Assessments of Nutritional Status

Question 1

Nutritional Assessment Why?

Answer 1

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

Question 2

Methods of Nutritional Assessment

Answer 2

1) Direct
2) Indirect

Question 3

Direct Methods of Nutritional Assessment

Answer 3

These are summarized as ABCD
• Anthropometric methods
• Biochemical, laboratory methods
• Clinical methods
• Dietary evaluation methods

Question 4

Indirect Methods of Nutritional Assessment

Answer 4

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

Question 5

CLINICAL ASSESSMENT

Answer 5

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

Question 6

MALNUTRITION

Answer 6

– 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

Question 7

CLINICAL ASSESSMENT (AD & DIS)

Answer 7

• ADVANTAGES
–Fast & Easy to perform
– Inexpensive
– Non-invasive

• LIMITATIONS
– Did not detect early cases

Question 8

Clinical signs of nutritional deficiency (HAIR)

Answer 8

1) Spare & thin ===> Protein, zinc, biotin deficiency

2) Easy to pull out ==> Protein deficiency

3) Corkscrew Coiled hair => Vit C & Vit A deficiency

Question 9

Clinical signs of nutritional deficiency (MOUTH)

Answer 9

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

Question 10

Clinical signs of nutritional deficiency (EYES)

Answer 10

1) Night blindness, ==> Vitamin A deficiency
exophthalmia

2) Photophobiablurring, conjunctival inflammation
==> Vit B2 & vit A deficiencies

Question 11

Clinical signs of nutritional deficiency (NAILS)

Answer 11

1) Spooning ==> Iron deficiency

2) Tranverse Lines ==> Protein Deficiency

Question 12

Clinical signs of nutritional deficiency (SKIN)

Answer 12

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

Question 13

Thyroid gland

Answer 13

In mountainous areas and far from sea places.

Goiter is a reliable sign of iodine deficiency.

Question 14

Joins & bones

Answer 14

Help detect signs of vitamin D deficiency (Rickets) & vitamin C deficiency (Scurvy)

Question 15

Anthropometric Methods

Answer 15

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 .

Question 16

Other anthropometric Measurements

Answer 16

• Mid-arm circumference
• Skin fold thickness
• Head circumference
• Head/chest ratio
• Hip/waist ratio

Question 17

Anthropometry for children

Answer 17

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

Question 18

Height:

Answer 18

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.

Question 19

WEIGHT MEASUREMENT (Weight)

Answer 19

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)

Question 20

BMI (WHO - Classification)

Answer 20

 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)

Question 21

Waist/Hip Ratio

Answer 21

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.

Question 22

Waist circumference

Answer 22

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

Question 23

Hip Circumference

Answer 23

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.

Question 24

Interpretation of WHR

Answer 24

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.

Question 25

ADVANTAGES OF ANTHROPOMETRY

Answer 25

• 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

Question 26

Limitations of Anthropometry

Answer 26

Inter-observers errors in measurement

Limited nutritional diagnosis

Problems with reference standards,
i.e. local versus international standards.

Question 27

Nutritional intake of humans is assessed by five different methods.

Answer 27

– 24 hours dietary recall
–Food frequency questionnaire
– Dietary history since early life
–Food dairy technique
–Observed food consumption

Question 28

24 Hours Dietary Recall

Answer 28

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

Question 29

Food Frequency Questionnaire

Answer 29

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.

Question 30

Limitations (Food Frequency Questionnaire);

Answer 30

 Long Questionnaire
 Errors with estimating serving size.
 Needs updating with new commercial food products to keep pace with changing dietary habits.

Question 31

DIETARY HISTORY

Answer 31

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.

Question 32

FOOD DIARY

Answer 32

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.

Question 33

Observed Food Consumption

Answer 33

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.

Question 34

Interpretation of Dietary Data

Answer 34

1) Qualitative Method
2) Quantitative Method

Question 35

Qualitative Method

Answer 35

• 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.

Question 36

Quantitative Method

Answer 36

• 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.

Question 37

Initial Laboratory Assessment

Answer 37

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

Question 38

Specific Lab Tests

Answer 38

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.

Question 39

Advantages of Biochemical Method

Answer 39

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.

Question 40

Limitations of Biochemical Method

Answer 40

1) Time consuming

2) Expensive

3) They cannot be applied on a large scale

4) Needs trained personnel & facilities