Nutritional Risk Index

The Nutrition Risk Index (NRI) was developed by the Veteran's Affairs Total Parenteral Nutrition group in 1991 for use in the evaluation of the efficacy of peri-operative total parenteral nutrition in patients

Table 1.3 Mini Nutritional Assessment (MNA)

NESTLÉ NUTRITION SEBVICES

fHf Mini Nutritional Assessment

Last name:

First name:

Sex:

Date:

Age:

Weight, kg:

Height, cm:

I.D. Number:

Complete the screen by filling in the boxes with the appropriate numbers.

Add the numbers for the screen. If score is 11 or less, continue with the assessment to gain a Malnutrition Indicator Score.

Screening

J

A Has food intake declined over the past 3 months due to loss of appetite, digestive problems, chewing or swallowing difficulties?

0 = severe loss of appetite

1 = moderate loss of appetite

2 = no loss of appetite

K

B Weight loss during last months

1 = does not know

2 = weight loss between 1 and 3 kg (2.2 and 6.6 lbs)

3 = no weight loss

0 = bed or chair bound

1 = able to get out of bed/chair but does not go out

2 = goes out

M

D Has suffered psychological stress or acute disease in the past 3 months 0 = yes 2 = no

E Neuropsychological problems

0 = severe dementia or depression

1 = mild dementia

2 = no psychological problems

N

F Body Mass Index (BMI) (weight in kg) / (height in m)

0 = BMI less than 19

3 = BMI 23 or greater

O

Screening score (subtotal max. 14 points)

□ □

P

12 points or greater Normal - not at risk -

no need to complete assessment

11 points or below Possible malnutrition - continue assessment

0.0= not as good 0.5 = does not know 1.0 = as good 2.0= better

1 meal

3 meals I_I

• At least one serving of dairy products

(milk, cheese, yogurt) per day? yesD noD

• Two or more serving of legumes or eggs perweek? yes □ noD

• Meat, fish or poultryevery day yesD noD 0.0= if 0 or lyes

0.0= less than 3 cups

al status g malnourished al state

0.0= not as good 0.5 = does not know 1.0 = as good 2.0= better

M How much fluid (water, juice, coffea tea milk..J

.

Q Mid-a 0.0 =

mc^Z^r0 in cm

Assessment

1 0.5 = 1 1.0 =

MAC 21 to 22 MAC 22 or greater

.

G Lives independently (not in a nursing home or hospital) 0 = no 1 = yes

0=

rcCuCmlefesrsetnhcaen(3C1C) in cm 1 =

CC 31 or greater

H Takes more than 3 prescription diugs per day 0 = yes 1 = no

H Takes more than 3 prescription diugs per day 0 = yes 1 = no

Assessment (max. 16 points) D D D

Screening score dl D

Total Assessment (max. 30 points) CH CH O

Ref.

yes assistance

Ref.

undergoing thoracic or abdominal surgery [35]. The NRI relies on serum albumin measurements and differences in a patient's current and previous body weight (Table 1.5). It has been used in clinical studies with reasonable reliability [36]. In a mixed group of Irish medical and

Table 1.4 Nutrition risk score

Patient's Name: Date of Birth:

Weight: Height/Length:

Please circle relevant score. Only select one score from each section.

PEDIATRICS (0-17 years) PRESENT WEIGHT

Expected weight for length 90-99% of expected weight for length

80-89% of expected weight for length

<79% of expected weight for length

Omit Question 2 For Pediatrics

SCORE

Ward: Date:

ADULTS (>18 years) WEIGHT LOSS IN LAST 3 MONTHS (Unintentional)

No weight loss 0-3 kg weight loss

>3-6 kg weight loss

6 kg or more

BMI (Body Mass Index)

20 or more 18 or 19 15-17

Fess than 15

APPETITE

• Good appetite, manages most of 3 meals/day (or equivalent)

• Poor appetite, poor intake - leaving > half of meals provided (or equivalent)

• Appetite nil or virtually nil, unable to eat, NBM (for > 4 meals)

SCORE

(Continued)

Table 1.4 (Continued)

ABILITY TO EAT/RETAIN FOOD

• No difficulties eating, able to eat independently. 0

• No diarrhea or vomiting.

• Problems handling food, e.g., needs special cutlery. 1 Vomiting/frequent regurgitation, or diarrhea).

• Difficulty swallowing, requiring modified consistency. 2 Problems with dentures, affecting food intake. Problems with chewing, affecting food intake.

Slow to feed. Moderate vomiting and/or diarrhea (1-2/day for children). Needs help with feeding (e.g., physical handicap).

• Unable to take food orally. Unable to swallow (complete dysphagia). 3 Severe vomiting and/or diarrhea (> 2/days for children). Malabsorption.

STRESS FACTOR

• No Stress Factor: (Includes admission for investigation only). 0

• Mild Minor surgery. Minor infection. 1

• Moderate Chronic disease. Major Surgery. Infections. 2

Fractures. Pressure sores/ulcers. CVA.

Inflammatory bowel disease. Other gastrointestinal disease.

• Severe Multiple injuries. Multiple fractures/burns. 3

Multiple deep pressure sores/ulcers. Severe sepsis. Carcinoma/malignant disease.

TOTAL

Table 1.5 Nutritional Risk Index

NRI = 1.519 x serum albumin (g/l) + 0.417x (current weight/usual weight) x 100

No nutrition risk: NRI > 100 Borderline nutrition risk: NRI > 97.5 Mild nutrition risk: NRI 83.5-97.5 Severe nutritional risk: NRI < 83.5

surgical patients, the NRI identified patients with a prolonged length of stay in the hospital, or a reduced ability to return home, and higher patient mortality [16].

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Good Carb Diet

WHAT IT IS A three-phase plan that has been likened to the low-carbohydrate Atkins program because during the first two weeks, South Beach eliminates most carbs, including bread, pasta, potatoes, fruit and most dairy products. In PHASE 2, healthy carbs, including most fruits, whole grains and dairy products are gradually reintroduced, but processed carbs such as bagels, cookies, cornflakes, regular pasta and rice cakes remain on the list of foods to avoid or eat rarely.

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