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Journal of Parenteral and Enteral Nutrition http://pen.sagepub.com/ A.S.P.E.N. Clinical Guidelines : Nutrition Screening, Assessment, and Intervention in Adults Charles Mueller, Charlene Compher, Druyan Mary Ellen and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors JPEN J Parenter Enteral Nutr 2011 35: 16 DOI: 10.1177/0148607110389335 The online version of this article can be found at: http://pen.sagepub.com/content/35/1/16 Published by: http://www.sagepublications.com On behalf of: The American Society for Parenteral & Enteral Nutrition Additional services and information for Journal of Parenteral and Enteral Nutrition can be found at: Email Alerts: http://pen.sagepub.com/cgi/alerts Subscriptions: http://pen.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav Downloaded from pen.sagepub.com at Vrije Univ Bibliotheek on July 14, 2011 Clinical Guidelines Journal of Parenteral and Enteral Nutrition Volume 35 Number 1 A.S.P.E.N. Clinical Guidelines January 2011 16-24 © 2011 American Society for Parenteral and nteral Nutrition 1011014601103335 Nutrition Screening, Assessment, and Intervention in ttenaeubcom oted at Adults ttonlineaeubcom arle ueller P NS arlene om er P AA NS N ruyan ary llen P P NS AN and t e American Society for Parenteral and nteral Nutrition ASPN oard of irector Financial disclosure: none declared. 1 utrition creenin aement and interention meaurement and laboratory data” A nutrition ae- in atient it malnutrition are ey comonent ment roide t e bai for a nutrition interention Nof nutrition care iure 1 Nutrition creenin ndeed t ee definition are conitent it t e Joint a been defined by t e American Society for Parenteral ommiion’ interretation of a creen a an intrument and nteral Nutrition ASPN a “a roce to iden- ued to determine et er additional information from 2 tify an indiidual o i malnouri ed or o i at ri for an aement i re£uired to arrant an interention malnutrition to determine if a detailed nutrition ae- Nutrition aement erformed by a nutrition uort 1 ment i indicated” n t e nited State t e Joint clinician i a riorou roce t at include obtainin diet ommiion mandate nutrition creenin it in 24 our and medical itory current clinical tatu ant roomet- 2 of admiion to an acute care center e oal of nutrition ric data laboratory data yical aement informa- aement i to identify any ecific nutrition ri or tion and often functional and economic information clear eitence of malnutrition Nutrition aement may etimatin nutrient re£uirement and uually electin lead to recommendation for imroin nutrition tatu a treatment lan linical ill reource aailability and e ome interention uc a c ane in diet enteral or t e ettin determine t e ecific met od ued to er- 6 arenteral nutrition or furt er medical aement or a form a clinical nutrition aement idence-baed 3-5 recommendation for recreenin Nutrition aement linical ¤uideline for ecific dieae and condition a been defined by ASPN a “a comre enie may identify aement arameter aroriate to t oe aroac to dianoin nutrition roblem t at ue a condition n addition reaement and monitorin combination of t e folloin medical nutrition and met od are an etenion of t e aement roce medication itorie yical eamination ant roometric it in oerall nutrition care iure 1 A illutrated in iure 1 clinical aement includin recreenin and reaement i a continuou roce rom t e arle ueller P NS Nutrition eearc ert define malnutrition a “an acute ubacute or anaer linical and ranlational Science enter eill c ronic tate of nutrition in ic aryin deree of ornell edical ollee 1300 or Aenue o 14 Ne or oernutrition or undernutrition it or it out inflam- N 10065 matory actiity ae led to a c ane in body comoition 1 arlene om er P AA NS N nierity and dimini ed function” Parameter ued to dianoe of Pennylania Sc ool of Nurin laire ain all 41 malnutrition in t e creenin and aement rocee urie ouleard P iladel ia PA 1104-421 reflect bot nutrition intae and eerity and duration of ary llen ruyan P P NS AN road dieae ee factor may lead to c ane in body abi- Sectrum ommunication 236 oodtoc Aenue larendon tu and metabolic alteration aociated it oor out- ill 60514 come An nternational onenu ¤uideline ommittee Addre correondence to arlene om er P AA a rooed an aroac to dianoin malnutrition in NS N nierity of Pennylania Sc ool of Nurin adult baed on etioloy t u interatin t e reent laire ain all 41 urie ouleard P iladel ia PA undertandin of inflammatory reone to dieae and 1104-421 e-mail com erc¡nurinuennedu trauma e committee rooed t e folloin nutrition 16 Downloaded from pen.sagepub.com at Vrije Univ Bibliotheek on July 14, 2011 A.S.P.E.N. Clinical Guidelines / Mueller et al 1 3 Figure . Nutrition care alorit m dianoe 1 starvation-related malnutrition ic i ee intrument ere enerally deeloed to redict or c ronic taration it out inflammation 2 chronic dis- ae undernutrition ¥ernutrition and obeity are en- ease–related malnutrition ere inflammation i c ronic erally aeed uin t e body ma inde andor ait and of mild to moderate deree and 3 acute disease or circumference uideline in able 2 injur–related malnutrition ere inflammation i acute ee linical ¤uideline ill comare clinical out- and eere come aociated it ubli ed nutrition creenin and nflammation and related comenatory mec anim aement tool and t e imact of furt er clinical ae- aociated it dieae or inury