Nutritional Assessment

Question 1

Conditions that Increase Energy Expenditure

Answer 1

Pregnancy/lactation

Trauma/Sepsis/Burn

Infx

Surgery

Chronic Lung Disease

Congenital Heart Disease

Cancer/AIDS

Hyperthyroidism

Inflammatory Disease

Question 2

Components of Nutritional Assessment

Answer 2

ABCD’s

Anthropometric

Biochemical

Clinical

Dietary

Question 3

Anthropometric

Answer 3

Height

• growth in children
• can suggest nutritional deficit, acute/chronic illness, or FTT

Weight

• same in relation to kids
• can also indicate fluid status
• unplanned weight loss is concerning

BMI–when talking about weight gains ask about weight changes throughout life

Waist circumference (>40” or 35”)

Waist to hip ratios (M>1 or W>0.8)

Body fat percentage

Question 4

Biochemical Assessment

Answer 4

**Hydration **

• Sodium (136-145mmol/L)
• Potassium (3.5-5 mEq/L)
• Hemoglobin (M 14-16, W 12-14)
• Urine specific gravity–elevated
• BUN/Cr–elevated
• Electrolytes (Na, K, Mg)

Note:

• if sodium=water loss, Na will be normal
• when water replaced without Na =hyponatrium
• low potassium and magnesium with V/D and fistulas
• Low chloride with vomiting

Protein

• pre-albumin: sensitive to changes in protein
• transferrin: iron transport protein

**Carbohydrate **

• Blood glucose

Lipids

• Lipid profile
• Essential fatty acids (rare)

Vitamins

• generally expensive and inpractical to check, but some are available to check that can be then be fixed with supplements

Question 5

Clinical Assessment

Answer 5

Clinical lesions generally appear only at advanced stages of deficiency

Better to detect early by biochemical assays to prevent long term damage

Question 6

Clinical signs of protein deficiency

Answer 6

non-healing wounds

Question 7

Clinical signs of fatty acid deficiency

Answer 7

dry, scaly skin

Question 8

Clinical signs of Vitamin A deficiency

Answer 8

One of the leading causes of blindness world wide

Question 9

Clinical signs of Vitamin D Deficiency

Answer 9

Rickets: structural abdnormalities in growing bones (i.e. bowing)

Osteomalacia

Osteoporosis

Question 10

Clinical signs of Vitamin C Deficiency

Answer 10

Scurvy–peridontal dz, bleeding gums

Question 11

Clinical signs of Niacin Deficiency

Answer 11

Pellegra (4 D’s)

Dermatitis

Diarrhea

Dementia

Death

Question 12

Clinical signs of Thiamine Deficiency

Answer 12

(Vitamin B1)

Beriberi

Wet–pitting edema

Dry–muscle wasting and weakness

Wernicke-Korsakoff Syndrome in alcoholics

Question 13

Clinical signs of Riboflavin Deficiency

Answer 13

Magenta tongue

Angular cheilosis

Question 14

Clinical signs of Iodine Deficiency

Answer 14

Goiter

Mental deficiency

Hypothyroidism

Question 15

Types of Diet History

Answer 15

24hr recall

Usual intake

3-7 day food record

Food frequency (quick look at problem areas/risk nutrients)