Download Nutritional Assessment of Adults

Nutritional Assessment of Adults
Purpose of Nutritional Assessment:
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Identifies individual at nutritional risk.
Identifies the appropriate nutritional plan.
Forms a basis for evaluating the nutrition care plan.
Component of Nutritional Assessment:
1.
Histories:
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Medical and Social:
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Diet:
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2.
Clinical diagnosis, drug and medications, surgery or acute illness, recent
significant weight loss, physical or mental disabilities, income, life style,
marital status, emotional problems, religion…etc.
Food quality and quantity, preferences, allergies, chewing and swallowing
problems, GI problems, appetite and taste changes, feeding aids or assistance,
cultural or religious restrictions, nutritional supplement intake.
Methods: detailed food intake information is calculated by using 7-days food
record, food frequency questionnaire, and 24-hours food recall. Energy and
nutrient content of food is compared to RDA's.
Physical Assessment:
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Its purpose is to look for physical signs and symptoms reflecting malnutrition.
Such signs and symptoms are not seen until late stages of nutrient deficiencies.
Signs and symptoms must be followed by appropriate biochemical, anthropometric
and dietary investigations.
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3.
Anthropometry and Body Composition:
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Used to determine body size and composition of muscles and fat.
1. Height (Ht):
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Taken by a measuring tape or a stadiometer.
Height should be measured without shoes.
Patient should stand erect, looking straight ahead, without tipping the head up
or down.
Use a horizontal bar should be placed flat on top of the head.
Height should be read to the nearest 0.5 cm.
For patients who are unable to stand, other techniques is used as : arm span,
knee height.
1 Inch = 2.54 cm.
2. Weight (Wt):
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Taken by standing scales (beam balance scale), chair scales, or bed scales.
Scales should be set to zero before measurement, and periodically calibrated.
Patient should be wearing minimal cloths, no shoes, and standing in the center
on the scale with no assistance.
1 lb = 2.2 kg
Changes in body hydration status should be noted, in case of:
a. Lower limb edema (LLE), subtract 2 kg of AWt.
b. Ascites, subtract 3-5 kg from AWt.
3. Frame Size:
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Can be determined by wrist circumference or elbow breadth technique.
Using the wrist circumference technique:
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Measure wrist circumference below styloid process.
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Calculate the ration of Ht. to wrist circumference(wc):
r=
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Ht (cm)
wc (cm)
Compare r value to interpret the frame size.
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4. Ideal Body Weight (IBW):
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Can be determined using :
a. Metropolitan Height and Weight Tables for Adults:
b. Hamwi Method:
- It is a rough estimate if Ht. is not available.
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Men = 48.18 kg for the first 150 cm ( + 1.1 kg /cm over 150
cm or - 1.1 kg /cm under 150 cm)
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Women = 45.45 kg for the first 150 cm ( + 0.91kg /cm over
150 cm or - 0.91 kg /cm under 150 cm)
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+ 10% for large frame size and – 10% for small frame size
c. Depending on BMI:
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BMI =Wt/Ht 2
IBW = (Ht) X 22.5
Incase of amputation, compare AWt. to Adjusted IBW, which take into
account the missing body part:
5. % Ideal Body Weight (% IBW):
% IBW =
AWt.
IBW
X 100
6. % Usual Body weight (% UBW):
% UBW =
AWt.
UBW
X 100
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7. % of Weight Change (% Wt. Change)
% Wt. Change =
UBW - AWt.
UBW
X 100
8. Body Mass Index (BMI)
Wt.
BMI =
2
(Ht)
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Interpret from below:
< 18.5
18.5 – 24.9
25 – 29.9
30 – 34.9
35 – 39.9
> 40
Under Wt.
Normal
Over Wt.
Grade I Obese
Grade II Obese
Grade III Obese (Morbid Obese)
9. Mid Arm Circumference(MAC):
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MAC decreases with malnutrition and increases in fat and muscles
hypertrophy.
It reflects skeletal muscle, bone, and subcutaneous fat.
It is insensitive for changes in skeletal muscles.
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Interpret MAC from the table below:
10. Triceps Skin Fold Thickness (TSF):
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To estimate the subcutaneous adipose stores in the body.
Taken by using a special caliber as follow :
a. At 1 cm above mid-arm point, grasp (by fingers) a vertical
fold with underlying fat.
b. Gently pull the fold way from the muscle. Apply the caliper
at a right angel.
c. Record the measure.
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TSF
>90 %tile
90 – 51 %tile
50 – 30%tile
< 30 %tile
Normal
Mild depletion of adipose fat.
Moderate depletion of adipose fat.
Severe depletion of adipose fat.
11. Mid Arm Muscle Circumference (MAMC):
MAMC (mm) – (3.14 X TSF).
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It corrects for the subcutaneous fat, and reflects the skeletal muscles and bone
within the arm (to estimate muscle mass).
Interpret MAMC from the table above ( see MAC )
MAMC >90 %tile
Normal
90 –81 %tile
Mild depletion of somatic protein.
80 – 70%tile
Moderate depletion of somatic protein.
< 70 %tile
Severe depletion of somatic protein.
12. Mid Arm Muscle Area (MAMA):
MAMA =
MAC – ( 3.14 X TSF )
4 X ( 3.14 )
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4.
Reflects skeletal muscles and bone within arm.
More adequate and sensitive for changes in somatic protein and stores that
MAC.
Biochemical Assessment:
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Biochemical data may be altered by nutrients, medication or illness. It can be used
to detect sub-clinical nutritional deficiencies.
Blood and urine are the most common sources of laboratory tests.
Visceral proteins, hematology, lipid profile, and micronutrient
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Nitrogen balance:
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N balance = protein intake (gm) – ( UUN + 4 )
6.25
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A healthy person will have a 0 N balance
Hypercatabolic patients will have a -ve balance
Goal = 2 – 6 +ve
Assessment of Energy and Nutrients Requirements
Energy:
a. Calculating (REE/BEE):
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Harris-benedict equation:
M: REE = 66.5 + (13.75 X Wt.) + (5.0 X Ht.) – (6.78 X Age)
Fe: REE = 655 + (9.56 X Wt.) + (1.85 X Ht.) – (4.68 X Age)
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Mifflin-St. jeor equation:
M: REE = (10 X Wt.) + (6.25 X Ht.) – (5.0 X Age) + 5
Fe: REE = (10 X Wt.) + (6.25 X Ht.) – (5.0 X Age) – 161
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
WHO based on age and body weight:
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for persons with normal height and weight:
M: REE = Wt. X 1 Kcal/kg X 24 hrs
Fe: REE = Wt. X 0.95 Kcal/kg X 24 hrs
b. multiply (REE/BEE) by activity and/or stress factor to estimate(TER) :
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c. Another way of estimating TER based on weight and activity level:
Protein:
For healthy adults
For elderly
0.6-0.8 gm /kg
0.8-1 gm/kg
For patients under stress:
Fluid :
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Note: Consider any disease-specific recommendations for fluid intake.
For Diet planning:
CHO……………..45 – 60 % of Kcal
Pro ………………15 – 20 % of Kcal
Fat ……………… 25 – 30 % of Kcal
Servings of milk………………2-3
Servings of vegetables……….. 3-5
Servings of fruit ……………... 2-4
Servings of meat ……………...2-3
Servings of starch ……………6-11
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