Nutrition Assessment Flashcards
What is the goal of nutrition assessment?
GOAL: Identify those with pre-existing malnutrition or those most at risk for developing it
What are the ABCDs of nutrition assessment?
Anthropometrics
Biochemical Data
Clinical Findings
Dietary Intake
What are Anthropometrics?
Height
Weight
Body Composition
Waist Circumference
What are some different ways to measure height?
direct:
standing
arm span
semi-arm span
indirect:
knee height
What are the benefits of measuring weight?
Provides a crude evaluation of fat and muscle stores
One of the best general parameters used to assess for malnutrition (the exception being obesity)
What are three different ways to measure weight?
Metropolitan Weight for Height Tables (1983, 1999)
Hamwi Method/“Rule of Thumb”
Males: 106 lb for 5 feet + 6 lb/inch over 5 feet
Females: 100 lb for 5 feet + 5 lb/inch over 5 feet
Body Mass Index
What is BMI?
BMI = weight (kg)/ height (m2)
Indicator of obesity and underweight in adults
Used to screen and monitor a population to detect risk of chronic disease
BMI >27 is associated with increased risk of chronic disease and death
What are the BMI classifications?
Assoc w/ mortality BMI 14-15 Underweight BMI < 18.5 Normal BMI 18.5-24.9 Overweight BMI 25.0-29.9 Obesity (I) BMI 30-34.9 Obesity (II) BMI of 35-39.9 Obesity (III) BMI > 40
What are the limitations of the BMI?
Overestimates body fat in very muscular people
Underestimates body fat in some underweight people with loss of lean tissue (i.e. the elderly)
How can you calculate the percentage of usual body weight and what to the numbers mean?
% of usual body weight = current weight/ x 100
usual weight
85 to 95% = mild malnutrition
75 to 84% = moderate malnutrition
< 74% = severe malnutrition
how do we calculate % of recent weight change? What does each percent mean in regards to 1 week, 1 month, 3 months, or 6 months?
% of recent weight change = usual weight - current weight x 100
usual weight
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Time Significant Weight Loss Severe weight loss
(%) (%)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
1 week 1- 2 > 2
1 month 5 >5
3 months 7.5 >7.5
6 months 10 >10
Unplanned/unintentional recent weight loss of >10%
is a risk factor for malnutrition
what is the most common site to check skin fold thickness?
triceps
what is Bioelectrical Impedance Analysis (BIA)?
Estimates body composition
Measures impedance of electrical current passing through the body
Impedance = resistance + reactance of low-electrical current
Estimates total body water, fat mass, fat-free mass (contains electrolytes, acts as electrical conductor), body cell mass
***low impedance = good
What might a microcytic or macorcytic anemia tell you in regards to B vitamin deficiency?
Mean Corpuscular Volume (MCV)
100 (macrocytic) Folate, Vit B-12 deficiency
Describe which two hepatic proteins are prognostic indicators of inflammation? How so?
- albumin and pre-albumin
ALBUMIN: Associated with inflammatory process Improves when inflammation resolves Prognostic indicator 2-3 week half-life Decreases colloid oncotic pressure Impairs carrier function Protein deficit not primary cause Not responsive to nutrition intervention
PRE-ALBUMIN: Associated with inflammatory process Improves when inflammation resolves Prognostic indicator 2-3 day half-life Affected by kidney function Protein deficit not primary cause Not responsive to nutrition intervention Cost $160 (UNMC 2012)
Are hepatic protein changes associated with nutrition or inflammation?
inflammation!!!!
NOT NUTRITION DEPENDENT, CANT FIX BY HAVING THEM EAT WELL.
What should be done about hepatic protein abnormalities?
Metabolic support
Use of acute phase proteins not recommended
What are the three malnutrition diagnoses?
- Starvation-related malnutrition
- No inflammation
- Marasmus - Chronic disease-related malnutrition
- Mild-moderate inflammation
- Cachexia - Acute disease- or injury-related malnutrition
- Severe inflammation
- “Marasmic-kwashiorkor”
compare starvation to disease/injury related malnutrition?
STARVATION: Serum levels of electrolytes, vitamins, and minerals do not reflect body stores Ketones/fat for energy Hypometabolism Wasted, cachectic appearance Simple starvation
INJURY/DISEASE RELATED: Hypermetabolism Hypercatabolism Glucose intolerance Nitrogen losses Fluid retention Potential to become malnourished Inflammation
What can nitrogen balance be used for?
to estimate how much protein is needed (measures intake nitrogen minus output)
Describe PE findings for iron def.?
Nails Pale, brittle, ridged
spoon-shaped
Describe PE findings for Zinc, protein, copper def:
Hair Dry, thin, color &
texture change, dry
easily pluckable
Describe PE findings for riboflavin or niacin def:
Tongue Swollen, magenta tongue
Describe PE findings for Vit c Def:
Gums Soft, bleeding, spongy
Describe PE findings for Vit A/B def.:
Eyes Pale conjunctiva, fissures
at corners of mouth
What are four methods of getting a diet history?
- 24 hour Recall
- Information about typical or usual intake
- Food frequency questionnaire
- Food record (3 to 7 days)
What is the subjective global assessment?
Well – tested and widely accepted as a practical and reliable tool for nutrition assessment
Easy to perform in a clinic setting
Components include:
Nutrition/Medical Hx
Weight changes, eating habits, GI symptoms, functional capacity, metabolic stress
Physical Exam
Subcutaneous fat, muscle mass, fluid status
Score A, B, C
What is indirect calorimetry?
- A method to measure energy expenditure. Uses open circuit spirometry or metabolic cart
- Results reported as Measured Energy Expenditure (MEE) and Respiratory Quotient (RQ)
- Food + O2 Heat + CO2 + H2O
- Uses relationship of oxygen consumed (VO2) to CO2 produced (VCO2)=RQ
- RQ helps determine the energy substrate used
- 7=fat
- 85=mixed fuel
- 95=CHO
What is a general guideline for estimating fluid requirements?
16-30 years, active 40ml/kg
20-55 years 35ml/kg
55-75 years 30ml/kg
>75years 25ml/kg
