Nutrition Assessment

Question 1

key elements of a nutrition assessment

Answer 1

*diet history
*weight history
*symptoms
*body composition
*nutrient stores
*daily requirements
*nutrition-focused physical exam

Question 2

nutrition assessment - social history

Answer 2

1. access to food
   -can the patient afford food? (financial status)
   -can the patient obtain food? (mobility status)
2. preparing food
   -who usually does the cooking?
   -can the patient cook? how often?
3. food traditions
   -national, ethnic, regional food styles
   -adaptation to local foods

Question 3

nutrition assessment - diet history

Answer 3

*is the patient following a specific diet? (gluten-free, low-carb, keto, paleo, vegan, fasting)
*food intolerances or allergies (dairy, fruit, red meat)
*fast food; dining out - how often?
*usual pattern of food intake (24 hour recall; food diaries; calorie count)
*use of vitamins & supplements

Question 4

nutrition assessment - past medical history

Answer 4

*gastrointestinal illnesses
-oropharynx: dysphagia, tooth extractions
-stomach: PUD, chronic nausea, gastroparesis
-intestine: diarrhea, celiac, Crohn’s

*surgical hx
-stomach: ulcer operation, resection, bypass
-intestine: resections, anastomoses
-cholecystectomy

*chronic illnesses
-DM, CHF, CFR, cirrhosis, cancer, AIDS, TB, SLE

Question 5

nutrition assessment - symptoms

Answer 5

*appetite: increased or decreased?
*edema -> depleted visceral protein stores
*symptoms of specific nutrient deficiencies:
-pica -> iron
-night blindness -> vitamin A

Question 6

nutrition assessment - weight history

Answer 6

*current weight & BMI
*ideal body weight (calculated or estimated - post-adolescent weight)
*% ideal body weight
*MAXIMUM lifetime weight
*desired weight
*recent change in weight:
-% change from usual weight
-rate of weight loss (time period)

Question 7

uses of BMI

Answer 7

*a surrogate for adiposity in healthy populations
*easy to compute
*may underestimate adiposity in the elderly and those with muscle loss
*may overestimate adiposity in trained athletes

Question 8

parameters of % ideal body weight

Answer 8

we want people to be + or - 10% of ideal body weight (90-110% of ideal body weight)

Question 9

methods for determining adiposity

Answer 9

1. anthropometry (pinch calipers) - fair accuracy, inexpensive, easily available; training required
2. bioelectric impedance - good accuracy; affordable, immediate results, often features on scales
3. DEXA scan - very good accuracy; more expensive; low radiation doses
4. CT and MRI scans - excellent accuracy + body fat distribution; expensive equipment; radiation exposure (CT)
5. underwater weighing - gold standard; research tool with scarce availabilty

Question 10

fat distribution

Answer 10

*intra-abdominal (central) obesity - “apple” shaped - estimated by waist/hip ratio (males < 0.95; females < 0.80)
vs
*peripheral obesity - “pear” shaped

*increased intra-abdominal fat is strongly associated with METABOLIC SYNDROME (DM2, HTN, hyperlipidemia, fatty liver disease)

Question 11

red flags for recent changes in weight

Answer 11

*lost > 5% of total body weight in 1 month
OR
*lost > 10% of total body weight in 6 months
when NOT TRYING TO

Question 12

nutrition-focused physical exam

Answer 12

*general: fat distribution (central vs. peripheral)
*derm: rash, hair loss, nail abnormalities
*MSK: muscle mass, temporal wasting
*eyes: uveitis, sunken appearance
*mouth: cheilosis, glossitis, poor dentition
*neuro: decreased vibration, proprioception, balance
*extremities: edema, ecchymoses

Question 13

kcal/day for weight maintenance

Answer 13

about 25-30 kcal/kg/day to maintain current weight

Question 14

normal daily protein requirement (rule of thumb)

Answer 14

0.8-1.0 grams/kg/day of protein