NRS-2002 — Nutritional Risk Screening: ESPEN-recommended tool for all hospitalised patients. Score ≥ 3 = nutritional risk. Mandatory screening within 24h of admission in many NHS/EU hospitals.
Step 1 — Initial Screening
No criteria met — Re-screen weekly or if clinical status changes.
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
All adult patients within 24h of hospital admission (ESPEN mandate)
Identify patients requiring proactive nutritional intervention before clinical deterioration
Mandatory documentation in many NHS, EU, and Australian accreditation frameworks
Patients with chronic disease, recent surgery, poor oral intake, or unexplained weight loss
Who to Screen
All medical and surgical inpatients ≥ 18 years. Re-screen weekly if initial screen is negative. If BMI > 30 with no other risk factors, patient scores 0 on initial screen but monitor given obesity-related malnutrition risk.
Section 2
Formula & Logic
Step 1 — Initial Screen (4 YES/NO Questions)
BMI < 20.5?
Weight loss in last 3 months?
Reduced dietary intake in last week?
Patient severely ill (ICU)?
Step 2 — Full Scoring (if any Step 1 = YES)
01
Nutritional status: 0 (normal) to 3 (severe malnutrition or minimal intake)
02
Disease severity: 0 (no disease) to 3 (ICU patient ± APACHE > 10)
03
Age ≥ 70 years: +1 point
Score Interpretation
Total score ≥ 3 = At nutritional risk. Initiate individualised nutritional support plan. Score < 3 = Not currently at risk. Re-screen weekly.
Section 3
Pearls/Pitfalls
NRS-2002 vs MUST
NRS-2002: Preferred for HOSPITALISED adult patients. Validated in 128 RCTs.
MUST: Better for community/outpatient settings and GP practices.
SNAQ: Shorter 4-item tool validated for hospital screening with comparable performance.
MNA (Mini Nutritional Assessment): Best validated tool for elderly populations (≥ 65 years).
Nutritional Intervention Targets
Protein target: 1.2–1.5 g/kg/day (higher in severe disease, burns, surgery)
Calorie target: 25–30 kcal/kg/day (avoid overfeeding in critically ill)
Enteral nutrition preferred over parenteral when gut functional
Initiate EN within 24–48h of ICU admission in ventilated patients
Section 4
Next Steps
Score ≥ 3 — Actions
01
Dietitian referral within 24h.
02
Document nutritional plan in patient notes.
03
Prescribe oral nutritional supplements (ONS) as initial step.
04
For swallowing difficulty or inadequate oral intake: nasogastric tube + enteral feeds.
05
For non-functional gut: parenteral nutrition via central access (PICC or CVC).
Score < 3 — Actions
01
Continue to encourage normal oral intake.
02
Re-screen weekly or if clinical status changes.
03
Reassess if prolonged NPO status, new infection, or surgery planned.
Complementary Tools
NEWS2
Ranson's Criteria
MELD Score
Section 5
Evidence Appraisal
Validation Study
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):321–336. Validated against 128 RCTs of nutritional interventions.
Section 6
Literature
ESPEN Development — 2003
NRS-2002 was developed by Kondrup and colleagues for the European Society for Clinical Nutrition and Metabolism (ESPEN). Unlike other tools that rely on clinician gestalt, NRS-2002 was uniquely derived by checking whether patients in 128 published RCTs who would have scored ≥ 3 actually benefited from nutritional intervention. This evidence-first approach makes it the most rigorously constructed nutritional screening tool in clinical use.
