Assessments of Nutritional Status Flashcards
Nutritional Assessment Why?
1) Identify individuals or population groups at risk of becoming malnourished
2) Identify individuals or population
groups who are malnourished
3) To develop health care programs that meet the community needs, which are defined by the assessment
4) To measure the effectiveness of the nutritional programs & intervention once initiated
Methods of Nutritional Assessment
1) Direct
2) Indirect
Direct Methods of Nutritional Assessment
These are summarized as ABCD
• Anthropometric methods
• Biochemical, laboratory methods
• Clinical methods
• Dietary evaluation methods
Indirect Methods of Nutritional Assessment
These include three categories:
1) Ecological variables, including crop production
2) Economic factors e.g. per capita income, population density & social habits
3)Vital health statistics, particularly infant & under 5 mortality & fertility index
CLINICAL ASSESSMENT
1) It is the simplest & most practical method of ascertaining the nutritional status of a group of individuals
2) It utilizes a number of physical signs, (specific & non specific), that are known to be associated with malnutrition and deficiency of vitamins & micronutrients
3) General clinical examination, with special attention to organs like hair, angles of the mouth, gums, nails, skin, eyes, tongue, muscles, bones, &
thyroid gland.
4) Detection of relevant signs helps in establishing the nutritional diagnosis
MALNUTRITION
– the person losing weight unintentionally
– the person eating/ drinking less than usual
– constipation or diarrhea
– lost muscle
– difficulty in recovering from an illness
– showing signs of pressure ulcers, or have a dry skin
– Have difficulties in chewing or swallowing
– suffer from a sore mouth, or tongue, bleeding, or swollen gums
CLINICAL ASSESSMENT (AD & DIS)
• ADVANTAGES
–Fast & Easy to perform
– Inexpensive
– Non-invasive
• LIMITATIONS
– Did not detect early cases
Clinical signs of nutritional deficiency (HAIR)
1) Spare & thin ===> Protein, zinc, biotin deficiency
2) Easy to pull out ==> Protein deficiency
3) Corkscrew Coiled hair => Vit C & Vit A deficiency
Clinical signs of nutritional deficiency (MOUTH)
1) Glossitis ==> Riboflavin, niacin, folic acid, B12.
2) Bleeding & spongy gums => Vit. C,A, K, folic acid
& niacin
3) Angular stomatitis, cheilosis & fissured tongue
==> B 2, 6, & niacin
4) Leukoplakia => Vit.A,B12, B-complex, folic acid & niacin
5) Sore mouth & tongue ==> Vit B12,6,C,niacin ,folic acid & iron
Clinical signs of nutritional deficiency (EYES)
1) Night blindness, ==> Vitamin A deficiency
exophthalmia
2) Photophobiablurring, conjunctival inflammation
==> Vit B2 & vit A deficiencies
Clinical signs of nutritional deficiency (NAILS)
1) Spooning ==> Iron deficiency
2) Tranverse Lines ==> Protein Deficiency
Clinical signs of nutritional deficiency (SKIN)
1) Pallor ==> Folic acid, iron, B12
2) Follicular hyperkeratosis =>Vitamin B & VitaminC
3) Flaking dermatitis => PEM, Vit B2, Vitamin A, Zinc & Niacin
4) Pigmentation, Desquamation => Niacin & PEM
5) Bruising, purpura==> Vit K ,Vit C & folic acid
Thyroid gland
In mountainous areas and far from sea places.
Goiter is a reliable sign of iodine deficiency.
Joins & bones
Help detect signs of vitamin D deficiency (Rickets) & vitamin C deficiency (Scurvy)
Anthropometric Methods
1) Anthropometry is the measurement of body
height, weight & proportions.
2) It is an essential component of clinical
examination of infants, children & pregnant
women.
3) It is used to evaluate both under & over nutrition.
4) The measured values reflects the current
nutritional status & don’t differentiate between acute & chronic changes .
Other anthropometric Measurements
• Mid-arm circumference
• Skin fold thickness
• Head circumference
• Head/chest ratio
• Hip/waist ratio
Anthropometry for children
For growth monitoring, the data are plotted on growth charts over a period of time that is enough to calculate growth velocity, which can then be
compared to international standards
Height:
The subject stands erect & bare footed on a stadiometer with a movable head piece. The head
piece is leveled with skull vault & height is recorded to the nearest 0.5 cm.
WEIGHT MEASUREMENT (Weight)
1) Use a regularly calibrated electronic or balanced-beam scale. Spring scales are less reliable.
2) Weigh in light clothes, no shoes
3) Read to the nearest 100 gm (0.1kg)
BMI (WHO - Classification)
BMI < 18.5 = Under Weight
BMI 18.5-24.5= Healthy weight range
BMI 25-30 = Overweight (grade 1obesity)
BMI >30-40 = Obese (grade 2 obesity)
BMI >40 =Very obese (morbid or grade 3 obesity)
Waist/Hip Ratio
1) Waist circumference is measured at the level of the umbilicus to the nearest 0.5 cm.
