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Background The aim of this paper was to give a critical appraisal of the methodology of nutritional screening and assessment tools. Methods A literature search identified 44 tools. Each tool was assessed in relation to details of its application, method of derivation and evaluation of its performance. Results The findings indicate that tools were published with insufficient details regarding their intended use and method of derivation, and with an inadequate assessment of their effectiveness. An appraisal of these features judged that no one tool satisfied a set of criteria regarding scientific merit. Conclusion There is thus a need to ensure that nutritional screening and assessment tools are developed using procedures based on good design and sound statistical practice. This paper suggests that a unified approach using multivariate techniques could make a significant contribution to this process.