assessment, Health Care, Nutritional Support, Malnutrition
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