Introducition to Nutrition Assessment Flashcards by iyah marquez

Health status of an
individual or population
groups as influenced by
their intake and utilization
of nutrients, which
change throughout the life
cycle

Nutritional Status or Nutriture

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THE BODY HAS AN ADEQUATE
SUPPLY OF ESSENTIAL
NUTRIENTS THAT ARE
EFFICIENTLY UTILIZED SUCH
THAT GROWTH AND GOOD
HEALTH ARE MAINTAINED AT
THE HIGHEST POSSIBLE LEVEL

Good or Optimal Nutrition

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pathological state due to a
relative or an absolute
deficiency or excess of
essential nutrients at the
cellular level for a long
period of time.

The condition manifests
itself by physical,
physiological and
biochemical abnormalities

MALNUTRITION

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2 Forms of Malnutrition

UNDERNUTRITION
OVERNUTRITION

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a deficiency state due to lack of
calories and or one or more of
the essential nutrients

UNDERNUTRITION

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refers to an excess of one or more nutrients but usually due to an excess of energy

OVERNUTRITION

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a process to identify an individual
who is malnourished or who is at
risk for malnutrition to determine
if a detailed nutrition assessment
is indicated

NUTRITION SCREENING

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nutrition screening can be done by any member of the health-care team such as:

dietitian, dietetic technician, dietary manager, nurse, or physician

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The Academy of Nutrition
and Dietetics defines
as
“a systematic method for
obtaining, verifying, and
interpreting data needed to
identify nutrition-related
problems, their causes and
their significance

NUTRITION ASSESSMENT

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nutrition assessment abcd

*Anthropometric
*Biochemical
*Dietary
*Clinical
*Nutrition Focused Physical Exam

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*Identify individual who ismalnourished
* at risk of malnutrition

Objectives:
* predict probability of outcome
due to nutritional factor
* predict if nutritional
intervention will be beneficial

NUTRITION SCREENING

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Comprehensive approach to
define nutrition status:
A, B, C, D

Objectives:
* Determine nutrition status
* formulate an appropriate
nutrition care plan

NUTRITIONAL ASSESSMENT

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5 Nutrtion Screening tools

Mini Nutritional Assessment (MNA)-Nestle
Nutrition Screening Initiative - DETERMINE checklist
MUST (Malnutrition Universal
Screening Tool)
MST (Malnutrition Screening Tool)
Nutrition Risk Screenin

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forms of Mini Nutritional Assessment (Nestle)

SCREENING

ASSESSMENT

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BMI (kg/m2)
Weight loss in past 3 months
Acute illness or major stress
in past 3 months
Mobility
Dementia or depression
Has appetite & food intake
decreased in past 3 months

Mini Nutritional Assessment (Nestle) – Screening Part

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MNA SCREENING PART

Screening score is normal, not at risk, no need to complete assessment

12 points or greater

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MNA SCREENING PART

Screening score means possible malnutrition, continue assessment

11 points or below

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Scoring system
Full MNA -
>/= 24 : normal nutrition

< 24 : Further assessment and
intervention
Limitations:
Not capable of covering special aspects of
malnutrition
(eg; insufficient micronutrient intake)
Not suitable for pt receiving enteral tube feeding & no oral foods
Not suitable for all ages groups and disease
states.

Mini Nutritional Assessment nestle-screening part

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Design to increase community
dwelling elders awareness about
health and nutrition

Self-administered checklist
determines need for referral to a
health care professional
Not clinically validated
Suitable for community / out
patient

Nutrition Screening
Initiative - DETERMINE

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Nutrition Screening
Initiative - DETERMINE

Disease
Eating poorly
Tooth Loss/ Mouth Pain
Economic hardship
Reduce social contact
Multiple medicines
Involuntary weight loss/gain
Need assistance in Self-care
Elder year above age 80

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scoring system in NUT SCREENING INITIATIVE DETERMINE

Good! Rechecked nutritional score in 6 months

0-2

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scoring system in NUT SCREENING INITIATIVE DETERMINE

You are at moderate nutritional risk
-Rechecked nutritional score in 3

3-5

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scoring system in NUT SCREENING INITIATIVE DETERMINE

You are at high nutritional risk
Bring this checklist when you see
health care professionals and ask
for help to improve your nutritional
health.

> /= 6

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Developed by BAPEN, UK
A practical, reliable, validated tool for nutrition screening
Allows comparable nutritional
screening across different care
settings by different health
professionals
primary care, home, acute care,
long term care (suitable both out-pt and in hospital setting)

MALNUTRITION UNIVERSAL SCREENING TOOLS (MUST)

MUST Recommended Management Guidelines

0 = Low risk: Routine Care 1 = Medium risk: Observe >/= 2 = High Risk: Treat

MUST RMG repeat screening - hospital: weekly - care homes: monthly - community: annually for special group eg; >75yr

0 = Low risk: Routine Care

MUST RMG repeat screening - hospital: weekly - care homes: monthly - community: annually for special group eg; >75yr

1 = Medium risk: Observe

MUST RMG - hospital: refer to dietitian/ implement local policies. - care homes: (as for hospital) - community: (as for hospital

