• All adult patients within 24h of hospital admission (ESPEN mandate)
• Identify patients requiring proactive nutritional intervention before clinical deterioration
• Mandatory documentation in many NHS, EU, and Australian accreditation frameworks
• Patients with chronic disease, recent surgery, poor oral intake, or unexplained weight loss

• BMI < 20.5?
• Weight loss in last 3 months?
• Reduced dietary intake in last week?
• Patient severely ill (ICU)?

• Nutritional status: 0 (normal) to 3 (severe malnutrition or minimal intake)
• Disease severity: 0 (no disease) to 3 (ICU patient ± APACHE > 10)
• Age ≥ 70 years: +1 point

• NRS-2002: Preferred for HOSPITALISED adult patients. Validated in 128 RCTs.
• MUST: Better for community/outpatient settings and GP practices.
• SNAQ: Shorter 4-item tool validated for hospital screening with comparable performance.
• MNA (Mini Nutritional Assessment): Best validated tool for elderly populations (≥ 65 years).

• Protein target: 1.2–1.5 g/kg/day (higher in severe disease, burns, surgery)
• Calorie target: 25–30 kcal/kg/day (avoid overfeeding in critically ill)
• Enteral nutrition preferred over parenteral when gut functional
• Initiate EN within 24–48h of ICU admission in ventilated patients

• Dietitian referral within 24h.
• Document nutritional plan in patient notes.
• Prescribe oral nutritional supplements (ONS) as initial step.
• For swallowing difficulty or inadequate oral intake: nasogastric tube + enteral feeds.
• For non-functional gut: parenteral nutrition via central access (PICC or CVC).

• Continue to encourage normal oral intake.
• Re-screen weekly or if clinical status changes.
• Reassess if prolonged NPO status, new infection, or surgery planned.

NRS-2002 was developed by Kondrup and colleagues for the European Society for Clinical Nutrition and Metabolism (ESPEN). Unlike other tools that rely on clinician gestalt, NRS-2002 was uniquely derived by checking whether patients in 128 published RCTs who would have scored ≥ 3 actually benefited from nutritional intervention. This evidence-first approach makes it the most rigorously constructed nutritional screening tool in clinical use.