Which Nutrition Screening Tool Should I Use?

Nutrition screening is the process of identifying individuals who are at nutrition risk and referring those who would benefit from the nutrition care process to the registered dietitian nutritionist (RDN)¹. Nutrition screening relies on tools that are quick and easy-to-use, can be conducted by anyone with minimal training, and usually take less than 10 minutes to complete. The use of valid and reliable tools is essential to avoid under- or over- referring patients or clients with malnutrition.

Academy Evidence Analysis Library

Several validated nutrition screening tools are available for use in clinical practice. In 2018, The Academy of Nutrition and Dietetics (Academy) Evidence Analysis Library completed a systematic review of six nutrition screening tools commonly used in health care settings. The next section lists the nutrition screening tools evaluated for validity, reliability, and agreement by the Academy Evidence Analysis Library (EAL)¹.

Nutrition Screening Tools

Modified Mini-Nutritional Assessment short form (MNA-SF-BMI): Exhibited a high degree of validity and a moderate degree of agreement in identifying malnutrition risk in adults across care settings, medical conditions and ages. Inter-rater reliability of the tool was not reported.
Short Nutritional Assessment Questionnaire (SNAQ): Exhibited a moderate degree of validity and a moderate degree of inter-rater reliability in identifying malnutrition risk in adults across care settings, medical conditions and ages. Agreement of the tool was not reported. (Academy EAL)
Malnutrition Screening Tool (MST): Exhibited a high degree of validity, a moderate degree of agreement and a moderate degree of inter-rater reliability in identifying malnutrition risk in adults across care settings, medical conditions and ages.
Nutritional Risk Screening 2002 (NSR-2002): Exhibited a moderate degree of validity and a moderate degree of agreement in identifying malnutrition risk in adults across care settings, medical conditions and ages. Inter-rater reliability of the tool was not reported.
Malnutrition Universal Screening Tool (MUST): Exhibited a high degree of validity, a moderate degree of agreement and a moderate degree of inter-rater reliability in identifying malnutrition risk in adults across care settings, medical conditions and ages.
Mini Nutritional Assessment Short Form (MNA-SF): Exhibited a moderate degree of validity, a low degree of agreement and a moderate degree of inter-rater reliability in identifying malnutrition risk in adults across care settings, medical conditions and ages. It is most often used in institutionalized older adults².

Recommendations

Based on the results of the EAL review, a position paper was published by the Academy of Nutrition and Dietetics in 2020, indicating that the Malnutrition Screening Tool (MST) is recommended for adults in all settings³. However, the EAL review did not include the Subjective Global Assessment (SGA). This tool is more in-depth than other nutrition screening tools but not a comprehensive assessment. Nevertheless, it has been widely validated as a strong predictor of malnutrition-related outcomes⁴. Researchers confirmed the effectiveness of the Mini Nutritional Assessment (MNA) and the Subjective Global Assessment (SGA) in assessing and diagnosing malnutrition⁴.

Conclusion

It is important to utilize validated tools for the assessment and diagnosis of malnutrition. The EAL favors the Malnutrition Screening Tool (MST) for use in adults across all settings. Additionally, research conducted in 2022 further validated the effectiveness of the Mini Nutritional Assessment (MNA) and the Subjective Global Assessment (SGA) as reliable methods for evaluating malnutrition⁴. Together, these tools provide a framework for identifying and addressing malnutrition in various populations.

See Academy Evidence Analysis Library for more information on adult nutrition screening.
Refer individuals whose nutrition screening indicates a risk of or presence of malnutrition, undernutrition, or unintended weight loss to a registered dietitian nutritionist (RDN) for comprehensive nutrition assessment and other interdisciplinary team (IDT) members as appropriate.
Learn more in our Diet and Nutrition Care Manual. Also, search our courses and webinars for more on malnutrition including our Adult Malnutrition Course Bundle.

References

Academy of Nutrition and Dietetics. Academy of Nutrition and Dietetics definition of terms list. September 2023. Available from CDR.net. Accessed October 12, 2024.
Reber E, Gomes F, Vasiloglou MF et al. Nutritional Risk Screening and Assessment. J Clin. Med. 2019;8(7):1065. https://doi.org/10.3390/jcm8071065
Skipper A, Coltman A, Tomesko A et al. Position of the Academy of Nutrition and Dietetics: malnutrition (undernutrition) screening tools for all adults. J Acad Nutri Diet. 2020;120(4):709-713.
Malone A, Mogensen KM. Key approaches to diagnosing malnutrition in adults. Nutr. Clin. Pract. 2022;37(1):23-34. https://doi.org/10.1002/ncp.10810

Originally published April 22, 2022. Revised November 6, 2024.