Nutriitional Assessment Flashcards
What is nutritional status and what determines it
Name some internal and external factors
Nutritional status is the current body status, of a person or a population group, related to their state of nourishment (the consumption and utilization of nutrients)
•The nutritional status is determined by a complex interaction between internal and external environmental factors
Internal or constitutional factors like: age, sex, nutrition, behavior, physical activity and diseases.
•External environmental factors like: food safety, cultural, social and economic circumstances.
People can have an optimal nutritional status or they can be under-, over- and/or malnourished
True or false
What is the ideal nutritional status
What is nutritional assessment
True
ideal nutritional status occurs when the supply of nutrients conforms to the nutritional requirements or needs
It is a detailed evaluation of an individual’s nutritional state
- Undertaken by nutrition specialists
- May be time consuming and thorough
What is the purpose of nutritional assessment
Identify individuals or population groups at risk of becoming malnourished
- Identify individuals or population groups who are malnourished
- To develop health care programs that meet the community needs which are defined by the assessment
- To measure the effectiveness of the nutritional programs & interventions once initiated
- Establish possible causes of malnutrition
What are the methods of nutritional assessment
Nutrition is assessed by two methods:
• Direct and Indirect Methods
•The direct methods deal with the individual and measure objective criteria, while indirect methods use community indices that reflect the community nutritional status/needs.
What are the indirect methods of nutritional assessment
Indirect Methods of Nutritional Assessment:
•Ecological variables including agricultural crops production
•Economic factors e.g. household income, per capita income, population density, food availability and prices
•Cultural and social habits
What are the direct methods of nutrition assessment
Direct Methods of Nutritional Assessment are summarized as ABCDE: •Anthropometric Assessment •Biochemical Assessment •Clinical Assessment •Dietary Assessment •Environmental Assessment
What is anthropometric assessment
What are the types
Explain the types of anthropometric assessment
(Get the names of the types of instruments used and how they look like)
Measurement of characteristics of the human body size, both the physical dimensions and the gross composition
•Anthropometric measurements are of two types: growth and body composition
Growth Measurements •The most widely used anthropometric measurements of growth are: •height and length • head circumference • body weight • Hip circumference •Waist circumference
How is BMI determined Who is underweight? Overweight? Healthy weight? Obese?
Body Mass Index (BMI)
•This is considered to be the best body mass index for most adult populations.
•Determined by dividing the Weight of and individual in kilograms by the height in meters squared.
Underweight:BMI less than 18.50
Healthy: 18.50-24.99
Overweight: 25.00-29.99
Obese: 30 or more
What are the values of apple,pear and avocado shape according to the waist to hip ratio for men and women and in which is the risk for health diseases high
Women
- 80 or below ,health risk is low, this is pear shape
- 81-0.85, health risk is moderate,this is avocado
- 85 and above ,health risk is high,this is apple shape
Men:
- 95 or below,low,shape is pear
- 96-1.0,moderate, shape is avocado
- 0 or more,high, shape is apple
What are the advantages of using BMI
Advantages of using BMI to classify obesity:
–it is low-cost and easy to use for health professionals for assessing individuals
–it is commonly used to determine desirable body weights and allows people to compare their own weight status to that of the general population
–it correlates well with the amount of body fat as measured by more complex techniques
It predicts dangers associated with obesity; as BMI increases the risk for diseases increases
•It is a useful screening tool to use at the population level and, because it is universally accepted, BMI reference data is available for many different populations
What are the disadvantages of using BMI
What are the body composition measurements
Although BMI is equally high in both men, in (a) it is due to lean body mass whereas in (b) it is due to body fat.
- This shows that, BMI cannot be used alone to diagnose obesity.
- BMI also varies with age and sex in those <18 years.
Body composition measurements
•Mid upper-arm circumference (MUAC)
- Triceps skinfold
- Subscapular skinfold
What are the advantages of using anthropometric measurement
State one disadvantage
Relatively inexpensive equipment and procedures
- Requires limited training and supervision
- Procedures are safe, simple and non-invasive and can be used even at bedside and are applicable to large sample size
- Relatively unskilled personnel can perform measurement procedures
There could measurement errors
What are biochemical assessment
Name three biological samples used
Name some biochemical parameters measured
This involves the measurement of the concentrations of nutrients and nutrient by-products in the blood, urine and stool tests and of specific blood enzyme activity.
Blood (whole blood, serum, plasma, cells)
- Urine (24-hour collection, early morning)
- Stool samples
VARIOUS BIOCHEMICAL PARAMETERS MEASURED
Serum proteins,
- serum micronutrients
- Serum lipids
- Immunological parameters
- Urine products (either unmetabolised molecules or metabolites of nutrients)
Name the advantages and disadvantages of using biochemical assessment
For detecting early (sub-clinical) changes, before appearance of overt clinical signs.