may caue anoreia and ment and nutrition interention on clinical outcome alteration in body comoition and tre metabolim etabolic alteration aociated it inflammation are redominantly cytoine mediated and erit a lon a Methods t e inflammatory timulu i reent ee metabolic alteration include eleated enery eenditure lean ti- ASPN conit of ealt care rofeional rereentin ue catabolim roteolyi fluid ift to t e etracellular t e diciline of medicine nurin armacy dietetic comartment acute ae rotein c ane and yerly- and nutrition cience e miion of ASPN i to cemia ecreaed ynt ei of neatie acute ae ro- imroe atient care by adancin t e cience and ractice tein ill reult in reduced erum albumin tranferrin of nutrition uort t eray ASPN iorouly or to realbumin and retinol bindin rotein concentration uort £uality atient care education and reearc in t e t at are otent indicator of oor outcome ndeed field of nutrition and metabolic uort in all ealt care eert ae adied t at albumin and realbumin not be ettin ee linical ¤uideline ere deeloed under ued in iolation to ae nutrition tatu becaue t ey t e uidance of t e ASPN oard of irector are fundamentally marer of inflammatory metabo- Promotion of afe and effectie atient care by nutrition -11 lim Poitie acute ae rotein uc a -reactie uort ractitioner i a critical role of ASPN e rotein are alo otent redictor of morbidity and mortal- ASPN oard of irector a ubli ed linical 10 26-2 ity and are eleated in t e reence of inflammation ¤uideline ince 16 ASPN ealuate in an ono- able 1 lit creenin and aement intrument in roce en indiidual linical ¤uideline ould be 12 commonly cited in t e literature and ued in t e article udated ealuated for t ee linical ¤uideline e table ere- ee ASPN linical ¤uideline are baed uon ate arameter ued in t ee intrument t at are ri- eneral concluion of ealt rofeional o in deel- marily related to ant roometry and diet rimarily related oin uc uideline ae balanced otential benefit to to eerity of illne dieae and trauma or ot er includ- be deried from a articular mode of medical t eray in yical and yc oloical ariable alnouri ed aaint certain ri in erent it uc t eray oeer tate are aociated it metabolic alteration caued by t e rofeional udment of t e attendin ealt rofe- dieae- and trauma-triered inflammatory reone ional i t e rimary comonent of £uality medical care Downloaded from pen.sagepub.com at Vrije Univ Bibliotheek on July 14, 2011 1 ournal o Parenteral and Enteral Nutrition / Vol 35 No 1 January 2011 ale . Selected Nutrition Screenin and Aement ntrument Parameter ¥t er P yical Ant roometry andor iet- Pyc oloical Variable or ntrument elated Seerity of llne Symtom Screening tools 13 irmin am Nutrition i Score ei t lo aetite Stre factor eerity of ability to eat dianoi 14 alnutrition Screenin ool Aetite unintentional ei t lo alnutrition nieral Screenin c ane in ei t Preence of acute dieae ool15 aatric t nde16 Percentae ideal body ei t Albumin realbumin lym- ocyte count 1 Nutrition i laification ei t lo ercentae ideal ¤atrointetinal function body ei t dietary intae Nutritional i nde1 Preent and uual body ei t Albumin 1 Nutritional i Screenin 2002 ei t lo food intae ianoi eerity Pronotic nflammatory and Albumin realbumin Nutritional nde20 -reactie rotein α1-acid lycorotein Pronotic Nutritional nde21 rice in fold Albumin tranferrin in enitiity 22 Simle Screenin ool ercentae ei t lo Albumin S ort Nutrition Aement ecent ei t itory aetite §uetionnaire23 ue of oral ulement or tube feedin Nutrition assessment tools 24 ini Nutritional Aement ei t data ei t mid-arm Albumin realbumin Self-ercetion of nutrition circumference calf circum- c oleterol lym ocyte and ealt tatu ference diet itory aetite count feedin mode 25 Subectie ¤lobal Aement ei t itory diet itory Primary dianoi tre leel P yical ymtom ubcutaneou fat mu- cle atin anle edema acral edema acite functional caacity a- trointetinal ymtom body ma inde ale . ¥beity laification and i ecaue uideline cannot account for eery ariation in circumtance t e ractitioner mut alay eercie ro- 2 ¥beity la m feional udment in t eir alication ee linical nderei t ¨15 ¤uideline are intended to ulement but not relace Normal 15–24 rofeional trainin and udment ¥erei t 25–2 ee linical ¤uideline ere created in accord- ¥beity cla 30–34 ance it ntitute of edicine recommendation a ¥beity cla 35–3 “ytematically deeloed tatement to ait ractitioner ¥beity cla ≥ 40 and atient deciion about aroriate ealt care for 2 i i ait ircumference cm ecific clinical circumtance” ee linical en ª 102 ¤uideline are for ue by ealt care rofeional o omen ª roide nutrition uort erice and offer clinical adice body ma inde for manain adult and ediatric includin adolecent Adated from linical ¤uideline on t e dentification atient in inatient and outatient ambulatory ome aluation and reatment of ¥erei t and ¥beity in Adult and eciali¦ed care ettin e utility of t e linical e idence eort N Publication No -403 Setember ¤uideline i atteted to by t e fre£uent citation of t ee 1 National ntitute of ealt National eart lood and document in eer-reieed ublication and t eir fre- un ntitute in cooeration it t e National ntitute of £uent ue by ASPN member and ot er ealt care iabete and ietie and «idney ieae rofeional in clinical ractice academia reearc and Downloaded from pen.sagepub.com at Vrije Univ Bibliotheek on July 14, 2011
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