What is Screening? • Penapisan/identifikasi untuk mengetahui orang yg berisiko terjadi masalah gizi atau malnutrisi • Tes Skrining sebaiknya bersifat non-invasive, murah dan hasilnya cepat diketahui • Cakupan utama skrining : 1.
Berat – IMT
2.
Penurunan BB
3.
Selera makan
4.
Kondisi medis dimana tjd peningkatan kebutuhan
Skrining vs Assessment Nutrition Screening • Purpose : to quickly identify individuals nutritionally at-risk or who are malnourished • Rapid, simple general procedure done at first contact with subject to detect risk of malnutrition, done by nurses, doctors or others Nutrition Assessment • Purpose: to identify early signs of malnutrition and prevent it from morbidity and mortality • Detailed, more specific in depth evaluation, done by those with nutritional expertise
Start screening ASAP! • MNA® Short Form • SGA • MUST (Malnutrition Universal Screening Tool) • Nutrition Risk Screening (NRS,2002 by ESPEN)
• Developed in 1990 • Validated for ages 65+ • Simple, reliable, non-invasive, & quick • Inexpensive • Validated in hospital & community setting • For screening & assessment
Guigoz et al., Nutr. Rev. 1996;54:S59-65 Vellas B et al., J Am Geriatr Soc 2000;48:1300-1309c
Global assessment • lifestyle • medications • mobility
•
Subjective assessment • self perception of health & nutrition
MNA® score interpretation maximum score 30 points •
24 :
•
17 - 23.5 :
•
< 17 :
normal/well-nourished border line/at risk of malnutrition undernutrition
Guigoz et al., Facts & Res. Gerontol. 1994 (suppl.2):15-70
MUST Malnutrition Universal Screening Tool • A practical, reliable, validated tool for nutrition screening • Allows comparable nutritional screening across different care settings by different health professionals – primary care, home, acute care, long term care • Identifies individuals who are undernourished or obese • Not specific for the elderly, but adults
Step 5 Consider using suggested management guidelines Reassess risk category as subject moves through care settings •
MUST Validity Malnutrition Universal Screening Tool • Hospitals – predicts Length of stay – predicts discharge destination – mortality
• Community – predicts rates of hospitali admissions – predicts rates of GP visits – shows that appropriate intervention improves outcome
NRS - Nutrition Risk Screen • Developed in 2003 (Kondrup et al - ESPEN) • Used retrospective analysis of RCT (adults) – Nutritional criteria or characteristics – Clinical outcome Assumption: Indications for nutrition support are : • the severity of undernutrition • the increase in nutritional requirements from the disease
• Screen includes measures of current potential undernutrition & disease severity
NRS - Nutrition Risk Screen
Nutrition Screening is NOT the end but just the beginning!
