You probably know that when vulnerable populations go to the hospital, they go through a wide range of health checks to ensure that they are in good health. For example, adults aged 65 and above are often put through physiological tests to assess their physical well-being. At the same time, pregnant women often go through several tests to gauge how well they and their unborn babies are faring in preparation for the birth of the children.
But did you know that nutrition screening is considered important for everyone, including otherwise healthy adults? In fact, it is quite likely that you have been through several nutrition screenings in the past but have not been aware of them because they have been integrated into your triage during your routine check-ups with your doctor. But what are these checks and why are they important for you or anyone else?
What Is Nutrition Screening?
The terms nutrition screening and nutrition assessments are often used together, so much so that you may think that the two are the same. However, that is not the case, as they entail very different procedures.
You see, a nutrition screening is a triage step that health practitioners use to assess whether a person is at risk of developing malnutrition; that is, whether they are at nutrition risk. For context, malnutrition extends beyond undernutrition and also encompasses nutrient deficiencies, being overweight or obese, and suffering from diet-related non-communicable diseases such as type II diabetes. The screening process often takes five minutes or fewer and it focuses on key metrics such as weight loss percentages so as to determine whether someone is at low, moderate, or high risk of malnutrition. As such, it is a screening tool rather than a diagnostic tool.
Nutrition assessment, on the other hand, is the step taken when someone is categorized as being at high risk of malnutrition. A dietician takes you through various checks, including blood tests, physical examinations, and diet logs, all of which help them determine your current dietary needs. Given that the process is quite extensive, it takes about an hour to complete the tests, and the whole procedure could span several hours because you do have to wait for the test results.
These nuances do matter because screening is more of a risk categorization while the nutrition assessment is more of a clinical intervention that is geared toward preventing negative health outcomes.
Why Is Nutrition Screening Done?
For us to understand why anyone would need nutrition screening, we need to look at how our bodies work. Our bodies rely on a continuous supply of calories (the energy they use) and nutrients (macro and micro), which not only help them maintain cellular function but also meet other needs such as strengthening our immune systems and protecting our organ health. When we do not consume enough energy or adequate nutrients to meet these daily needs, our bodies are unable to function optimally. If this inadequacy continues over a prolonged period, the body can enter a state of catabolism where it breaks down its own tissues to survive. At the same time, nutrient deficiencies can lead to gaps in vital functions, leading to the following impacts, to name but a few:
Muscle Wasting
In cases where people do not consume enough calories to provide their bodies with sufficient energy to function, their bodies can break down their skeletal muscle tissue for energy. Such individuals are at high risk of falling, injuries, and even a loss of independence due to declining physical strength.
High Susceptibility to Diseases
Many people on low-calorie diets or nutritionally poor diets often consume minimal protein. Given that immune cells and antibodies are made of protein, these people are likely to be more vulnerable to infections and grapple with slow wound-healing as their bodies have impaired abilities to produce these vital cells and antibodies.
Weakening Of the Gut
Our bodies are designed to have a steady stream of food passing through our gastrointestinal tracts. As such, when people do not eat enough food or frequently enough, their gut linings are likely to shrink and weaken, thus allowing gut bacteria to leak into the bloodstream. If left unchecked, this can lead to sepsis, which can cause death.
Medical Complications
Have you ever noticed how vigilant hospitals are when they are admitting patients or booking someone for surgery? Part of this vigilance is due to nutrition complications. In cases where patients are at risk of malnutrition or are suffering from it, they are likely to not only have longer hospital stays but also have a significantly higher readmission rate compared to other patients. Studies have also shown that such patients have higher mortality rates.
As you can imagine and see from the above examples, nutrition deficiencies can have negative health impacts in the short and long term. Nutrition screening is thus used as a way to determine who is at risk of such effects so that preventative measures can be put in place before the damage to the body worsens. For example, when healthcare providers determine the people at high nutrition risk, they often follow through with oral supplements, diet changes, and specialized feeding methods to account for these nutritional gaps.
