To be completed by the patient:

Weight: During the past two weeks my weight has:

Food intake

As compared to my normal intake, I would rate my food intake during the past month as

I am now taking

Check all that apply


I have had the following problems that have kept me from eating enough during the past two weeks

Check all that apply

Activities and Function:

Over the past month, I would generally rate my activity as:

To be completed by your doctor, nurse, dietitian, or therapist:

Scoring Weight Loss

To determine score, use 1-month weight data if available. Use 6-month data only if there is no 1-month weight data. Use points below to score weight change and add one extra point if patient has lost weight during the past 2 weeks.

Disease and its relation to nutritional requirements:

Check all that apply

Metabolic Demand

Fever and fever duration
Score for metabolic stress is determined by a number of variables known to increase protein & caloric needs.
Fever and fever duration



Physical Exam

Exam includes a subjective evaluation of 3 aspects of body composition: fat, muscle, & fluid. Since this is subjective, each aspect of the exam is rated for degree. Muscle deficit/loss impacts point score more than fat deficit/loss. Definition of categories: no abnormality, mild, moderate, severe. Rating in these categories is not additive but are used to clinically assess the degree of deficit (or presence of excess fluid).

Muscle Status

Muscle Status

temples (temporalis muscle), clavicles (pectoralis & deltoids), shoulders (deltoids), interosseous muscles, scapula (latissimus dorsi, trapezius, deltoids), thigh (quadriceps), calf (gastrocnemius)

Fat Stores

Fat Stores

orbital fat pads, triceps skin fold, fat overlying lower ribs

Fluid status

Fluid status

ankle edema, sacral edema, ascites

subjective evaluation

PG-SGA Global Assessment Categories

Please fill out all questions





No intervention required at this time.

 Re-assessment on routine and regular basis during treatment.

Patient & family education by dietitian, nurse, or other clinician with pharmacologic intervention as indicated by symptom survey and lab values as appropriate.

Requires intervention by dietitian, in conjunction with nurse or physician as indicated by symptoms.

An evidence-based treatment algorithm for malnutrition management can be found "here".

Indicates a critical need for improved symptom management and/or nutrient intervention options.

An evidence-based therapeutic algorithm for management of malnutrition can be found "here".

Subjektive Einschätzung

Calculate nutritional goals

Information NutriScreen

Recognised/validated and commonly used screening tools to identify patients with manifest malnutrition or at increased risk of malnutrition

Nutrition therapy starts with the identification of patients with an increased risk of malnutrition. There are various "screening tools" recognised in medical practice for this purpose. The European Society for Clinical Nutrition and Metabolism (ESPEN) recommends the use of the Nutritional Risk Screening 2002 (NRS-2002). The treatment team should perform the screening within 24 h after hospital admission. With this application, the NRS-2002 can be easily calculated online 1.
The NRS-2002 quantifies the risk of malnutrition in adults based on nutritional status disorder (BMI, weight loss, food intake), severity of illness and age over 70 years on a scoring scale of 0-7:

  • NRS ≤2: Currently no risk of malnutrition requiring treatment.
  • NRS ≥3: Increased risk of malnutrition, initiate the following measures recommended:
  1. Detailed assessment and cause clarification of malnutrition.
  2. Nutritional counselling checks the indication for nutritional therapy in a multiprofessional setting.
  3. Record the diagnosis of malnutrition according to ICD ("International Classification of Diseases") and ensure coding.


  1. Kondrup J, et al. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003;22(3):321-36.

List of abbreviations

BMI Body Mass Index
ESPEN  European Society for Clinical Nutrition and Metabolism
ICD International Statistical Classification of Diseases and Related Health Problems
NRS Nutritional Risk Screening