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NRS-2002

Nutritional Risk Screening 2002

A validated two-step nutritional screening tool for hospital inpatients, endorsed by ESPEN. Combines nutritional status and disease severity to identify patients who benefit from nutritional support. The recommended screening tool for surgical and GI inpatients.

ESPENHospital InpatientsNutrition ScreeningSurgery
NRS-2002 Screening
Step 1 — Initial Screening
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NRS-2002 Total Score

Two-Step Screening Process

NRS-2002 uses a two-step approach. Step 1 is a rapid initial screen with 4 yes/no questions. If all answers are NO, the patient is at low nutritional risk and should be re-screened weekly. If any answer is YES, Step 2 is completed with a formal assessment of nutritional status score, disease severity score, and age adjustment.

NRS-2002 Total Score = Nutritional Status Score + Disease Severity Score + Age Score
Age Score: add 1 point if age ≥ 70 years

Score < 3: Not at nutritional risk — weekly rescreening
Score ≥ 3: At nutritional risk — initiate nutritional support

Nutritional Status Score

ScoreDegreeCriteria
0 Normal Normal nutritional status
1 Mild Weight loss >5% in 3 months, OR food intake 50–75% of normal requirement in preceding week
2 Moderate Weight loss >5% in 2 months, OR BMI 18.5–20.5 with impaired general condition, OR food intake 25–60% of normal in preceding week
3 Severe Weight loss >5% in 1 month (>15% in 3 months), OR BMI <18.5 with impaired general condition, OR food intake 0–25% of normal in preceding week

Disease Severity Score

ScoreDegreeClinical Examples
0 None Normal nutritional requirements
1 Mild Hip fracture, chronic patients with complications: cirrhosis, COPD, chronic haemodialysis, diabetes mellitus, oncology (non-metastatic)
2 Moderate Major abdominal surgery, stroke, severe pneumonia, haematological malignancy
3 Severe Head injury, bone marrow transplantation, ICU patients with APACHE score >10, major burns

Interpretation

NRS-2002 ScoreRiskAction
< 3 Not at Risk Continue regular food intake and rescan weekly in hospital setting. If patient is scheduled for major surgery, consider preventive nutritional support.
≥ 3 At Nutritional Risk Initiate nutritional support plan. Refer to dietitian. Set nutritional goal (calories and protein). Choose route (oral supplements, enteral, or parenteral). Reassess at 48–72 hours.

Clinical Application

  • ESPEN endorsement: NRS-2002 is the nutritional screening tool recommended by ESPEN for hospital inpatients. It is particularly well-validated in gastrointestinal surgical, gastroenterological, and hepatological patients.
  • Pre-operative use: Patients with NRS-2002 ≥ 3 undergoing major GI surgery benefit from pre-operative nutritional support (7–14 days oral/enteral supplementation) before elective procedures, even at the cost of a brief delay in surgery (ESPEN recommendation).
  • Prediction of outcomes: NRS-2002 ≥ 3 predicts longer hospital stay, higher complication rates, and increased mortality in surgical patients. It outperforms MUST for surgical outcome prediction in most head-to-head comparisons.
  • Rescreening: Rescan weekly in hospitalised patients or whenever clinical condition changes significantly.
  • Limitations: NRS-2002 requires weight and height measurement and detailed weight loss history, which may not always be available. For critically ill patients, the NUTRIC score is an alternative.

References

  1. Kondrup J, Rasmussen HH, Hamberg O, Stanga Z; Ad Hoc ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003;22(3):321–336.
  2. Weimann A, Braga M, Carli F, et al. ESPEN guideline: clinical nutrition in surgery. Clin Nutr. 2017;36(3):623–650.
  3. Sorensen J, Kondrup J, Prokopowicz J, et al. EuroOOPS: an international, multicentre study to implement nutritional risk screening and evaluate clinical outcome. Clin Nutr. 2008;27(3):340–349.

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MUST Score Prognostic Nutritional Index Calorie & Protein Requirements