Input the clinical status and disease severity parameters to visualize the inpatient nutritional risk profile.
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Standardized nutritional screening for hospitalized adult patients
To identify patients who are likely to benefit from specialized nutritional support (Enteral/Parenteral)
Required for many hospital accreditation and quality improvement protocols
The 'Risk' Definition
NRS-2002 defines risk as the "likelihood of better outcome with nutritional therapy." It combines nutritional depletion (Impairment) with the increased requirements of the current illness (Severity).
Section 2
Formula & Logic
The Two-Part System (Max 7 Points)
01
Part 1: Impaired Nutritional Status (0–3 pts): Based on BMI, weight loss, and recent food intake.
02
Part 2: Severity of Disease (0–3 pts): Reflecting increased metabolic demand (e.g., Hip fracture = 1, Major surgery = 2, ICU/Head injury = 3).
03
Age Modifier: Add 1 point if the patient is ≥ 70 years old.
Actionable Threshold
Score < 3
Low Risk. Re-screen weekly.
Score ≥ 3
Nutritionally At Risk. Start nutritional plan.
Section 3
Pearls/Pitfalls
Sensitivity to Metabolic Stress
The brilliance of NRS-2002 is that it recognizes a "well-nourished" patient with BMI 25 can still be at "nutritional risk" if they are admitted to the ICU with multi-organ failure. In this state, the metabolic requirement far exceeds body stores, and aggressive early nutrition (within 24–48 hours) improves survival.
ESPEN Approval
The NRS-2002 is the officially recommended screening tool for hospitalized patients by ESPEN (European Society for Clinical Nutrition and Metabolism).
Clinical Pearls
A 5% weight loss in 1 month or 15% in 3 months is heavily weighted in the impaired status score
In contrast to MUST (which is good for primary care), NRS-2002 is specifically optimized for acute inpatient stress
The Age modifier (≥70) reflects the lower physiological resilience of the elderly to periods of starvation
Section 4
Next Steps
Management Priority
01
Score ≥ 3: Clinical nutrition consult; aim for 25–30 kcal/kg/day; maximize protein intake (1.2–1.5 g/kg/day).
02
Score < 3: Monitor; Ensure "Mealtime assistance" if required.
Complementary Tools
MUST Score (Community screening)
Nutritional Risk Index (NRI)
BMI Calculator
Section 5
Evidence Appraisal
The Definitive Paper
Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials.
Kondrup J et al. • Clinical Nutrition. 2003;22(3):321-36. The description and validation of the tool.
Developed by a working group in Copenhagen, Denmark. The team performed a meta-analysis of 128 randomized trials to determine which clinical features best predicted who would actually benefit from being fed in the hospital.
