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NRS-2002 Calculator

Nutritional risk screening before surgery

NRS-2002 (Nutritional Risk Screening 2002) is the tool recommended by ESPEN for identifying hospitalised and surgical patients who need nutritional support. It does not only measure how depleted you are; it combines nutritional status with how much the disease increases protein requirements. For rectal cancer this matters directly: patients who are nutritionally at risk have significantly more complications after surgery, including anastomotic leak.

The tool has two stages. First you answer four short questions; if you answer "yes" to at least one of them, the final screening opens.

1 Initial screening

Is BMI <20.5?
kg
cm

Enter your weight and height; the answer is determined automatically.

Has the patient lost weight within the last 3 months?
Has the patient had a reduced dietary intake in the last week?
Is the patient severely ill? (e.g. in intensive therapy)

Why it matters before rectal cancer surgery

Nutritional risk is not a question of appearance or comfort — it is a measurable surgical risk factor. Studies in colorectal cancer patients have consistently shown that those with an NRS-2002 of 3 or more have more postoperative complications:

  • Complication rate 62% versus 40% in a prospective study of 186 patients operated on for colorectal cancer (Schwegler, Br J Surg 2010)
  • Significantly increased risk of anastomotic leak and of wound infection (Kwag, Ann Surg Treat Res 2014)
  • In a study of 1063 rectal cancer patients operated on with sphincter preservation, a raised nutritional score was an independent risk factor for anastomotic leak (Lee, Eur J Clin Nutr 2018)
  • Length of hospital stay was shortest in at-risk patients who received nutritional support and longest in at-risk patients left untreated (Kollar, Nutr Cancer 2022)

The ESPEN guideline on clinical nutrition in surgery recommends that nutritional support be started before admission, in the outpatient window, and that in patients at severe nutritional risk surgery may be delayed by 7–14 days for nutritional preparation, even in the case of cancer operations. This is the nutritional component of what is called prehabilitation.

Complete preoperative assessment

NRS-2002 covers the nutritional side. For operative risk there is CR-POSSUM, and for the impact of comorbidities, the Charlson index.

CR-POSSUM → Charlson Index →

Scientific references

Kondrup J, Rasmussen HH, Hamberg O, Stanga Z, ad hoc ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003;22(3):321-336. PubMed

Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003;22(4):415-421. PubMed

Weimann A, Braga M, Carli F, et al. ESPEN practical guideline: Clinical nutrition in surgery. Clin Nutr. 2021;40(7):4745-4761. PubMed

Methodological note: for dietary intake we use the 25–60% band from the official ESPEN document. Some secondary reproductions simplify it to 25–50%. The published bands overlap partially (50–75% for score 1 and 25–60% for score 2), so the evaluation proceeds in descending order and the more severe category is retained, following the logic of the tool. The criteria within each level are alternatives, not cumulative.