Assessment of nutritional status in the healthcare setting in Spain

Early identification of undernourished patients in the healthcare setting, and their nutritional treatment, are essential if the harmful effects of poor nourishment are to be avoided and care costs kept down. The aim of assessing nutritional status is to determine the general health of a patient from a nutritional viewpoint. All hospitalised patients should undergo nutritional screening within 24-48 h of admission, as should any patient who shows signs of being malnourished when visiting any healthcare centre. The infrastructure and resources available, the possibilities of automisation, and the healthcare setting in which such assessment must be performed, etc., determine which method can be used. The European Society of Parenteral and Enteral Nutrition (ESPEN) recommends the use of the Nutritional Risk Screening-2002 (NRS-2002) method for hospitalised patients, the Malnutrition Universal Screening Tool (MUST) in the community healthcare setting, and the first part of the Mini-Nutritional Assessment (MNA) for elderly patients. In centres where screening can be computerised, the CONUT® or INFORNUT® methods can be used. A nutritional diagnosis is arrived at using the patient's medical history, a physical examination (including anthropometric assessment), biochemical analysis, and functional tests. No single variable allows a diagnosis to be made. The Subjective Global Assessment (SGA) and MNA tests are useful in nutritional assessment, but they are not universally regarded as the gold standard. At our hospital, and at many other centres in the Spanish health system, the Nutritional Status Assessment (NSA) method (in Spanish Valoración del Estado Nutricional) is used, which involves the SGA method, the taking of anthropometric measurements, and biochemical analysis. After making a nutritional diagnosis, which should be included in the patient's medical history adhering to International Classification of Diseases code 9 (ICD- 9), and prescribing a nutritional treatment, the patient should be followed up. No single marker can be used to monitor progress; interpretations will once again require examination of the patient's medical history, the taking of anthropometric measurements and laboratory tests. Depending on whether a patient is ambulatory or hospitalised, the follow-up assessment times and variables measured will differ.