Lippincott Nursing Pocket Card - August 2023

Nutritional Assessment



The nutritional assessment is often integrated into the health history and physical examination. It provides information about nutritional deficiencies, such as malnutrition, undernutrition or obesity.

Initial Assessment of Nutritional Status

Malnutrition is diagnosed with two or more of the following:
  • Insufficient intake
  • Weight loss
  • Loss of muscle mass
  • Loss of subcutaneous fat
  • Decreased functional status
  • Fluid accumulation can mask weight loss 



  • Ask about the patient’s current dietary practices.
  • Use a nutritional screening tool to assess for adequate nutrition; the Mini Nutritional Assessment is a commonly used, well-validated tool to identify older adults who are malnourished or at risk of becoming malnourished.
  • Ask about health problems associated with poor nutrition, such as obesity, osteoporosis, cirrhosis, diverticulitis, Crohn’s disease, ulcerative colitis and eating disorders.
  • Inquire about previous surgeries, including bariatric surgery.
  • Ask about food insecurity. Use the Hunger Vital Sign™ two-question screening tool (Hager et a., 2010) to identify households at risk.
    • Have the patient or caregiver reply often true, sometimes true or never true to the statements below.
      • “Within the past 12 months, we worried whether our food would run out before we had money to buy more.”
      • “Within the past 12 months, the food we bought just didn’t last and we didn’t have money to get more.”  

Collect dietary data

  • To help estimate adequacy and appropriateness of food intake, collect data by having the patient complete a food record or perform a 24-hour food recall, or conduct a dietary interview.
  • Consult with a nutritionist or registered dietician, as needed.

Physical examination

  • Calculate the body mass index (BMI) and waist circumference.
  • Throughout the head-to-toe assessment, look for signs that suggest possible nutritional deficiency, such as muscle wasting, poor skin integrity, loss of subcutaneous tissue, and obesity.
  • Other tissues that serve as physical indicators of nutrition status include the hair, skin, teeth, gums, mucous membranes, mouth and tongue, skeletal muscles, abdomen, lower extremities, and thyroid gland.
  • Perform a biochemical assessment, which includes these tests of serum and urine.
    • Low serum albumin and prealbumin are most often used as measures of protein deficit in adults.
    • Transferrin is a protein that binds and carries iron from the intestine through the serum. Low levels of transferrin can also lead to a deficiency in iron.
    • Measurement of retinol-binding protein may be a useful means of monitoring acute, short-term changes in protein status.
    • The total lymphocyte count may be reduced in people who are acutely malnourished.
    • Serum electrolyte levels provide information about fluid and electrolyte balance and kidney function.
    • A 24-hour urine collection can be utilized to calculate the creatinine/height index that assesses metabolically active tissue and indicates the degree of protein depletion.


  • Some signs and symptoms that appear to indicate nutritional deficiency may reflect other systemic conditions, such as endocrine disorders or infection, or may result from impaired digestion, absorption, excretion, or storage of nutrients.
  • Inadequate dietary intake in older adults may result from physiologic changes in the gastrointestinal tract, financial factors, limited ability to shop and cook, drug interactions, disease, and poor dentition.
  • A waist circumference greater than 40 inches for men or 35 inches for women indicates excess abdominal fat.
  • Decreased albumin levels may be caused by overhydration, liver or renal disease, or excessive protein loss due to burns, major surgery, infection, or cancer.
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.
Hager, E. R., Quigg, A. M., Black, M. M., Coleman, S. M., Heeren, T., Rose-Jacobs, R., Cook, J. T., Ettinger de Cuba, S. A., Casey, P. H., Chilton, M., Cutts, D. B., Meyers, A. F., & Frank, D. A. (2010). Development and validity of a 2-item screen to identify families at risk for food insecurity. Pediatrics126(1), e26–e32.
Hinkle, J., & Cheever, K. H. (2017). Brunner & Suddarth's Textbook of Medical-Surgical Nursing (14th Edition). Wolters Kluwer Health.
Romanowski, K. (2021, November 15). Clinical assessment and monitoring of nutrition support in adult surgical patients. UpToDate.