mentalhealth | NADA NUTRITION

Mental Health Nutrition Risk Screening

This tool is designed to assess dietary and nutrition-related risks that may be relevant to mental health care. It does not diagnose depression, anxiety, or any psychiatric disorder.

Section 1. Required Basic Information

1. Name

2.Age

5. Females only: specific period

3.Physical Activity Level

6. Height (cm)

4. Gender

7. Weight (kg)

Section 2. Appetite and Recent Weight Change

8. Over the past 2 weeks, how has your appetite changed?

9. Has your weight changed in the past 3 months?

10. Approximate weight change in the past 3 months (kg)

11. Was the weight loss unintentional?

12. Have your clothes become noticeably looser recently?

Section 3. Meal Regularity and Eating Pattern

13. How regular are your meals?

14. How often do you eat breakfast?

15. Do you often go more than 8 hours during the day without eating?

16. Do you often eat a large amount of food late at night?

17. When do you usually consume the largest amount of food?

Section 4. Emotional Eating and Loss of Control Eating

18. When emotionally distressed, what usually happens to your eating?

19. Over the past 2 weeks, have you had episodes of eating much more than usual and feeling unable to stop?

20. Do you often crave sweet foods or sugary drinks?

21. Do you often use food to relieve stress, sadness, or anxiety?

Section 5. Caffeine, Alcohol, and Stimulant Intake

22. Daily coffee intake

23. Daily strong tea intake

24. Energy drink intake

25. Alcohol intake frequency

26. Usual alcohol amount per occasion

Section 6. Sleep and Daily Rhythm

27. Average sleep duration

28. How would you describe your sleep quality?

29. Do you often go to bed after midnight?

30. Do you work night shifts or rotating shifts?

Section 7. Diet Quality Risk Factors

31. How often do you eat vegetables?

32. How often do you eat fruit?

33. How often do you eat fish or seafood?

34. How often do you eat nuts or seeds?

35. How often do you eat whole grains or mixed grains?

36. How often do you eat highly processed snacks, instant foods, fast foods, or packaged sweets?

37. How often do you drink sugary beverages?

Section 8. Clinical Nutrition Follow-up Information

38. Are you currently receiving mental health treatment?

39. Main nutrition-related concern

40. Do you have recent lab test results?

41. Recent vitamin D test available?

42. Recent iron or ferritin test available?

43. Recent vitamin B12 or folate test available?

44. Additional notes for clinician

Dietary Records

To accurately assess the nutritional status of dialysis patients, please record all foods consumed per meal, including breakfast, lunch, dinner, and snacks.

Whenever possible, we recommend weighing each food item. If weighing is not feasible, refer to the standard portion size guide to assist with estimation. The more accurate the entry, the more reliable the analysis.

For each food entry, please provide:

Food Name: Type keywords and select the best match from the suggestion list
Amount (in grams): e.g., “Fried egg 60g”, “Whole wheat bread 40g”
Day: If recording 2–3 days of intake, use the “Which day?” dropdown to specify whether the item belongs to Day 1, Day 2, or Day 3

We recommend selecting 1 to 3 representative days from the current dialysis cycle. Up to 12 food entries per meal are supported, which is sufficient for a complete nutritional analysis.

The final report will be based on the average daily intake and include targeted nutrient evaluations and practical dietary recommendations.

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*If you record more than one day, please enter the total amount of beverages consumed across all recorded days
(water, tea, coffee, drinks; excluding water from foods).

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