nutritional assessment W4 Flashcards
most vulnerable groups for malnutrition?
those with acute and chronic diseases, those recently discharged from hospital, older people, poor or socially isolated people
clinical consequences of malnutrition
reduced cardiac output
impaired liver function and fatty change/fibrosis/necrosis
impaired gut integrity and immunity
impaired wound healing
depression and apathy
ventilation - loss of muscle and hypoxic responses
impaired renal function
sarcopenia - loss of muscle strength
important features of nutritional screening tools
practical (quick and easy)
universal
reliable
valid and evidence based
linked to a care plan for treatment
acceptable to patients and health care team
MUST (malnutrition universal screening tool) features?
BMI - where the patient is now
recent weight loss - where the patient has come from
starvation in presence of acute disease - where the patient is going
MUST: BMI scoring?
> 20 (>30 obese) = 0
18.5-20 = 1
<18.5 = 2
MUST: weight loss scoring?
unplanned weight loss in past 3-6 months:
<5% = 0
5-10% = 1
>10% = 2
MUST: acute disease effect scoring?
if patient is acutely ill and there has been or is likely to be no nutritional intake for >5 days = 2
MUST: calculating overall risk of malnutrition
add scores together:
0 = low risk
1 = medium risk
2 or more = high risk
minimal/moderate/severe ascites?
minimal = 2.2kg
moderate = 6.0kg
severe = 14.0kg
minimal/moderate/severe oedema?
minimal = 1.0kg
moderate = 5.0kg
severe = 10.0kg
how to calculate percentage weight loss?
(usual weight - current weight) / usual weight
x100
MUST: management guidelines?
adapt to local policy. should include:
-frequency of repeat screening
-recording of dietary intake
-measures to improve dietary intake
-referral for specialist advice
nutritional assessment: ABCDE?
anthropometry
biochemical data
clinical presentation
diet history and dietary intake
environmental/social factors
anthropometric data?
BMI
waist, mid arm circumference
weight history
body composition
skinfold thickness measurements
handgrip strength
bioelectrical impendence analysis (BIA)
dual energy x-ray absorptiometry (Dexa)
4 sites of skinfold thickness measurements?
triceps, biceps, subscapular, supra iliac
measuring weight?
light clothing, without shoes
diurnal variation - 2kg within a day
take account of hydration status
BMI equation?
weight / height (m^2)
BMI ranges?
<20 = underweight
20-25 = desirable weight
25-30 = overweight
>30 = obese
factors affecting BMI interpretation
ethnicity
age
body composition
in which patients is adiposity a better measure than BMI for? who is it not reliable for? how is it measured?
measured as waist circumference
older people
non-white ethnicity
not reliable in those with ascites, colostomy, ileostomy
surrogate height measures?
demi-span
knee height
ulnar length (olecranon and midpoint of styloid process)
surrogate weight measures? when are these useful?
mid-upper arm circumference
useful for when weight is distorted by fluid overload
how to estimate BMI category from mid upper arm circumference?
bend subjects left arm at a 90 degree angle. measure distance from bony protrusion on the shoulder (acromion) and the point of the elbow (olecranon process). mark the midpoint and measure circumference.
MUAC <23.5cm -> BMI <20
MUAC >32.0cm -> BMI >30
accuracy of reported height and weight?
height overestimated by older people, shorter men and heavier women
weight underestimated by heavier people, not affected by age or height
triceps skinfold thickness features?
estimate of total body fat
assumes constant relationship between subcutaneous and internal fat but varies with sex, body weight, ethnicity, age
MUAMC?
mid upper arm muscle circumference
calculated from MUAC and TSF
used to assess total body muscle mass
can be used to assess PEM (protein energy malnutrition) as is an index of protein reserves
handgrip strength features
assesses upper extremity muscle strength
measured by hand grip dynamometer
reflects physical function
affected by motivation, medication
some patients unable to perform technique
biochemistry for nutritional assessment?
used to assess body stores
albumin (half life 14-21 days), prealbumin (half life 2 days)
how is biochemistry altered/affected?
altered by inadequate intake of nutrients, medications, metabolic changes during illness or stressed state, fluid status
affected by protein deficiency but also renal and hepatic disease, wounds, burns, infections, cancer, inflammation, hydration status, stress
nutritional assessment - clinical examination
physical appearance
emancipation (pale skin, hair loss?)
loose clothing, rings, dentures
sunken eyes, dry mouth, fragile skin
oedema (underlying disease)
poor wound healing (impaired immune function)
physical problems affecting eating
dietary assessment techniques
food diary
food frequency questionnaire
24-hr recall
24-hr recall benefits?
doesn’t rely on patients perception of usual diet
culturally sensitive
doesn’t require literacy
less likely to alter eating behaviour since information is collected afterwards
minimal patient burden
environmental/social aspects?
cooking/storage, shopping facilities and ability
family commitments and support
social isolation/loneliness
employment and income
psychological status
alcohol or drug addiction
