The present paper explores the problems associated with assessment of nutritional status in the community and reviews the literature related to this subject. The first problem is one of terminology, since a logical first step before assessment is screening, which identifies characteristics known to be associated with dietary or nutritional problems. Its purpose is to differentiate individuals who are at high nutritional risk or have poor nutritional status. There are certain factors which should alert the primary health care team to the fact that nutritional intake may be reduced and that risk of malnutrition is increased. These include disease condition, functional disabilities, inadequate or inappropriate food intake, poor dentition or difficulty swallowing, polypharmacy, alcoholism, depression, poor social circumstances or recent discharge from hospital. Patients suffering from these factors need to be identified so that screening becomes a routine part of their medical treatment. At-risk groups include the elderly, the chronically ill, those with cancer and neurological disorders, post-surgical patients and children with developmental disabilities. In the community, practice and community nurses see the majority of at-risk patients and should carry out screening. A number of screening tools have been developed for community use. Most are aimed at the elderly population, but there are others designed to assess nutritional risk in children with developmental disabilities and the general population. These are reviewed and problems of content and validity identified. Some problems associated with nutritional assessment are also reviewed.

Surveys have shown that 20–50 % of hospital admissions suffer from nutritional depletion and that there is failure to recognize its existence and significance. More emphasis must be placed in clinical medicine on identifying subjects who are at high risk of developing disease-related malnutrition. There is a need to screen patients on admission to hospital to identify those at risk of nutrition-related complications. More formal determination of nutritional status should be carried out to define the nutritional status of the patient and to monitor changes in nutritional status during nutritional support. The most frequently used tests of nutritional status include dietary, anthropometric, biochemical and functional indices of nutritional status. It is important, and indeed is the skill of the nutritional care team (particularly the dietitian) to be able to evaluate these measurements, as many of them are affected by non-nutritional factors. There is no consensus on the best method for the accurate assessment of nutritional status. Practical difficulties arise with individual measurements and in their interpretation in the acute setting. The aim of the present paper is to identify the most relevant variables to measure in clinical medicine, and to discuss the limitations of their use in the acute setting.