ABCDs of the Nutritional Assessment

The ABCDs of Nutritional Assessment refer to four key components used to evaluate a person’s nutritional status. These components provide a comprehensive look at both the measurable and observable aspects of nutrition and include:

A: Anthropometric Assessment

• What It Involves: Taking direct measurements of the body such as weight, height, body mass index (BMI), skin-fold thickness, mid-arm circumference, head circumference (in children), and other body dimensions.
• Purpose: To assess growth, body composition, and overall nutritional status through objective, quantifiable data.

B: Biochemical Assessment

• What It Involves: Analyzing biological samples—usually blood, urine, or sometimes tissues—to measure nutrient levels, metabolites, or enzymes that reflect nutrient status.
• Purpose: To identify nutrient deficiencies or excesses (for example, blood glucose, cholesterol, vitamin levels, or protein markers) and to monitor the body’s response to a nutritional intervention.

C: Clinical Assessment

• What It Involves: A physical examination and review of the patient’s history to look for clinical signs and symptoms of nutritional deficiencies or imbalances. This may include examining the skin, hair, eyes, nails, and oral health.
• Purpose: To recognize clinical clues (such as changes in skin turgor, hair loss, or spoon-shaped nails) that indicate malnutrition or micronutrient deficiencies.

D: Dietary Assessment

• What It Involves: Evaluating food and nutrient intake through various methods such as 24-hour dietary recalls, food frequency questionnaires, dietary records, or food diaries.
• Purpose: To understand the quality and quantity of an individual’s diet, assess eating patterns, and identify potential gaps in nutrient intake.

When obtaining a patient’s health history, it is important to assess and document the nutritional status. Nutrition is critical in maintaining a healthy weight and to preventing conditions such as cardiovascular disease and diabetes. In addition, adequate nutrition is vital to healing and recovery from illness and injury. A complete nutritional assessment helps clinicians evaluate overall dietary status, and identify malnutrition and its underlying causes. Malnutrition can be both an inadequate or excessive intake of nutrients and is categorized as follows:

• Undernutrition (low weight-for-height, low height-for-age, and low weight-for-age)
• Micronutrient (vitamins and minerals) deficiency or excess
• Overnutrition (overweight, obesity, type 2 diabetes mellitus, cardiovascular disease)

Malnutrition Universal Screening Tool (MUST)

MUST is a five-step screening tool, to identify adults who are malnourished (or at the risk of malnutrition). It is for use in hospitals, community and other settings.

• Step 1 – BMI Score
• Step 2 – Unplanned Weight-loss Score
• Step 3 – Acute Disease Effect Score.
• Step 4 – Add scores to calculate overall risk of malnutrition.
• Step 5 – Use management guidelines to develop care plan.

Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP)

The STAMP (Screening Tool for the Assessment of Malnutrition in Paediatrics) follows a simple 5-step process to assess malnutrition risk in hospitalized children. Here’s how it works:

STAMP 5-Step Process

1. Step 1: Measure Nutritional Intake
   • Assess the child’s recent food intake compared to normal dietary needs.
2. Step 2: Identify Clinical Conditions
   • Determine if the child has a medical condition that affects nutrition.
3. Step 3: Evaluate Growth Parameters
   • Check weight, height, and BMI to assess nutritional status.
4. Step 4: Assign a Risk Score
   • Based on the findings, assign a malnutrition risk score.
5. Step 5: Develop an Action Plan

Malnutrition Screening Tool (MST)

The Malnutrition Screening Tool (MST) is a simple and effective method used to identify patients at risk of malnutrition. It consists of a three-step process that helps healthcare providers assess nutritional status and determine appropriate interventions.

MST 3-Step Process

Step 1: Screening Questions

• Weight Loss Assessment:
  • “Have you lost weight recently without trying?”
  • If yes, estimate the amount lost (e.g., 1-5 kg = 1 point, 6-10 kg = 2 points, etc.).
• Appetite Assessment:
• “Have you been eating poorly due to a decreased appetite?”
• If yes, assign 1 point.

Step 2: Risk Scoring

• Add the scores from weight loss and appetite assessment.
• MST Score Interpretation:
  • 0-1 points = Low risk (Monitor and rescreen weekly).
  • 2 or more points = At risk (Implement nutritional interventions and refer to a dietitian).

Step 3: Management Plan

• Patients at risk should receive nutritional support, including dietary modifications and supplementation.
• Regular monitoring and follow-up are essential to prevent further deterioration.

REFERENCES

1. Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bate’s Guide to Physical Examination and History Taking (13th ed.). Wolters Kluwer Health: Philadelphia.
2. Gillaspy, R. (n.d.). Assessing Your Nutrition, Diet & Health: How to Avoid Disease. Retrieved December 6, 2017, from Study.com: https://study.com/academy/lesson/assessing-your-nutrition-diet-health-how-to-avoid-disease.html
3. Dwyer JT, Gallo JJ, Reichel W. Assessing nutritional status in elderly patients. Am Fam Physician. 1993 Feb 15;47(3):613-20. PMID: 8434552.
4. Chu, A.S. & Delmore, B. (2020). Parameters for Nutrition Assessment. Advances in Skin & Wound Care: The Journal for Prevention and Healing.33(5), 232-232.
5. Cleveland Clinic. (2022, May 4). Malnutrition. https://my.clevelandclinic.org/health/diseases/22987-malnutrition
6. Hinkle, J. (2021). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (15^th ed.). Wolters Kluwer Health. https://wolterskluwer.vitalsource.com/books/9781975161057
7. Kesari A, Noel JY. Nutritional Assessment. [Updated 2023 Apr 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK580496/

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