Download Nutritional indices

ASSESSMENT OF
NUTRITIONAL STATUS
LEARNING OBJECTIVES
1. Value the use of nutritional diagnosis in clinic and at
the level of population.
2. Understand the implications for using nutritional
indices.
3. Define anthropometry.
4. List 10 nutritional indices.
5. List the requirements for measuring anthropometric
data.
6. List two references used for anthropometric indices.
7. Understand the implications of international
references for assessment of local people.
LEARNING OBJECTIVES
8. Compare the interpretation of single Vs multiple
serial measurements of indices.
9. List the data needed for calculation of nutritional
indices.
10. Identify a computer program used for calculating
nutritional indices.
11. Learn the formula for calculating z score.
12. Identify the cut-off values for percentiles and zscore used for defining malnutrition and obesity.
13. Differentiate between acute and chronic
malnutrition.
INTRODUCTION
The nutritional status is influenced by food intake,
quantity & quality, & physical health.
Malnutrition
Obesity
NUTRITIONAL ASSESSMENT
WHY?
The purpose of nutritional assessment is to:
1. Identify individuals or population groups at risk of
becoming malnourished.
2. Identify individuals or population groups who are
malnourished
NUTRITIONAL ASSESSMENT
IMPLICATIONS?
1. To develop health care programs that meet the
community needs which are defined by the
assessment
2. To measure the effectiveness of the nutritional
programs & intervention once initiated
ANTHROPOMETRIC METHODS
(DEFINITION)
Anthropometry is the measurement of body height,
weight & proportions.
It is an essential component of clinical examination of
infants, children & pregnant women.
NUTRITIONAL INDICES
Weight for age
Height for age
Weight for height
BMI
BMI for age
Mid-arm circumference for age
Mid-arm circumference for height
Skin fold thickness
Head circumference
Waist / hip ratio
ANTHROPOMETRY FOR CHILDREN

Growth assessment is an essential component of pediatric medicine.

The most powerful tool in growth assessment in children is the growth
chart. It requires:
1.
Accurate scale
2.
A measuring board (stadiometer). For infants, the
measure of linear growth is length, taken by two
examiners (one to position the child) with the child
supine on a measuring board. For older children, the
measure is stature, taken with a child standing on a
stadiometer
3.
A tape measure.
REFERENCE VALUES

The old version of standard growth charts were
based on data collected by the National Center for
Health Statistics, 1977 (NCHS). These
normalized growth curves are recommended by
the World Health Organization (WHO) for
international use.

Newer standards are being used, based on a
nationally representative sample collected from
1988 to 1994 as part of the US National Health
Examination (NHES) and National Health and
Nutrition Examination Surveys (NHANES-III)
data. Published by CDC in year 2000.
WHY TO ACCEPT THE INTERNATIONAL
STANDARDS AS REFERENCE IN IRAQ
Disparities in growth between developed and
developing countries reflect nutritional rather than
genetic differences.
Remember: The NCHS curves are less appropriate
for adolescents. Growth during adolescence is
linked temporally to the onset of puberty, which
varies widely across populations.
HOW MANY MEASUREMENTS
DO WE NEED?
Ideally,
individuals
should
have
several
anthropometric measurements over time. A decline
in an individual's anthropometric index from one
point in time to another could be an indication of
illness and/or nutritional deficiency that may result
in serious health outcomes.
A single set of measurements may be used for
screening populations or individuals to identify
abnormal nutritional status and priority for
treatment.
DATA NEEDED FOR CALCULATION?
Information is needed on each individual's:
1.
2.
3.
4.
5.
6.
Sex
age (in months for under 5 years of age)
Weight (Kg)
Height (cm)
head circumference (cm)
arm circumference (cm)
CALCULATION?

Separate charts are provided for boys and girls.

These indices can be expressed in terms of Zscores or percentiles.
𝑉𝑎𝑙𝑢𝑒 − 𝑀𝑒𝑎𝑛 𝑜𝑓 𝑟𝑒𝑓𝑒𝑟𝑒𝑛𝑐𝑒
𝑍=
𝑆𝐷 𝑜𝑓 𝑟𝑒𝑓𝑒𝑟𝑒𝑛𝑐𝑒


The reference group is defined by gender and
age group.
Epi-info is a CDC published computer
software that can calculate nutritional indices
BMI for age
percentiles
curve (Boys)
INTERPRETATION OF INDICES

Weight-for-height (or BMI for age) below the fifth
(or third) percentile is the single best growth chart
indicator of acute malnutrition.

While between 85th and 95th centile is labeled as
overweight.

Above the 95th or 97th centile is obese.
INTERPRETATION OF INDICES

After several months of caloric deprivation, the heightfor-age curve drops (stunting or chronic malnutrition).

The weight-for-age is a composite indicator, which can
not differentiate acute from chronic malnutrition. It is
the best screening tool.

Weight for age below 2 SD from median or mean (-2
Z) is regarded as Malnutrition. It is used for mass
screening of children to detect under nutrition. While a
Z score of +2 and above is an indication of obesity.

The cutoff for very low anthropometric index (severe
malnutrition) is usually Z ≤ -3
NUTRITIONAL INDICES IN ADULTS

The international standard for assessing body size
in adults is the body mass index (BMI).

BMI = Weight (kg) / Height (m²)

Evidence shows that high BMI (obesity level) is
associated with type 2 diabetes & high risk of
cardiovascular morbidity & mortality
BMI (WHO - CLASSIFICATION)

BMI < 18.5
= Under Weight

BMI 18.5-24.5 = Healthy weight range

BMI 25-30

BMI > 30-40 = Obese (grade 2 obesity)

BMI > 40
= Overweight (grade-1 obesity)
= Very obese (morbid obesity)
Thanks
for your
patience