Nutritional Status Assessment


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Nutritional Status Assessment

  1. 2. <ul><li>Why Nutrition Monitoring is essential? </li></ul><ul><li>to assess the magnitude & distribution of nutrition </li></ul><ul><li>problems in the community </li></ul><ul><li>to formulate and implement the programmes </li></ul><ul><li>for the prevention and control of malnutrition </li></ul><ul><li>to evaluate on-going nutrition programmes </li></ul>
  2. 3. METHODS FOR NUTRITIONAL STATUS ASSESSMENT DIRECT Clinical Exam., Anthropometry, Biochemical/Lab.Inv., Functional Indicators INDIRECT Morbidity & mortality data, Assessment of dietary intake, Food balance sheet
  3. 4. <ul><li>1.CLINICAL EXAMINATION </li></ul><ul><li>Simplest & most practical method </li></ul><ul><li>Examples: </li></ul><ul><li>Bitot’s spots (VAD), </li></ul><ul><li>Absence of Knee/ankle jerk (beri beri), </li></ul><ul><li>Enlarged thyroid (Goitre), </li></ul><ul><li>Angular stomatitis (Riboflavin defi.), </li></ul><ul><li>Flaky paint dermatosis (Kwashiorkar), </li></ul><ul><li>Pallor of tongue & conjuctiva (Anaemia) </li></ul>
  4. 5. <ul><ul><li>Bitot’s spot </li></ul></ul>
  5. 7. Vitamin B complex deficiency - glossitis - cheilosis - stomatitis - neurological problems - anaemia - beri beri (Thiamine) - pellagra (Niacin) - birth defects (Folate) - infertility (Folate + B12)
  6. 8. <ul><ul><ul><li>Angular cheilitis </li></ul></ul></ul>
  7. 9. <ul><li>Lesions on the back of the hands and ‘Casal’s necklace’ </li></ul>
  8. 10. Vitamin D (Rickets) - bony deformities - rickety rosary - tetany - osteomalacia
  9. 11. Iodine deficiency disorder - deficiency of micronutrient iodine - thyroid hormone deficiency features: - goitre - swelling over legs (myxoedema) - voice change - skin changes - abortions
  10. 12. <ul><li>ADVANTAGES </li></ul><ul><ul><li>Fast & Easy to perform </li></ul></ul><ul><ul><li>Inexpensive </li></ul></ul><ul><ul><li>Non-invasive </li></ul></ul><ul><li>LIMITATIONS </li></ul><ul><ul><li>Did not detect early cases </li></ul></ul><ul><ul><li>Trained staff needed </li></ul></ul>
  11. 13. <ul><li>2.ANTHROPOMETRY </li></ul><ul><li>Anthropometry is the study of human body measurements </li></ul><ul><li>Compare the observed readings with the expected levels </li></ul><ul><li>Ht., Wt., MUAC ,Skin fold thickness </li></ul><ul><li>Head & Chest circumferences </li></ul><ul><li>Common indicators </li></ul><ul><li>Wt. for Height (W/H), Ht. for Age (H/A) </li></ul><ul><li>Wt. for Age (W/A),BMI </li></ul><ul><li>Head and Chest circumference </li></ul><ul><li>At birth: Head Circumference: 34 cm </li></ul><ul><li>Chest Circumference:32 cm </li></ul><ul><li>In normal development: at 9 months both </li></ul><ul><li>Head circum. and Chest circum. becomes equal </li></ul>
  12. 14. Weight: Spring scale
  13. 15. Height: board for recumbent, various means for standing
  14. 16. ZERFAS TAPE (For MUAC)
  15. 17. <ul><ul><li>Inter-observers’ errors in measurement </li></ul></ul><ul><ul><li>Limited nutritional diagnosis </li></ul></ul><ul><ul><li>Problems with reference standards </li></ul></ul><ul><ul><li>Arbitrary statistical cut-off levels for abnormality </li></ul></ul>
  16. 18. 3.BIOCHEMICAL & LAB INVESTIGATION Biochemical Tests: To measure mainly the nutrient conc. or enzymes (where vitamins are cofactors) Examples: Serum Retinol(20 mcg/dl), Serum folate( 6 mcg/ml) Serum Albumin(35 g/l), Serum Vit.B12 conc.(160 mg/L) Urinary Iodine level(100 mcg/l) Lab Investigations: 1.Stool Examination 2.Urine examination 3.Hb Conc. 4.Blood Smear: Malaria,Filaria,Anaemia Disadvantages of biochemical tests & lab.inv.: Time consuming, Expensive, Needs sample, Can’t be used at community level
  17. 19. 4.FUNCTIONAL INDICATORS SYSTEM NUTRIENTS Host defence- Delayed cuta.hypersensitivity Zn,Proteins Haemostasis- Prothrombin time,CT Vit.K Nerve function- Dark adaptation Vit.A,Zn Work capacity- HR Fe,Proteins
  18. 20. INDIRECT METHODS 1.MORBIDITY DATA Hospital or community morbidity surveys PEM, Anaemia, Xerophthalmia, Measles, Diarrheoa, Parasitic infestations 2.MORTALITY DATA IMR (Specially postneonatal mortality) 1-4 yr mortality rate (imp.indi.of malnutrition) % deaths under 5 yr to total deaths
  19. 21. 3.ASSESSMENT OF DIETARY INTAKE Involves dietary surveys. Methods of dietary survey are: A.Direct weighing of foods: Weights of different food items to be cooked are measured and all the remaining leftover food is also measured. Duration of survey: 1-7 days(7 days is one dietary cycle) B.Random Diet Interview/ Recall or Oral Questionnaire method Enquiry about the food generally eaten by a person in 24 hours
  20. 22. C.Weighing of cooked foods: Not easily acceptable by community Data collected in Dietary survey is translated into mean intake of nutrients With the help of suitable tables of food composition
  21. 23. 4.FOOD BALANCE SHEET or FOOD PRODUCTION DATA Simplest (at the national level) Average per capita available food: (Food grown +Food imported)-(Food exported+ Food waste) Total population
  22. 24. NUTRITIONAL ASSESSMENT & GROWTH MONITORING Factor Growth monitoring Nutritional assessment Definition It is repeated measurements of an individual child taken at regular intervals to preserve the normal growth Keeping watch over nutrition in community ,in order to make decisions that will lead to improvement in nutrition in population Strategy Preservation of normal growth Detection of under-nutrition Enrolment All infants (before 6 month) Representative sample of children (under 5 yr) Time interval Monthly At longer intervals Number Groups(10-20) Sample(50-100 or more)
  23. 25. NUTRITIONAL ASSESSMENT & GROWTH MONITORING Factor Growth monitoring Nutritional assessment Weight Recorder Mothers (Guided by workers) Trained worker Approach Educational-Motivational Diagnostic-Interventional Inter- -ventions Early home intervention based on local knowledge, Primary Health Care, ORT, Immunization, Vit. A, Deworming,other treatments Nutritional Rehabilitation often with supplements of food, food subsidy Referral Health system for check up & possible food supplements Often special centres