Download Lecture in nutritional assessment

Nutritional assessment;
It is the evaluation of nutritional status (as the
individual before doing so. One calculates the percent of
individual as well as in detecting nutritional inadequacies
usual weight.
or excesses.
health condition of an individual as influenced by food
Adult weight / usual weight x 100
consumption and utilization of nutrients).
The classification of malnutrition is as
Nutritional status:
It is the degree to which an individual’s
The main advantages of such measurements
follows (based on percent of usual weight);
are that it is simple, safe, and inexpensive and it can be
applied at the bedside.
Mild 85 – 90%
The limitation of the technique is that it
physiological need for nutrients is being met by the food
Moderate 75 – 84%
can detect only those nutrient abnormalities that result
he/she is eating. It is the state of balance in the individual
Severe <75%
in measurable changes in body size or proportion.
between the nutrient intake and the nutrient expenditure or
need. It can be affected by many factors including disease,
Assessment of nutritional status is usually
undertaken for three reasons;
Body weight is one to the most convenient
and useful indicators of nutritional status.
cultural patterns, eating behaviour habits, psychological
1-
to confirm the diagnosis of under nutrition
stress, economic, and nutrient absorption. Nutritional
2-
to identify the reasons for the presence of under
two layers of subcutaneous fat without any muscle or
nutrition
tendon. Since a correlation exists between subcutaneous
assessment is a comprehensive approach to the definition
of nutritional status. It includes information about medical
history, social history, laboratory data, and anthropometric
measurements. The process usually includes two parts;
Screening & Assessment.
The purpose of screening is to identify
patients at risk for nutritional diseases. These include
malnutrition but also such nutrition related diseases as
3-
to
provide
a
means
of
monitoring
Skin fold thickness as skin fold consists of
the
effectiveness of nutritional support
So the evaluation of one’s nutritional state is
fat and the fat within the body. SFT measurements are
used to estimate total body fat. SF sites typically measured
are the triceps, biceps, below the scapular (subscapular)
carried out by one or more of the following methods;
and above iliac crest (supra iliac crest). The thickness may
1- Anthropometric measurements
vary according to the subject age, sex, and correlate as
2- Clinical evaluation
well with subcutaneous fat. In men, values of thickness
less than 12.5 mm suggest under nutrition and values over
diabetes and ulcerative colitis. The goals of assessment
3- Laboratory assessment
20 mm suggest excess fat and over nutrition. In women,
are directed towards therapy. The outcome of a nutritional
4- Dietary assessment
values less than 16.5 mm suggest under nutrition, while
assessment should be a care plan for the patient which
identifies the appropriate medical nutrition therapies, both
in people requiring only modifications of a normal diet
and in those who require aggressive nutritional repletion
and support.
Anthropometric measurements;
The science of measuring the size, the
physical dimensions, and the gross composition of the
body. It include height, weight, skin fold thickness, and
the circumference measurements of various parts of the
Malnutrition is defined as a state of overnutrition or under-nutrition. Over nutrition is called
obesity, and malnutrition is usually taken to mean under
nutrition.
body. it uses measurements of body thickness to estimate
fat and lean tissue mass.
It is the simplest and most quantitative
measure of nutritional status. It is useful in monitoring
Malunutrition can be classified by loss of
body weight one must consider the hydration status of the
normal growth and nutritional health in well-nourished
values greater than 25 mm indicate excessive body fat and
over nutrition.
Circumference measurements can include
the waist and hip circumference ratio (differentiate
between gynoid and android obesity). Mid upper arm
circumference (indicative of skeletal muscle mass). These
number are then compared against norms.
Body Mass Index (BMI); the BMI is
commonly used to estimate the level of adiposity in
individuals or in groups. It defines obesity as a
relationship of weight to height. So BMI is defined as the
ratio of the weight to the square of the height
BMI = Wt (Kg) / Ht (meters)2
(xerophthalmia, retromalacia) (Vit A), neck (goiter
to
The commonly used definition of normal
(Idoine). By noting physical changes in the patient, the
abnormalities any may suggest proper remedial steps.