- Has accuracy, precision and reproducibility
- Can be used to validate data obtained from other methods; eg. Comparison of dietary salt intake and 24-hour urinary excretion of sodium
DISADVANTAGES
•Processes are time-consuming
•Cannot be applied on a large scale
•Require the use of well-trained personnel
•Require specialised facilities; laboratories with requisite equipment, reagents, etc
•Expensive
•Some of the tests are non-specific
DISADVANTAGES (contd)
•Laboratory results can be affected by medications, hydration state, disease states and stress
Why should biochemical assessments be used
For detection of a nutritional deficiency before it becomes clinically evident or clinical state becomes irreversible
- For the recognition of acute malnutrition in which the clinical signs are non-specific
- For the confirmation of the clinical diagnosis of a deficiency disease; eg. Albumin in kwashiorkor, haemoglobin in iron deficiency anaemia
For targeted nutritional surveys (eg. Community, school children) for detection of sub-clinical micronutrient deficiencies, like iron and iodine deficiencies.
- For the objective demonstration of the response to a nutritional education campaign.
- For diagnosis of haematological disorders, like anaemia due to micronutrient deficiency; eg iron, Folate, vitamin B12
Name three micronutrient measurements under biochemical assessment
Name three other tests under biochemical assessment
Vitamins in plasma (folic acid, ascorbate, 25-hydroxycholecalciferol, beta-carotene, etc)
- Plasma trace metals (iron, magnesium, zinc, etc)
- Urinary excretion (thiamin, 4-pyridoxic acid, sodium, potassium, iodine, etc)
OTHER TESTS
•Urine dipstick and microscopy for detection of protein, blood, glucose. ketones
STOOL TESTS
•For determining the presence of intestinal parasites
•Measurements of immunoglobulins, CD4 and CD8
What is clinical assessment
What does it utilize?
Give three examples each of illnesses caused by improper nutrition to consumption - too much and too little
- It is an essential feature of all nutritional surveys.
- 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
- General clinical examination, with special attention to organs like hair, angles of the mouth, gums, nails, skin, eyes, tongue, muscles, bones & thyroid gland
Too much: Stroke Heart disease Gallstones Diabetes mellitus Dental Caries Gout
Too little: Protein energy malnutrition Anaemia due to iron deficiency Osteoporosis due to calcium deficiency Goiter due to iodine deficiency Xeropthalmia or night blindness due to vitamin A deficiency
What things can be checked in the physical state in clinica assessment
In Niacin deficiency pellagra (body can’t absorb niacin or vitamin B3 that’s why) name the four Ds
Vitamin b7 deficiency causes biotin deficiency true or false
Physical appearance – emaciation, skin changes
- Sunken cheeks
- Prominent rib bones
•Discolouration of hair
•Oedema- may be due to protein depletion
•
•Weight loss
•Breathlessness- could be due to anaemia
Dermatitis, Diarrhea, Dementia, Death
What are the advantages and limitations of clinical assessment
Fast & Easy to perform
•Inexpensive
•Non-invasive
Limitations:
•Does not detect early cases
•Some of the signs are not very specific and may be due to other diseases
What is dietary assessment
What are the methods used
This form of assessment examines the food intake of an individual
Dietary Assessment Methods •24 Hour Recall •Food Frequency •Dietary History •Weighed Food Record •Food Diary •Estimated Food Record
What is food frequency What is it designed to assess What does it comprise of What instruments are used Look on slides for example
Questionnaire is made of foods and frequencies and respondents are asked to say how often they usually consume an item of food or drink
- Most frequently used of all the methods
- Designed to assess usual eating habits over recent months or years
Food Frequency
•Comprise list of foods most informative about the nutrients of interest
- Instruments vary from very short questionnaire with few foods to measure a nutrient say calcium
- Or a long list of foods to measure variety of nutrients
What is dietary history
Who usually conducts it
What does it require
It’s not used much in which studies
Usually conducted by trained interviewers
- Obtain detailed information on usual foods consumed, portion sizes, recipes and frequency of consumption over the recent past
- Requires face-to-face interview e.g. dietician with client
- Not used much in population based studies
What are the advantages and disadvantages of dietary history
Advantages
•A single, extended interview can provide detailed information about meal patterns, food consumption and nutrient intake of an individual
- It can provide data on usual nutrient intakes for a wide variety of nutrients
- Subject involvement can be minimized
- No numeracy or literacy is required
Disadvantages
•Memory issues
- Single assessment may not tell much about usual habits
- Procedure is complex
- Prone to interviewer bias
- Subjects may recall diet about immediate past which did not influence disease
What is 24 hour recall
Look on slide for example
Interviewed or written information about the previous day’s intake
•In this the actual foods consumed are described and information on portion weights obtained
