A.S.P.E.N. clinical guidelines: Nutrition screening, assessment, and intervention in adults.

N utrition screening, assessment, and intervention in patients with malnutrition are key components of nutrition care (Figure 1). Nutrition screening has been defined by the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) as " a process to identify an individual who is malnourished or who is at risk for malnutrition to determine if a detailed nutrition assessment is indicated. " 1 In the United States, the Joint Commission mandates nutrition screening within 24 hours of admission to an acute care center. 2 The goal of nutrition assessment is to identify any specific nutrition risk(s) or clear existence of malnutrition. Nutrition assessments may lead to recommendations for improving nutrition status (eg, some intervention such as change in diet, enteral or parenteral nutrition, or further medical assessment) or a recommendation for rescreening. measurements; and laboratory data. " 1 A nutrition assessment provides the basis for a nutrition intervention. Indeed, these definitions are consistent with the Joint Commission's interpretation of a screen as an instrument used to determine whether additional information (from an assessment) is required to warrant an intervention. 2 Nutrition assessment performed by a nutrition support clinician is a rigorous process that includes obtaining diet and medical history, current clinical status, anthropomet-ric data, laboratory data, physical assessment information , and often functional and economic information; estimating nutrient requirements; and, usually, selecting a treatment plan. Clinical skill, resource availability, and the setting determine the specific methods used to perform a clinical nutrition assessment. 6,7 Evidence-based Clinical Guidelines for specific diseases and conditions may identify assessment parameters appropriate to those conditions. In addition, reassessment and monitoring methods are an extension of the assessment process within overall nutrition care (Figure 1). As illustrated in Figure 1, clinical assessment (including rescreening and reassessment) is a continuous process. Experts define malnutrition as " an acute, subacute or chronic state of nutrition, in which varying degrees of overnutrition or undernutrition with or without inflam-matory activity have led to a change in body composition and diminished function. " 1 Parameters used to diagnose malnutrition in the screening and assessment processes reflect both nutrition intake and severity and duration of disease. These factors may lead to changes in body habi-tus and metabolic alterations associated with poor outcome. An International Consensus Guideline Committee has proposed an approach to diagnosing malnutrition in adults based on etiology, thus integrating the present understanding of inflammatory responses to disease and trauma. Financial disclosure: …