BMI is 20 – 25%which is the least risk for early death.
physician may have a clinical impression of the nutritional
24-hour recall is one of the most common
Score above 25 is classified into three categories of
status, which objective anthropometric and laboratory
methods of dietary assessment. As the individual is asked
obesity; Mild 25 – 29; moderate 30 – 40, and severe 40
measurements can confirm.
to recall all food and beverages consumed over the
explain
any observed
clinical
or biochemical
and above. Generally a BMI greater than 27 indicates
Laboratory assessment;
preceeding 24 hours and sometimes the physical activity
clinical obesity and is associated with greater risk for the
Laboratory evaluation can identify specific
level during this period. The advantage of the 24 hour
nutrition-related abnormalities such as anemia, iron
recall is that it requires little effort on the part of the
deficiency, or protein deficiency. Biochemical tests
respondent, but he consumption is a single 24 hour may
provide the first indication of nutritional abnormality
not be representative of current weekly or monthly
a-Medical history:
before clinical or anthropometric changes occur. These
consumption as in addition, the data are subject to
Contributing factors to malnutrition may be
tests are specific for the particular nutrient being
inaccuracies due to faulty memory and quantitative errors
uncovered from the history of chronic illness, weight loss
investigated and therefore, one must have a suspicion on
in assessing how much has been eaten. Diet history by
and weight gain. History is agreed to identify underlying
clinical ground that a particular deficiency may exist so
recall can be corroborating by asking specific questions
mechanisms that put patients at risk for nutritional
the appropriate test can be taken.
about the patient consumption and the family purchases of
development of health problems and diseases.
Clinical evaluation:
depletion or excess. From the history the physicians may
detect reasons for an existing nutritional problem or assess
A number of laboratory tests are available for
studying nutritional status, these are;
individual food items such as bread, milk, vegetables,
eggs, meat, beverages, and so on.
the likelihood of a nutritional problem developing in
Protein: Serum protein fractions, especially
A more accurate assessment is performed by
future. The individual’s nutrient utilization may be
albumin, urinary urea, urinary creatinine excretion (unit-
the dietitian by having the patient maintain a one week
affected by prescribed drugs. Medical history should
time)
diet diary. All foods and fluids ingested with approximate
include diagnosis, metabolic needs, chronic or acute
Vitamin A: Serum vit A, serum carotene
quantities are recorded at the time of actual consumption.
diseases, recent surgery, GIT problems, weight loss,
Folic acid: Haemoglobin, serum folate, RBC (figlu test)
The data obtained from these records are then evaluated.
alcohol use, and increase nutrient losses. Other factor
Vit D: Serum alkaline phosphatase
Understanding an individual dietary practices and food
important to assess are poor eye sight, physical disability,
Vit B12: Heamoglobin, serum B12, Schilling’s test
consumption patterns allows the medical professional to
mental status changes, and drug side effects, social factor
Iodine: urinary iodine, tests for thyroid function.
identify nutrient deficiencies, imbalances and excesses.
include adequate income, to purchase food, the ability to
Calcium: Serum and bone calcium
Water submersion method to ass body density
shop for a proper food and living conditions.
Iron: Serum iron, iron binding capacity and serum
BMI <18.5 underweight, 20 – 24.9 ideal; 25 –
b-Physical examination:
29.9 over weight (G 1 obesity); 30 – 39.9 obesity (G 2
ferritin.
This forms an important part of all nutritional
obesity), 40+ G 3 pathological morbid obesity).SKF,
surveys by assessing the physical signs which gave us an
Dietary assessment:
WHR used to measure the fat content of body which is the
idea about deviation from health due to nutritional
Dietary evaluation is an important adjunct to
risk indicator for diseases.MRI can be used to determine
conditions. As nail ridging, brittle, spoon shaped (iron
the other three assessments since it provides the
the fat content of the body.Height, Weight (measurement)
deficiency); mouth angular stomatitis, angular scar
description of dietary intake background which may help

(riboflavin deficiency), bones, bow legs (Vit D), eyes
BIM
(indicator)Waist
circum.,
Hip
circum.
(measurement)  WHR (indicator)MUAC (measurement
and indicator)SFK (measurement and indicator)