Geriatric Nutritional Risk Index

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The Geriatric Nutrition Risk Index (GNRI) is an adaptation to the Nutritional Risk Index (NRI). The GNRI is specifically designed to predict the risk of morbidity and mortality in hospitalized elderly patients (Table 1.7) [38]. Because the normal weight of the elderly patients is often difficult to determine, this tool substitutes "ideal weight" in place of "usual weight" used by the NRI. The GNRI is calculated using a special formula incorporating both serum albumin

Table 1.6

Malnutrition Universal Screening Tool (MUST)

BMI Score Effect Weight Loss Score Acute Disease

(unemplanned weight loss in 3-6 months)

BMI >20.0 ( >30 obese) = 0 Wt loss <5% = 0 Add a score of 2 if there BMI 18.5-20.0 = 1 Wt loss 5-10% = 1 has been or is likely to

BMI <18.5 = 2 Wt loss >10% = 2 be no nutritional intake for > 5 days

Add all scores ;

Overall risk of malnutrition and management guidelines 0 1 >2 Low Risk Medium Risk High Risk

Routine Clinical Care Observe Treat

Repeat screening to dietitian, Document dietaryRefer to dietitian intake

Hospital: weekly for 3d if subject innutrition support hospital

Care homes: Monthly or care home team or implement

Community:annually for if improved orlocal policy adequate intake, special groups ( >75 years old )little clinicallmprove and concern; if no

Improvement,clinicalincrease overall conern:

Follow local policy nutritional intake Repeat screeing Monitor and Care home:at leastHospital:weekly monthly

Community:at leastCare home: monthly every 2-3

Months Community:month and weight loss. Ideal body weight is calculated using the Lorentz formula based on the patient's height and sex [38]. After determining the GNRI score, patients are categorized into four grades of nutrition-related risk: major, moderate, low and no risk. Finally, the GNRI scores are correlated with a severity score that takes into account nutritional-status-related complications.

The GNRI is not an index of malnutrition, but rather a "nutrition-related" risk index. Two independent predictors of mortality in the

Table 1.7 Geriatric Nutrition Risk Index

GNRI = [1.489 x albumin (g/l)] + [41.7 x (weight/WLo)]

The GNRI results from replacement of ideal weight in the NRI formula by usual weight as calculated from the Lorentz formula (WLo). Four grades of nutrition-related risk: major risk (GNRI < 82), moderate risk (GNRI 82-91), low risk (GNRI 92 to < 98), no risk (GNRI > 98)

Table 1.8

Instant Nutritional Assessment parameters

Table 1.8

Instant Nutritional Assessment parameters

Parameter

Abnormal if:

Serum albumin ------

-----> Less than 3.5 g %

Total lymphocyte----

-----Less than 1, 500/mm3

count

elderly, weight loss and serum albumin, are used to calculate the GNRI. Interestingly, studies have shown that by measuring these two variables, the GNRI is a more reliable prognostic indicator of morbidity and mortality in hospitalized elderly patients than are other techniques using albumin or BMI alone [39].

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