Workstream:

Malnutrition Screening

The Malnutrition Screening Workstream is working to ensure adults at risk of malnutrition are identified earlier and more consistently across Aotearoa New Zealand. By recommending practical, evidence-based, culturally appropriate screening tools and implementation approaches, the workstream aims to support timely nutrition assessment and care and improve health outcomes nationwide.

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This work addresses longstanding variation in malnutrition screening practices resulting from the absence of a nationally consistent approach. Without routine screening, people at risk of malnutrition may not be identified, delaying nutrition assessment and intervention and contributing to poorer health outcomes. Inconsistent approaches also limit national data collection, making it difficult to monitor outcomes, compare services and address inequities in care.

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A nationally consistent approach to screening is an important part of the wider Malnutrition Care Aotearoa New Zealand strategy and will support improved equity, quality of care and health system performance.

Priorities

Current focus areas include:
  • Identifying validated malnutrition screening tools that may be suitable for use in Aotearoa New Zealand.
  • Assessing the cultural appropriateness of screening tools across New Zealand populations.
  • Evaluating the practicality and feasibility of screening tools across different care settings.
  • Gaining sector consensus on the recommended screening approach and tool(s).
  • Identifying barriers and enablers to successful implementation.
  • Developing guidance to support the integration of malnutrition screening into routine clinical practice across hospital, community, primary care and aged residential care settings.

Intended Outcomes/Goals

The Malnutrition Screening Workstream aims to support consistent and effective identification of malnutrition risk across recommended areas of the health system.

If adopted and implemented, the workstream's recommendations are intended to:

  • Support the use of a nationally recommended malnutrition screening tool(s) for adults in Aotearoa New Zealand.
  • Improve consistency in identifying adults at risk of malnutrition across acute, community, primary care and aged residential care settings.
  • Enable earlier referral for nutrition assessment and intervention.
  • Improve health outcomes through timely and appropriate nutrition care.
  • Reduce variation in malnutrition care and support equitable, culturally responsive malnutrition screening for Māori, Pacific peoples and all New Zealanders.
  • Support more consistent collection and reporting of malnutrition screening and risk data.

Scope and Coverage

This workstream focuses on malnutrition screening for adults aged 18 years and over in:
  • Acute hospital and inpatient settings
  • Aged residential care
  • Community healthcare settings
  • General practice and primary care
The following populations and settings are not currently within the scope:
  • Paediatric populations
  • Maternity services
  • Intensive Care Units (ICU)
  • Specialist populations or clinical conditions requiring population specific screening approaches

Preliminary Recommendations

The recommendations below are for an adult population, excluding paediatric and specific diseases.

  • There is not one single specific malnutrition screening tool that can be recommended for use in all settings.
  • Malnutrition Screening Tool (MST) is recommended for Acute/inpatient settings
  • Mini Nutritional Assessment – Short Form (MNA-SF) and MST are recommended for Community settings
  • MNA-SF and MST are recommended for Aged Residential Care settings.
  • Further work is needed to develop/validate appropriate screening tools for the New Zealand context.

We have taken the following into account when making the final recommendations numbered above:

  • Screening tools using BMI are likely to underestimate malnutrition risk for some population groups.
  • Screening tools that include BMI need to be used with caution within the NZ context.
  • MST is quick, easy to use.
  • MST is the most commonly used screening tool in NZ hospitals (acute setting) that have implemented malnutrition screening.
  • We don’t know what screening tools, if any, are being used widely in NZ community settings. We recommend adopting the recommendations of the Evidence-based Guide for the Identification and Nutritional Management of Malnutrition and Frailty in the Australian and New Zealand Community (Roberts, 2022).
  • Survey responses from NZ Aged Residential Care settings were limited. Mini Nutritional Assessment – Short Form (MNA-SF) and Malnutrition Universal Screening Tool (MUST) have been used. InterRAI Undernutrition Collaborative Action Plans were not identified by survey responders as being utilised as a malnutrition screening tool.

Governance

The MCANZ workstreams are guided by a Steering Group, which provides strategic oversight and helps ensure the work reflects clinical, community and health system needs across Aotearoa New Zealand.

Workstream Chair

  • Amy Pettigrew-Porter, NZRD, MSc

References and Resources

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