4 Nutritional Assessment

8/16/2019 4 Nutritional Assessment

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Nutritional assessme


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Nutritional Assessment Why?

The purpose of nutritional assessment is to:

Identify individuals or population groups at rbecoming malnourished

Identify individuals or population groups wh

malnourishedTo develop health care programs that meet tcommunity needs which are dened by theassessment

To measure the eectiveness of the nutritioro rams ! intervention once initiated


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Methods of Nutritional Assessm

•Nutrition is assessed by two types of methods; dand indirect.

• The direct methods deal with the individual andmeasure objective criteria, while indirect method

community health indices that reects nutritionainuences.


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Direct Methods of NutritionalAssessment•

These are summaried as A!"D

• Anthropometric methods

• !iochemical, laboratory methods

•

"linical methods• Dietary evaluation methods


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#ndirect Methods of NutritionalAssessment

These include three cate$ories%• &colo$ical variables includin$ crop production

• &conomic factors e.$. per capita income, populadensity ' social habits

• (ital health statistics particularly infant ' under mortality ' fertility inde*


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"#INI"A# A$$%$$&%NTIt is an essential features of all nutritional su

It is the simplest ! most practical method ofascertaining the nutritional status of a group individuals

It utili'es a number of physical signs( )specispecic*( that are known to be associated wit

malnutrition and deciency of vitamins !micronutrients+


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"+#N#"A+ A&M&NT

•

-ood nutritional history should be obtained• -eneral clinical e*amination, with special attent

or$ans lie hair, an$les of the mouth, $ums, naileyes, ton$ue, muscles, bones, ' thyroid $land.

• Detection of relevant si$ns helps in establishin$

nutritional dia$nosis


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"+#N#"A+ A&M&NT

•

AD(ANTA-&• /ast ' &asy to perform

• #ne*pensive

• Non0invasive

• +#M#TAT#1N

• Do not detect early cases


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"linical si$ns of nutritional de2ci

• 3A#4 ,rotein( 'inc( biotin

deciency

$pare !

,rotein deciency %asy to

-it " ! -it A

deciency

"orkscre

"oiled h


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• M15T3 Riboflavin, niacin, folic acid,

B12 , protein

Glossitis

Vit. C,A, K, folic acid & niacin Bleeding & spo

B 2,!,& niacin Angular stoac"eilosis & fistongue

Vit.A,B12, B#cople$, folicacid & niacin

leu%opla%ia

Vit B12,!,c, niacin ,folic acid& iron

ore out" &


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• &6& -itamin A

deciency

Night blind

e.ophthalm

-it /0 ! vit A

deciencies

,hotophob

blurring(con2unctivain3ammatio


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• NA#+ Iron deciency $pooning

,rotein

deciency

Transvers


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• 7#N 4olic acid( iron( /50 ,allor

-itamin / ! -itamin"

4ollicularhyperkera

,%&( -it /0( -itaminA( 6inc ! Niacin

4lakingdermatiti

Niacin ! ,%& ,igmentades7uama

-it 8 (-it " ! folicacid

/ruising(


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"linical si$ns of nutritionalde2ciency

Thyroid $land• in mountainous areas and

far from sea places -oiteris a reliable si$n of iodinede2ciency.


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"linical si$ns of nutritionalde2ciency

8oins ' bones• 3elp detect si$ns of

vitamin D de2ciency94icets: ' vitamin "de2ciency 9curvy:


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Anthropometric Methods

•

Anthropometry is the measurement of body hei$wei$ht ' proportions.

• #t is an essential component of clinical e*aminatinfants, children ' pre$nant women.

• #t is used to evaluate both under ' over nutrition

• The measured values reects the current nutritiostatus ' dont di


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1ther anthropometricMeasurements•

Mid0arm circumference• in fold thicness

• 3ead circumference

• 3ead=chest ratio

• 3ip=waist ratio


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Anthropometry for children

•

Accurate measurement of hei$ht and wei$ht isessential. The results can then be used to evaluaphysical $rowth of the child.

• /or $rowth monitorin$ the data are plotted on $r

charts over a period of time that is enou$h to ca$rowth velocity, which can then be compared tointernational standards

G th M it i Ch t


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Growth Monitoring Chart,ercentile chart


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Measurements for adults

3ei$ht>ei$ht


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Nutritional #ndices in Adults

•

The international standard for assessin$ body siadults is the body mass inde* 9!M#:.

• !M# is computed usin$ the followin$ formula% !M>ei$ht 9$:= 3ei$ht 9m@:

• &vidence shows that hi$h !M# 9obesity level: is

associated with type diabetes ' hi$h ris ofcardiovascular morbidity ' mortality


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!M# 9>31 0 "lassi2cation:

•

!M# B C.) ? 5nder >ei$ht• !M# C.)0E.)? 3ealthy wei$ht ran$e

• !M# )0FG ? 1verwei$ht 9$rade C obesity:

• !M# HFG0EG ? 1bese 9$rade obesity:

• !M# HEG ?(ery obese 9morbid or $rade F ob


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>aist=3ip 4atio

•

>aist circumference is measured at the level of umbilicus to the nearest G.) cm.

