Nutritional Health Checklist

Endocrine, Nutrition & Obesity, Patient Education
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Nutritional Health Checklist
[select name="Q1" value="false (0 points)=0|TRUE (2 points)=2"] <-- 1. I have an illness or condition that made me change the kind or amount of food I eat.
[select name="Q2" value="false (0 points)=0|TRUE (2 points)=2"] <-- 2. I eat fewer than two meals per day.
[select name="Q3" value="false (0 points)=0|TRUE (3 points)=3"] <-- 3. I eat few fruits, vegetables, or milk products.
[select name="Q4" value="false (0 points)=0|TRUE (2 points)=2"] <-- 4. I have three or more drinks of beer, liquor, or wine almost every day.
[select name="Q5" value="false (0 points)=0|TRUE (2 points)=2"] <-- 5. I have tooth or mouth problems that make it hard for me to eat.
[select name="Q6" value="false (0 points)=0|TRUE (4 points)=4"] <-- 6. I don't always have enough money to buy the food I need.
[select name="Q7" value="false (0 points)=0|TRUE (1 point)=1"] <-- 7. I eat alone most of the time.
[select name="Q8" value="false (0 points)=0|TRUE (1 point)=1"] <-- 8. I take three or more different prescription or over-the-counter drugs per day.
[select name="Q9" value="false (0 points)=0|TRUE (2 points)=2"] <-- 9. Without wanting to, I have lost or gained 10 lb in the past six months.
[select name="Q10" value="false (0 points)=0|TRUE (2 points)=2"] <-- 10. I am not always physically able to shop, cook, or feed myself.
Score --> [calc memo="score" value="score=(Q1)+(Q2)+(Q3)+(Q4)+(Q5)+(Q6)+(Q7)+(Q8)+(Q9)+(Q10)"] out of 21 points
Interpretation --> [calc memo="interpretation" value="score=(Q1)+(Q2)+(Q3)+(Q4)+(Q5)+(Q6)+(Q7)+(Q8)+(Q9)+(Q10);score>5?'High nutritional risk, may require immediate assistance to improve your nutritional status.':score>2?'Moderate nutritional risk. Lifestyle and eating habit improvements needed. Recheck your nutritional score in three months.':'Good nutrition. Recheck nutritional score in six months.'"]
[html]<hr>[/html][checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).is('')"][html]
reference: The Nutrition Health Checklist was developed for the Nutrition Screening Initiative, a project of the American Academy of Family Physicians, the American Dietetic Association and the National Council on Aging, Inc.<a href="http://www.aafp.org/afp/980301ap/edits.html"> Info at AAFP website</a>, AAFP Geriatric assessment article: <a href="http://www.aafp.org/afp/2011/0101/p48.html">Elsawy (2011) Am Fam Phys 83: 48-56</a>.[/html][/conditional]
Nutritional Health Checklist
<-- 1. I have an illness or condition that made me change the kind or amount of food I eat.
<-- 2. I eat fewer than two meals per day.
<-- 3. I eat few fruits, vegetables, or milk products.
<-- 4. I have three or more drinks of beer, liquor, or wine almost every day.
<-- 5. I have tooth or mouth problems that make it hard for me to eat.
<-- 6. I don't always have enough money to buy the food I need.
<-- 7. I eat alone most of the time.
<-- 8. I take three or more different prescription or over-the-counter drugs per day.
<-- 9. Without wanting to, I have lost or gained 10 lb in the past six months.
<-- 10. I am not always physically able to shop, cook, or feed myself.
Score --> scorescore=(Q1)+(Q2)+(Q3)+(Q4)+(Q5)+(Q6)+(Q7)+(Q8)+(Q9)+(Q10) out of 21 points
Interpretation --> interpretationscore=(Q1)+(Q2)+(Q3)+(Q4)+(Q5)+(Q6)+(Q7)+(Q8)+(Q9)+(Q10);score>5?'High nutritional risk, may require immediate assistance to improve your nutritional status.':score>2?'Moderate nutritional risk. Lifestyle and eating habit improvements needed. Recheck your nutritional score in three months.':'Good nutrition. Recheck nutritional score in six months.'

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Result - Copy and paste this output:

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