Chapter 7 Unintended Weight Loss Figure 7.2 Short Nutritional Assessment Questionnaire Short Nutritional Assessment Questionnaire (SNAQ) Name: _________________________________________________________ Sex (circle): Male Female Age: ______________ Weight: ______________ Height: ______________ Date: _____________________

Administration Instructions: Ask the subject to complete the questionnaire by circling the correct answers and then tally the results based upon the following numerical scale: a = 1, b = 2, c = 3, d = 4, e = 5. The sum of the scores for the individual items constitutes the SNAQ score.

1. My appetite is

a. very poor b. poor c. average d. good e. very good

2. When I eat

a. I feel full after eating only a few mouthfuls b. I feel full after eating about a third of a meal c. I feel full after eating over half a meal d. I feel full after eating most of the meal e. I hardly ever feel full

3. Food tastes

a. very bad b. bad c. average d. good e. very good

4. Normally I eat

a. less than one meal a day b. one meal a day c. two meals a day d. three meals a day e. more than three meals a day

Source: Reprinted with permission from Wilson MG, Thomas DR , Rubenstein LZ, Chibnal JT, Anderso S, Baxi A, Diebold MR, Morley JE. Appetite assessment: simple appetite questionnaire predicts weight loss in community-dwelling adults and nursing home residents. Am J Clin Nutr. 2005;82:1074-1081. http://ajcn.nutrition.org/content/82/5/1074/T6.expansion.html.

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