Who Needs Nutrition Screening?
Nutrition screening is often integrated into most triage processes in hospitals because anyone experiencing health problems is likely to be at nutrition risk. Even so, you find that some people require frequent nutrition screening because they are at higher nutrition risk compared to others. These groups are as follows:
Patients
Typically, most people go through nutrition screening at least once a year as part of their primary care. But for some groups of people, the screenings are quite regular and could even be weekly or monthly. These include:
Admissions
When you fall ill, undergo surgery, or get into an accident, your body’s metabolic rate increases to keep up with the demands of the disease. As such, it burns through calories much faster than usual, and this can leave you with nutritional gaps. Hospitals thus screen their patients within 24 hours of admission to ensure that they are providing each patient with the right food for optimal health.
Outpatients Undergoing Treatment
There are many sick people who require frequent outpatient and inpatient treatments due to the nature of their disease. Examples include cancer patients, people with chronic kidney disease, and people with gastrointestinal conditions. Their diseases often impair their abilities to consume or absorb food, and this puts them at risk of developing malnutrition. Their doctors thus put them through regular screenings to ensure that they are eating enough despite these barriers to healthy eating.
Older Adults
In Canada, anyone aged 65 and above is considered to be an older adult, and per the government policies, people in this age group require frequent nutrition screening. So, why is this?
As you age, you undergo physiological changes, such as reductions in your stomach acid levels, decreases in your taste bud sensitivity, and slowed gastric emptying. As a result, you may find that you feel full even if you have not had much food. At the same time, you may find that you do not feel the urge to eat as often as you did in the past. Some older adults also have trouble with eating because of challenges such as missing teeth, poorly fitting dentures, and dry mouth. These changes can predispose you to undereating, both in terms of energy intake and nutrient consumption.
Older adults are also faced with a variety of social and economic barriers to eating. Socially, many older adults live alone in isolation and have limited capabilities to care for themselves. Therefore, they face challenges in shopping for food and preparing it, such that many of them have few meals each day, some of which can be nutrient-poor. Many older adults also live on fixed incomes and may be unable to afford fresh produce and may turn to shelf-stable, cheaper foods that are high in calories and low in nutrients.
Given these likely issues, doctors take it upon themselves to conduct regular nutrition screenings on their patients to ensure that they are not lagging when it comes to their diets.
Children and Expectant Mothers
It probably comes as no surprise that pregnant women undergo several nutrition screenings throughout the course of their pregnancies to allow doctors to keep tabs on their diets. After all, these women’s nutritional needs increase as their bodies are tasked with providing for the needs of their unborn children. And as studies have shown, nutritional gaps during pregnancy can affect mothers and their babies in the long term.
Children, too, are subjected to nutrition screenings. In fact, in Canada, every healthy infant must be monitored at least 8 times until they reach 15 months, and those who have exhibited nutritional gaps must undergo additional screenings to ensure that their diets are able to provide them with the nutrients they need for healthy development. Parents are also taught to conduct these screenings at home for children aged 18 months to 5 years through programs such as NutriSTEP as they guide their children in transitioning to solid foods.
Beyond people in the above groups, it is important to note that various social, economic, and environmental factors can put us at nutrition risk. For instance, people experiencing food insecurity may find themselves cutting back on nutritious foods in favor of what is affordable and convenient, and they may experience nutritional deficits as a result. Thus, even if you may not identify with any of the categories above, this does not negate your need for nutrition screening, as we will explore in this guide.
How Does Nutrition Screening Take Place?
The term nutrition screening may make this procedure sound quite complex, but that could not be further from the truth. If anything, it is as simple as most triage procedures. So, what can you expect when you get screened?
Well, the steps vary based on the screening tool used. For adults, we have the MUST (Malnutrition Universal Screening Tool), which is used in primary care settings, the MNA (Mini Nutritional Assessment), which is often used for older adults, and the Canadian Nutrition Screening Tool (CNST), which is often used in inpatient settings.