• The subject stands erect with rela*ed abdominamuscles, arms at the side, and feet to$ether.

• The measurement should be taen at the end of

normal e*piration.


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>aist circumference

•

>aist circumference predicts mortality better thother anthropometric measurement.

• #t has been proposed that waist measurement abe used to assess obesity, and two levels of ris

been identi2edMA+& /&MA+&

• +&(&+ C H IEcm H Gcm

• +&(&+ H CGcm H cm


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>aist circumference

•

+evel C is the ma*imum acceptable waist circumirrespective of the adult a$e and there should befurther wei$ht $ain.

• +evel denotes obesity and reJuires wei$ht

mana$ement to reduce the ris of type diabet"( complications.


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3ip "ircumference

•

#s measured at the point of $reatest circumferenaround hips ' buttocs to the nearest G.) cm.

• !oth measurement should taen with a e*ible, stretchable tape in close contact with the sin, bwithout indentin$ the soft tissue.


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#nterpretation of >34

•

3i$h ris >34? HG.G for females ' HG.I) for mi.e. waist measurement HGK of hip measuremewomen and HI)K for men indicates central 9upbody: obesity and is considered hi$h ris for dia"( disorders.

• A >34 below these cut0o< levels is considered lo


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AD(ANTA-& 1/ ANT341L1M&

•

1bjective with hi$h speci2city ' sensitivity• Measures many variables of nutritional si$ni2can

>t, MA", 3", sin fold thicness, waist ' hip rat!M#:.

• 4eadin$s are numerical ' $radable on standard

charts• 4eadin$s are reproducible.

• Non0e*pensive ' need minimal trainin$


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+imitations of Anthropometry

•

#nter0observers errors in measurement• +imited nutritional dia$nosis

• Lroblems with reference standards, i.e. versus international standards.

•

Arbitrary statistical cut0o< levels for whaconsidered as abnormal values.


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9I%TA; A$$%$$&%NT

•

Nutritional intake of humans is assessed bydierent methods+ These are:

• 0< hours dietary recall

• 4ood fre7uency 7uestionnaire

• 9ietary history since early life

• 4ood dairy techni7ue

• =bserved food consumption


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0< >ours 9ietary ecall

A trained interviewer asks the sub2ect to rec

food ! drink taken in the previous 0< hours+

It is 7uick( easy( ! depends on short1term me

but may not be truly representative of the pe

usual intake


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4ood 4re7uency @uestionnaireIn this method the sub2ect is given a list of

5 food items to indicate his or her intake)fre7uency ! 7uantity* per day( per week !

month+

ine.pensive( more representative ! easy to


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4ood 4re7uency @uestionnai

#imitations:

long @uestionnaire

%rrors with estimating serving si'e+

Needs updating with new commercial foodproducts to keep pace with changing dietar

habits+


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9I%TA; >I$T=;

It is an accurate method for assessing the

nutritional status+The information should be collected by atrained interviewer+

9etails about usual intake( types( amount(

fre7uency ! timing needs to be obtained+"ross1checking to verify data is important+


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4==9 9AI; 4ood intake )types ! amounts* should be

recorded by the sub2ect at the time of

consumption+

The length of the collection period range

between 51B days+

eliable but diCcult to maintain+

=bserved 4ood


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=bserved 4ood"onsumption

The most unused method in clinical practice

recommended for research purposes+

The meal eaten by the individual is weighed

contents are e.actly calculated+

The method is characteri'ed by having a hig

of accuracy but e.pensive ! needs time ! e


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Interpretation of 9ietary 9ata

5+ @ualitative &ethod• using the food pyramid ! the basic food g

method+

• 9ierent nutrients are classied into D gro! oils( bread ! cereals( milk products( me

poultry( vegetables ! fruits*• determine the number of serving from eac

! compare it with minimum re7uirement+


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Interpretation of 9ietary 9at

0+ @uantitative &ethod

• The amount of energy ! specic nutrients ifood consumed can be calculated using foo

composition tables ! then compare it with

recommended daily intake+

• %valuation by this method is e.pensive ! ti

consuming( unless computing facilities are

available+

Initial #aboratory


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Initial #aboratoryAssessment

3emo$lobin estimation is the most important teuseful inde* of the overall state of nutrition.

!eside anemia it also tells about protein ' traceelement nutrition.

tool e*amination for the presence of ova and=ointestinal parasites

5rine dipstic ' microscopy for albumin, su$ar ablood


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$pecic #ab Tests

Measurement of individual nutrient in buids 9e.$. serum retinol, serum iron, uriodine, vitamin D:

Detection of abnormal amount of metabthe urine 9e.$. urinary creatinine=hydro*

ratio:Analysis of hair, nails ' sin for micro0n

Advantages of /iochemical


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Advantages of /iochemical&ethod

#t is useful in detectin$ early chan$es in body me' nutrition before the appearance of overt clinica

#t is precise, accurate and reproducible.

5seful to validate data obtained from dietary me

e.$. comparin$ salt intae with E0hour urinary e*

i i i f i h i l h


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#imitations of /iochemical &eth

Time consumin$

&*pensive

They cannot be applied on lar$e scale

Needs trained personnel ' facilities

4 Nutritional Assessment

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