2) The subject stands erect with relaxed abdominal muscles, arms at the side, and feet together.
3) The measurement should be taken at the end of a normal expiration.
Waist circumference
1) Waist circumference predicts mortality better
than any other anthropometric measurement.
2) It has been proposed that waist measurement
alone can be used to assess obesity, and two
levels of risk have been identified
MALES FEMALE LEVEL 1 > 94cm > 80cm LEVEL2 > 102cm > 88cm
Hip Circumference
1) Is measured at the point of greatest
circumference around hips & buttocks to the
nearest 0.5 cm.
2) The subject should be standing, and the measurer should squat beside him.
3) Both measurements should be taken with a flexible, non-stretchable tape in close contact with the skins, but without indenting the soft tissue.
Interpretation of WHR
1) High risk WHR= >0.80 for females & >0.95 for males i.e. waist measurement
2) >80% of hip measurement for women and >95% for men indicates central (upper body) obesity and is considered high risk for diabetes & CVS disorders.
3) A WHR below these cut-off levels is considered low risk.
ADVANTAGES OF ANTHROPOMETRY
• Objective with high specificity & sensitivity
• Measures many variables of nutritional
significance (Ht, Wt, WAC, HC, skin fold thickness, waist & hip ratio & BMI).
• Readings are numerical & gradable on standard growth charts
• Readings are reproducible.
• Non-expensive & need minimal training
Limitations of Anthropometry
Inter-observers errors in measurement
Limited nutritional diagnosis
Problems with reference standards,
i.e. local versus international standards.
Nutritional intake of humans is assessed by five different methods.
– 24 hours dietary recall
–Food frequency questionnaire
– Dietary history since early life
–Food dairy technique
–Observed food consumption
24 Hours Dietary Recall
1) A trained interviewer asks the subject to recall all food & drink taken in the previous 24 hours.
2) It is quick, easy, & depends on short-term memory, but may not be truly representative of the person’s usual intake
Food Frequency Questionnaire
1) In this method, the subject is given a list of around 100 food items to indicate his or her intake (frequency & quantity) per day, per week & per month.
2) Inexpensive, more representative & easy to use.
Limitations (Food Frequency Questionnaire);
Long Questionnaire
Errors with estimating serving size.
Needs updating with new commercial food products to keep pace with changing dietary habits.
DIETARY HISTORY
1) It is an accurate method for assessing the nutritional status.
2) The information should be collected by a trained interviewer.
3) Details about usual intake, types, amount, frequency & timing need to be obtained.
4) Cross-checking to verify data is important.
FOOD DIARY
1) Food intake (types & amounts) should be recorded by the subject at the time of consumption.
2) The length of the collection period ranges between 1-7 days.
3) Reliable but difficult to maintain.
Observed Food Consumption
The most unused method in clinical practice,
but it is recommended for research purposes.
The meal eaten by the individual is weighed, and contents are exactly calculated.
The method is characterized by having a high
degree of accuracy but expensive & needs time & efforts.
Interpretation of Dietary Data
1) Qualitative Method
2) Quantitative Method
Qualitative Method
• Using the food pyramid & the basic food groups method.
• Different nutrients are classified into 5 groups (fat & oils, bread & cereals, milk products, meat-fish-poultry, vegetables & fruits)
• Determine the number of serving from each group & compare it with minimum requirements.
Quantitative Method
• The amount of energy & specific nutrients in
each food consumed can be calculated using food composition tables & then compare it with the recommended daily intake.
• Evaluation by this method is expensive & time consuming, unless computing facilities are available.
Initial Laboratory Assessment
1) Hemoglobin estimation is the most important test, & useful index of the overall state of nutrition.
2) Beside anemia, it also tells about protein & trace
element nutrition.
3) Stool examination for the presence of ova and/or intestinal parasites
4) Urine dipstick & microscopy for albumin, sugar, and blood
Specific Lab Tests
1) Measurement of individual nutrients in body fluids (e.g. serum retinol, serum iron, urinary iodine, vitamin D)
2) Detection of abnormal amount of metabolites in the urine (e.g. urinary creatinine/hydroxyproline ratio)
3) Analysis of hair, nails & skin for micronutrients.
Advantages of Biochemical Method
1) It is useful in detecting early changes in body metabolism & nutrition before the appearance of overt clinical signs.
2) It is precise, accurate, and reproducible.
3) Useful to validate data obtained from dietary methods e.g. comparing salt intake with 24-hour urinary excretion.
Limitations of Biochemical Method
1) Time consuming
2) Expensive
3) They cannot be applied on a large scale
4) Needs trained personnel & facilities