>/= 2 = High Risk: Treat

1. Have you lost weight recently without trying? No 0 Unsure 2 If yes, how much weight (kg) have you lost? 1-5 1 6-10 2 11- 15 3 > 15 4 Unsure 2 2. Have you been eating poorly because of a decreased appetite? No 0 Yes 1 Total Score of 2 or more = patient at risk of malnutrition

MALNUTRITION SCREENING TOOLS OR MST

MST score Eating well with no recent weight loss RESCREEN If length of stay 7 days or more and weekly thereafter

Low risk MST= 0-1

MST score Eating poorly or recent weight loss of

Medium risk MST = 2-3

MST score Eating poorly plus recent weight loss < 13 lb RECOMMENDED ORAL NUTRITIONAL SUPPLEMENT Dietary consult within 24 hrs

High risk

• Developed by Kondrup et al –ESPEN • Used retrospective analysis of RCT (adults) Based on concept of: Indications for nutrition support are a) the severity of undernutrition b) the increase of nutritional requirements from the disease Screen includes measures of current potential under nutrition and disease severity

NUTRITION RISK SCREENING 2002

Strengths: • Proven to be a practical tool in the hospital setting • Can be facilitated by a range of healthcare workers • It meant to cover all possible pt categories in a hospital Limitation: • May not effectively screen for deficiencies or toxicities of certain micronutrients

Nutrional Risk Screening 2002

Immediate • Minimum measurements • Least expense • Concise information • Can be facilitated by any member of health care team

Nutrition screening

• Longer time • More measurements • More expense • In – depth information • Requires greater expertise in its facilitation

Nutritional Assessment

The objectives of the survey are to determine and evaluate the food intakes, nutrition and health status of Filipinos, and provide official statistics on food, nutrition and health situations of the country

Nutrition Survey

OBJECTIVES • To establish baseline nutritional data and/or ascertain the overall nutritional status of the population • To identify and describe those population subgroups at-risk to chronic malnutrition

Nutrition survey

Identifies • WHO are malnourished • HOW MANY are malnourished • WHERE are they BUT does not give information on… • WHAT type of malnutrition exists (if only weight-for-age indicator is used) • WHY does it exist

Nutrition survey

• Continuous monitoring of the nutritional status of selected population groups • Data are collected, analyzed, and utilized for an extended period of time • Identify possible causes of malnutrition

Nutrition surveillance

Data obtained can be used to formulate and initiate intervention measures at the population and subpopulation level • Called ‘monitoring’ when carried out on selected high-risk individual Results obtained can be used for: a. Long term planning b. timely warning c. Program management

Nutrition surveillance

OBJECTIVES: • To promote decisions by governments concerning priorities and disposal of resources • To formulate predictions on the basis of current trends • To evaluate the effectiveness of nutrition programs

Nutrition surveillance

Initially identifies: • WHO are malnourished • HOW MANY are malnourished • WHERE are they • WHAT type of malnutrition exists(depends on indicator used) During monitoring it will answer: • WHY it exists

Nutrition surveillance

Direct Method of Nutrition Assessment

A- anthropometry B – Biochemical C – Clinical D – Dietary

Indirect methods of Nutrition Assessment

E – Ecological factors F- Functional assessment Vital statistics

This is the measurement of body height, weight & proportions. • It is an essential component of clinical examination of infants, children & pregnant women. • It is used to evaluate both under & over nutrition

Anthropometry

Other anthropometric Measurements

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

Biochemical or laboratory methods include measuring a nutrient or its metabolite in: • Blood • feces • urine • measuring a variety of other components in blood and other tissues that have a relationship to nutritional status

Biochemical

Hemoglobin estimation is the most important test, & useful index of the overall state of nutrition. Beside anemia it also tells about protein & trace element nutrition. • Stool examination for the presence of ova and/or intestinal parasites • Urine dipstick & microscopy for albumin, sugar and blood

Biochemical

It is the simplest & most practical method of ascertaining the nutritional status of a group of individuals • It utilizes a number of physical signs, (specific & non specific), that are known to be associated with malnutrition and deficiency of vitamins & micronutrients.

Clinical

General clinical examination, with special attention to organs like hair, angles of the mouth, gums, nails, skin, eyes, tongue, muscles, bones, & thyroid gland

Clinical

In this, the methods generally involve surveys measuring the quantity of the individual foods and beverages consumed during the course of one to several days or assessing the pattern of food use during the previous several months.

Dietary

Nutritional intake of humans is assessed by five different methods. These are: • 24 hours dietary recall • Food frequency questionnaire • Dietary history since early life • Food diary technique • Observed food consumption

Dietary

Ecological Factors

This is an indirect method of assessing food consumption, in which supplies are related to census population to derive levels of food consumption in terms of per capita supply availability

Food Balance Sheet

Advantage: This method is cheaper and probably simpler than any method of direct assessment. This method give indication of the general pattern of food consumption in the country

Balance sheet

Food consumption patterns are likely to vary among various socioeconomic groups. Family size, occupation, income, education, customs, cultural pattern in relation to feeding practices of consumption patterns.

Socio-economic factor

Primary health care services, feeding and immunization programs should also be taken into consideration.

Health and Educational services

These include parasitic, bacterial, and viral infections which precipitate malnutrition. It is necessary to make an “ecological diagnosis” of various factors influencing nutrition in the community before it is possible to put into effect measures for the prevention and control of malnutrition.

Condutioning Influences