Complete 18 Items
Part 1: Screening
A. Has food intake declined over the past 3 months due to loss of appetite, digestive problems, chewing or swallowing difficulties?
B. Weight loss during the last 3 months
C. Mobility
D. Has suffered psychological stress or acute disease in the past 3 months?
E. Neuropsychological problems
F. Body Mass Index (BMI)
If BMI unavailable, Calf Circumference (CC) in cm:
Part 2: Assessment
G. Lives independently (not in nursing home or hospital)?
H. Takes more than 3 prescription drugs per day?
I. Pressure sores or skin ulcers?
J. How many full meals does the patient eat daily?
K. Selected consumption markers for protein intake
At least 1 serving of dairy/day? Two or more servings of legumes/eggs/week? Meat, fish or poultry every day?
L. Consumes two or more servings of fruit or vegetables per day?
M. How much fluid is consumed per day? (Water, juice, coffee, tea, milk...)
N. Mode of feeding
O. Self view of nutritional status
P. In comparison with other people of the same age, how does the patient consider their health status?
Q. Mid-arm circumference (MAC) in cm
R. Calf circumference (CC) in cm
Verified
Last Review: 2026
Last Comprehensive Review: 2026
