NRS-2002: how nutritional risk screening is scored

NRS-2002 (Nutritional Risk Screening 2002) adds a grade for impaired nutritional status (0 to 3), a grade for disease severity (0 to 3) and 1 point for age 70 or over. A total of 3 or more sets at_risk to true.

Not a medical device. Not a diagnosis or dosing recommendation.

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Emergency calculators
Kondrup J et al. · 2003
The NRS-2002 formula
Worked examples
Frequently asked questions

What is NRS-2002?

NRS-2002 is a nutritional risk screening tool for adults in hospital. Jens Kondrup and an ad hoc working group of ESPEN (the European Society for Clinical Nutrition and Metabolism) published it in Clinical Nutrition in 2003. It looks at two things together: how undernourished a person is and how severe their illness is, with an extra point for older age.

Magent's calculator adds the two grades you assign and the age point, returns the total out of 7, and sets at_risk to true at 3 or more. It doesn't return any other band.

This page explains the scoring. It doesn't say what a score means for a particular person.

The NRS-2002 formula

NRS-2002 = impaired nutritional status   0 absent · 1 mild · 2 moderate · 3 severe
         + disease severity              0 absent · 1 mild · 2 moderate · 3 severe
         + 1 if age is 70 or over
total 0 to 7 · at_risk = true if total is 3 or more

Exact expression the calculator uses:

NRS-2002 = nutrition_status (0–3) + disease_severity (0–3) + 1 if age ≥ 70; max 7; at_risk if score ≥ 3

Inputs

Input	Meaning	Accepted range
`nutrition_status`	Impaired nutritional status grade, as you assign it	0, 1, 2 or 3
`disease_severity`	Disease severity grade, as you assign it	0, 1, 2 or 3
`age`	Age in years, a whole number	18 to 120

How the scoring works

Grade impaired nutritional status, 0 to 3. If weight loss, BMI and food intake point to different grades, use the highest.

Grade	Impaired nutritional status
0	Absent
1	Mild: weight loss >5% in 3 months, or food intake 50–75% of requirement in the last week
2	Moderate: weight loss >5% in 2 months, or BMI 18.5–20.5 plus impaired general condition, or intake 25–60%
3	Severe: weight loss >5% in 1 month (>15% in 3 months), or BMI <18.5 plus impaired general condition, or intake 0–25%

Grade disease severity, 0 to 3.

Grade	Disease severity (examples)
0	Absent: normal nutritional requirements
1	Mild: hip fracture; chronic illness with complications such as cirrhosis, COPD, chronic hemodialysis, diabetes, oncology
2	Moderate: major abdominal surgery, stroke, severe pneumonia, hematologic malignancy
3	Severe: head injury, bone marrow transplant, ICU patients with APACHE >10

Age: add 1 if age is 70 or over. Age 70 scores; age 69 doesn't.
Add the three parts. The total runs from 0 to 7.
Flag: at_risk is true at 3 or more.

Inputs and output

The two grades are whole numbers you assign, and age is in whole years. The calculator doesn't weigh anyone or work out BMI, weight loss or food intake; the grade tables above are how a person assigns the grades. A value outside its range is rejected with an error. The calculator returns each part, the total, the maximum of 7 and at_risk.

Worked examples

These use Magent's own expected values for the calculator.

Example 1: no impairment, age 50

Nutritional status 0 + disease severity 0 + age 50 (under 70) → 0.
Total 0 out of 7 → at_risk false.

Example 2: severe nutritional status alone, age 50

3 + 0 + 0 = 3.
at_risk true. A grade of 3 on either part reaches the cutoff by itself.

Example 3: severe disease alone, age 50

0 + 3 + 0 = 3 → at_risk true.

Example 4: no impairment, age 70

0 + 0 + 1 = 1.
at_risk false.

Example 5: mild and mild, age 70

1 + 1 + 1 = 3.
at_risk true.

Example 6: severe and severe, age 80

3 + 3 + 1 = 7, the maximum.
at_risk true.

History of the NRS screening tool

Kondrup J, Rasmussen HH, Hamberg O, Stanga Z and the Ad Hoc ESPEN Working Group published the tool in Clinical Nutrition in 2003 (volume 22, issue 3, pages 321–336). The abstract explains that degrees of disease severity and undernutrition were defined as absent, mild, moderate or severe from data in selected randomized controlled trials, then turned into a numeric score. The screening system was then checked against published trials comparing nutritional support with spontaneous intake.

When it's used

NRS-2002 was built to screen adults in hospital for nutritional risk.

Where it's used

The grades draw on weight history, BMI, recent food intake, the illness and age. No lab values go into it.

Who uses it

The person using the calculator assigns the two grades and enters age. The calculator adds them and applies the cutoff of 3.

Limits of the calculation

The calculator doesn't weigh anyone or compute BMI, weight loss or food intake. The grades come from the person entering them.
at_risk reflects a cutoff of 3. No other band is returned.
It isn't a diet order or a nutrition plan.
It's NRS-2002, not the Nutritional Risk Index (NRI).
This page doesn't say what to do with a score.

Clinical decisions belong to a qualified clinician who knows the patient.

NRI (Nutritional Risk Index) is a formula from serum albumin and current and usual weight, from the VA TPN Cooperative Study. NRS-2002 adds graded categories instead.
MUST is the Malnutrition Universal Screening Tool, built from BMI, unplanned weight loss and acute illness effect.

Glossary

Impaired nutritional status: graded from weight loss, BMI and recent food intake.
Disease severity: graded from how much the illness raises nutritional requirements.
BMI: body mass index, in kg/m².
ESPEN: the European Society for Clinical Nutrition and Metabolism.
APACHE: an intensive care illness severity score, mentioned in the severe grade.

Common mistakes

Averaging the nutrition grades. If weight loss, BMI and intake differ, use the highest grade.
Missing the age point at 70. Age 70 scores 1.
Confusing NRS-2002 with NRI. They're different tools with different inputs.
Reading at_risk as a plan. It's a screening flag at 3 or more.

Source

Kondrup J, Rasmussen HH, Hamberg O, Stanga Z; Ad Hoc ESPEN Working Group. Clin Nutr. 2003;22(3):321-336. DOI: 10.1016/s0261-5614(02)00214-5. PMID: 12765673

Frequently asked questions

How is NRS-2002 scored?

Add the impaired nutritional status grade (0 to 3), the disease severity grade (0 to 3) and 1 point for age 70 or over.

What NRS-2002 score means nutritional risk?

3 or more. At that total the calculator sets at_risk to true.

What is the highest NRS-2002 score?

7: severe on both grades plus the age point.

Does age 70 get the extra point?

Yes. The point applies at 70 and over.

Is NRS-2002 the same as the Nutritional Risk Index?

No. NRI is a formula from albumin and weight; NRS-2002 adds graded categories and an age point.