NRS-2002 Nutrition Risk Screening Calculator — Hospital Malnutrition

How to Use This Calculator

1. Answer the initial screening questions (BMI, weight loss, reduced intake).
2. Select disease severity score (0–3) based on diagnosis category.
3. Indicate whether patient is aged ≥ 70 years for the age adjustment.
4. NRS-2002 score and action appear instantly.
5. Use the Enteral vs Parenteral tab to select nutrition route based on GI function.
6. Use the Refeeding Risk tab to assess syndrome risk before starting feeds.

Formula

Example

Frequently Asked Questions

• What is the NRS-2002? ▼
  The NRS-2002 (Nutrition Risk Screening 2002) is a validated hospital nutrition screening tool developed by Jens Kondrup and colleagues at the University of Copenhagen, published in Clinical Nutrition in 2003. It was specifically designed for use in hospitalised patients and endorsed by the European Society for Clinical Nutrition and Metabolism (ESPEN) as its recommended hospital nutrition screening tool. The NRS-2002 combines two components: a nutritional status score (0–3 based on BMI, recent weight loss, and reduction in dietary intake) and a disease severity score (0–3 based on the degree to which the illness increases nutritional requirements). An age adjustment of 1 point is added for patients aged 70 years or older, reflecting the increased nutritional vulnerability of elderly patients. The total score ranges from 0 to 7; a score of 3 or above identifies patients at nutritional risk who require a full nutritional assessment and a nutrition care plan. The tool was validated against a comprehensive review of 128 randomised controlled trials examining nutritional support in hospitalised patients, making it one of the most evidence-grounded screening tools available.
• Who should be screened with NRS-2002? ▼
  ESPEN and most national nutrition guidelines recommend that all adult patients be screened for nutritional risk on admission to hospital and weekly thereafter during the hospital stay. Priority populations where nutritional risk is particularly high include: patients with major surgery (gastrointestinal, orthopaedic, or cardiac surgery), who have increased metabolic demands and often reduced postoperative intake; patients with malignancy (cancer-associated malnutrition affects 30–85% of cancer patients depending on diagnosis and treatment stage); patients with chronic diseases associated with reduced intake or absorption (COPD, inflammatory bowel disease, chronic kidney disease, liver cirrhosis); elderly patients (metabolic changes, reduced appetite, polypharmacy, and functional impairment increase nutritional risk); patients admitted to the ICU (virtually all critically ill patients are at nutritional risk); patients with dysphagia (stroke, neurological disease, head and neck cancer); and patients undergoing prolonged NPO or bowel rest periods. Paediatric patients require paediatric-specific screening tools (e.g., STAMP, STRONG kids) rather than NRS-2002, which was validated only in adults.
• When does NRS-2002 trigger nutrition intervention? ▼
  An NRS-2002 score of 3 or above triggers a formal nutrition intervention pathway. The immediate steps per ESPEN guidelines are: referral to a registered dietitian for comprehensive nutritional assessment (including full dietary history, anthropometric measurements, biochemical markers, and clinical examination); setting individual energy and protein targets (typically 25–35 kcal/kg/day and 1.2–1.5 g protein/kg/day for at-risk hospitalised patients); initiating oral nutritional supplements if the patient can eat but is unable to meet targets orally; considering enteral nutrition via nasogastric tube or other route if oral intake is inadequate (< 60% of estimated requirements for more than 3 days); and considering parenteral nutrition if the GI tract is non-functional or EN is contraindicated or insufficient. ESPEN recommends initiating nutrition support within 24–48 hours of ICU admission for critically ill patients regardless of NRS score. The NRS score also guides the frequency of reassessment: patients with NRS ≥ 3 should be reassessed weekly (or more frequently if deteriorating), while those below 3 are rescreened weekly and receive standard care.
• How does NRS-2002 compare to MUST (Malnutrition Universal Screening Tool)? ▼
  NRS-2002 and MUST (Malnutrition Universal Screening Tool, developed by BAPEN in 2003) are the two most widely used hospital malnutrition screening tools in Europe, and are often studied head-to-head. Key differences: NRS-2002 includes a disease severity component that explicitly accounts for the increase in nutritional requirements caused by acute illness, making it particularly appropriate for acutely hospitalised patients with high metabolic demands (e.g., ICU, post-surgical). MUST uses BMI, unintentional weight loss, and an acute disease effect (adding 2 points if patient has been or is likely to have no nutritional intake for > 5 days), which captures community and subacute care settings well. MUST is more widely used in community, primary care, and nursing home settings in the UK and is required by many NHS Trusts on community patient contact. NRS-2002 is more appropriate for the acute hospital setting and is the ESPEN-endorsed tool for inpatient use. Comparative studies in acute hospital settings have found broadly similar sensitivity and specificity for predicting complications and length of stay. ESPEN recommends NRS-2002 for hospitals; BAPEN recommends MUST for all settings. Many facilities use both depending on care location.
• What is refeeding syndrome and how is it prevented? ▼
  Refeeding syndrome is a potentially life-threatening metabolic complication that occurs when nutrition is reintroduced to severely malnourished or prolonged-fasted patients too rapidly. During starvation, cells deplete intracellular phosphate, potassium, and magnesium while maintaining serum levels by mobilising intracellular stores. When carbohydrates are provided, insulin surges, driving glucose into cells along with phosphate, potassium, and magnesium — causing precipitous drops in serum levels. Severe hypophosphataemia (< 0.5 mmol/L) can cause respiratory failure, cardiac arrhythmia, haemolytic anaemia, seizures, and death. High-risk groups include: BMI < 16, minimal intake for > 10 days, significant unintentional weight loss, chronic alcoholism, prolonged fasting (post-surgery, eating disorders), or severe electrolyte derangements before feeding. Prevention requires: checking and correcting electrolytes (especially phosphate, potassium, magnesium) before starting feeds; giving IV or high-dose oral thiamine (200–300 mg) before and during early feeding (Wernicke's encephalopathy risk in alcoholism and starvation); starting at 10 kcal/kg/day (maximum) and increasing slowly over 4–7 days to target; and monitoring electrolytes every 12 hours during the first 3 days of refeeding.

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