For children, there are various pediatric screening tools, including the STRONGkids (Screening Tool for Risk on Nutritional Status and Growth), the STAMP (Screening Tool for the Assessment of Malnutrition in Pediatrics), and the Pediatric SGNA (Subjective Global Nutritional Assessment), which are used in hospital settings. For primary care, the tools include the WHO Growth Charts for Canada, the Rourke Baby Record (RBR), and NutriSTEP.
While the tools may vary based on the settings and target population, you find that the steps taken are quite similar, as follows:
Data Collection
The person administering the screening asks you questions that are geared towards figuring out your current nutritional status. These include:
Recent Changes in Your Weight
Unintended weight loss of 5% to 10% of your body weight in 3 to 6 months is considered moderate risk, while a loss of over 10% in 3 to 6 months is considered high risk.
What You Eat
Here, the assessment hinges on whether you have had changes in what you eat, if your food intake has decreased or increased in the last one to two weeks, whether you have any trouble eating or digesting food, and so on.
They also calculate your body mass index by taking your height and current weight so as to assess whether you are at a healthy weight.
Risk Classification
Having assessed you, the person administering the screening scores you based on the screening tool in use. With the CNST, people are considered either at risk or not at risk, but with standardized tools like the MUST, there are three risk categories – low, moderate, and high.
People who are classified as low risk are advised to continue with their routine screenings based on their primary care. Those who fall into the moderate risk category are considered to have early warning signs of nutrition risk. They are asked to keep logs of their food intake for a given period and are also scheduled for regular screenings, which can be weekly or monthly based on the severity of their symptoms.
High-risk individuals usually have key indicators of nutrition risk, such as fast unintentional weight loss, an acute illness, or the inability to eat. Given the likelihood of malnutrition, such people are often referred to registered dietitians for a full nutrition assessment, as we had earlier discussed. This way, they are set up with a personalized nutrition plan that can address their nutrition gaps.
Revelations During Nutrition Screening
Many people are often unaware of what, when, and how they eat, and how this impacts their health. Nutrition screenings thus serve as mirrors through which we can come face to face with our current nutrition needs and whether we are meeting them. Examples of patterns that come up include severe calorie deficits, dietary fears that have led to food elimination, the tendency to substitute food with liquids, and erratic eating schedules.
For instance, a person may have gotten accustomed to snacking late at night and working all day without eating, thus leaving the body in a prolonged catabolic state, which can lead to wasting. Nutrition screening can highlight this and enable such a person to get back on track with eating enough to sustain their needs.
Is It Time to Speak to a Healthcare Professional?
The typical advice regarding nutrition is to wait until a problem presents itself. However, the reality is that nutritional deficiencies can creep up quite fast such that by the time you score high on the nutrition screening, your body may have undergone a lot of damage. Therefore, waiting is not always the best option. Instead, you should speak to a healthcare professional, such as a registered dietitian or a physician, if you or someone close to you starts showing the following symptoms:
Unintentional Weight Loss
If you lose more than 5% of your total body weight in 30 days or more than 10% of your total body weight in 6 months without making lifestyle changes or dieting, you have a cause for concern.
Changes In Eating Patterns
If you find that you are eating less than half of your usual food volume and this continues for more than 7 consecutive days, this is an early warning sign that all may not be well. Additionally, if you find that you are unable to eat because of issues such as oral pain or pain when swallowing, you need medical help.
Gastrointestinal Issues
You are at risk of nutritional deficiencies if you are experiencing problems such as frequent nausea, vomiting, diarrhea, bloating, and other gastrointestinal issues that could prevent you from eating or absorbing your meals.
We should also add that if you have recently been diagnosed with a medical condition that affects your nutritional needs, you will benefit from speaking to a professional. Examples of such conditions include type II diabetes, chronic kidney disease, celiac disease, heart failure, and inflammatory bowel disease. A registered dietitian can help you come up with a personalized and extensive nutrition plan that can help you consume enough food without worsening your symptoms.
With the kind support:
