Nutritional Assessment

Question 1

Risks for Nutritional Deficiencies

Answer 1

1. Inadequate Intake
2. Inadequate Absorption
3. Decreased Utilization
4. Increased Losses
5. Increased Requirements
   
   • due to various stresses such as fever, burns, trauma, etc
   • hypercatabolic state caused by elevated counterregulatory hormones
   • increased need for calories, proteins, and some vitamins

Question 2

Anthropometric Measures

Answer 2

The physical measures of weight or body dimensions.

• For children:
  
  • most commonly involve height and weight
  • mid-arm circumference common in developing countries
  • comparison to growth charts
• For adults:
  
  • BMI most common criterion
  • waist size measurement also used
  • skin-fold thickness provides a measure of sub-Q fat

Question 3

Hamwi Method

Answer 3

Most common method for calculating ideal body weight.

Comparison of ideal weight & weight at which people have the greatest longevity found them in close agreement.

Question 4

Body Mass Index

(BMI)

Answer 4

Proxy for body fat percentage.

Used to classify individuals as obese or non-obese in order to evaluate for potential risk factors.

Question 5

Weight Classifications

Answer 5

BMI ranges associated with weight classifications.

Question 6

Malnutrition

Answer 6

An involuntary weight loss of 10% or more over a 6-month period.

Question 7

Biochemical Measures

Answer 7

1. Serum albumin
   
   • most common visceral protein evaluated as part of nutrition assessment
   • useful for free-living populations or upon hospital admission
   • gives an integrated picture of nutritional intake over a period of several weeks
2. Serum prealbumin (aka transthyretin)
   
   • half-life of 2-3 days
   • measure of choice for monitoring progress of hospitalized patients
   • gives information about short-term changes in nutritional status
3. Transferrin
   
   • intermediate half-life of 8-9 days
   • useful in establishing cumulative nutrition status over an intermediate time interval
4. Hemoglobin and hematocrit
   
   • likely the first detected sign of severe protein malnutrition
5. Creatine-height index (CHI)
   
   • sometimes used to estimate skeletal muscle mass

Question 8

Dietary Assessment

Answer 8

1. Twenty-four hour recall
   
   • all food & beverages consumed over the past 24 hours
   • usually starts with meal immediately preceding interview and working backwards
2. Food frequency questionnaire
   
   • retrospective review of intake frequency
   • how much of each category consumed per day, week, or month
3. Typical day history
   
   • patient orally reports all foods and beverages consumed on a typical day
4. Food diary
   
   • only prospective approach
   • patient records specific types and exact amounts of food & beverages eaten as soon as possible after consumption

Question 9

Mini Nutritional Assessment

Answer 9

Typically used with the elderly.

Evaluates areas such as:

• anthropomorphic measures
• dietary measures
• “global assessment”
  
  • mobility
  • lifestyle
  • medications
  • etc
• subjective measures
  
  • self-perception of health and nutritional status

Question 10

Alimentation

Methods

Answer 10

Routes for feeding of a patient incapable of taking food by mouth:

1. Enteral
   
   • liquid diet fed directly into stomach or intestine via tube
   • preferred method
     
     • preserves gut integrity
     • less expense
2. Parenteral (IV) aka hyperalimentation or “hyperal” nutrition
   
   • formulas require glucose, AAs, vitamins, minerals, and triglyceride emulsions
     
     • components in the form normally encountered in blood
   • no fiber
   • must be sterile