This document discusses methods for assessing nutritional status. It defines nutritional status as the current body status related to nourishment and consumption of nutrients. Assessment methods include clinical examinations, anthropometry, biochemical tests, dietary assessments, and analyzing vital statistics and ecological factors. Anthropometry involves measuring height, weight, mid-upper arm circumference, and other indicators to evaluate growth, wasting, and malnutrition. Laboratory tests examine nutrients in blood and other samples. Dietary assessments evaluate food intake through recalls, diaries, and other methods. Vital statistics and ecological analysis provide population-level insights. The overall goal of nutritional assessment is to identify malnutrition and use the data to design effective nutrition programs.

1. ASSESSMENT OF
NUTRITIONAL STATUS
DR. FAIZA LIAQAT

2. CONTENTS
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● Definition of Nutritional Status
● Introduction
● Purpose of Assessment
● Methods
● Summary

3. NUTRITIONAL STATUS
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● It is the current body status, of a person or a population group
related to their state of nourishment (the consumption and
utilization of nutrients).
● It is determined by the complex interaction between
internal/constitutional factors (age, sex, nutrition, physical activity,
diseases) and external/environmental factors
(food safety, cultural, socio-economic circumstances).

4. PURPOSE OF NUTRITIONAL
ASSESSMENT
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● Identify individuals or population groups at risk of becoming
malnourished.
● Identify individuals or population who are malnourished.
● To develop health care programs to meet the community needs
which are defined by the assessment.
● To measure the effectiveness of the nutritional programs and
intervention once initiated.

5. ASSESSMENT METHODS
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● Clinical examinations
● Anthropometry
● Biochemical evaluation
● Functional assessment
● Assessment of dietary intake
● Vital and health statistics
● Ecological studies

6. 1. CLINICAL EXAMINATION
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● Simplest and the most practical method of ascertaining the
nutritional status.
● Number of physical signs (specific and non-specific) associated
with malnutrition.
● Good nutritional history should be obtained.
● General clinical examination of hair, angles of mouth, gums, nails,
skin, eyes, tongue, muscles , bones and thyroid gland.
● Detection of relevant signs - nutritional diagnosis.

7. EXAMPLES:
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● Bitot’s spots, Xerophthalmia- Vitamin A deficiency.
● Goitre- Iodine deficiency.
● Visible severe wasting.
● Bilateral pitting edema.
● Pale palms, conjunctiva, tongue- Anemia (may be due to
deficiency iron, folic acid, vitamin B12).

8. EXAMPLES
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9. 2. ANTHROPOMETRY
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● Measurements such as height, weight, skinfold thickness and
mid upper arm circumference- valuable indicators of
nutritional status.
● Additional measurements in young children- head and chest
circumference.
● Results can be used to evaluate the growth of the child.

10. LENGTH:
● The wooden measuring board (sliding board) used to measure
length of children below 2 years of age.
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11. HEIGHT:
● Measured with the child (above 2 years) or an
adult in standing position.
● Head- in the Frankfurt Position (a position where
the line passing from the external ear hole to the
lower eyelid is parallel to the floor).
● Shoulders, buttocks, heels touch the stand.
● Stadiometer or portable anthropometer.
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12. WEIGHT:
● A weighing sling (spring balance)- Salter scale to measure
the weight of children under 2 years old.
● A beam balance- in children over two years and adults.
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13. HEAD CIRCUMFERENCE:
● HC is the measurement of head along the supraorbital ridge
(forehead) anteriorly and occipital prominence (prominent area on
the back part of the head) posteriorly.
● Useful in assessing chronic nutritional problems in children under
2 years of age as the brain grows faster during first two years of
life.
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14. CONVERTING MEASUREMENTS TO
INDICES
● Weight-for-age is an index used in growth monitoring for assessing children
who may be underweight.
● Height-for-age- used for assessing stunting (chronic malnutrition in
children).
● Weight-for-height- used for assessing wasting (acute malnutrition).

15. ● Body Mass Index- weight of a child or adult in kg divided by their height
in meters squared.
BMI
● Below 18.5
● 18.5-24.9
● 25.0-29.9
● 30.0-34.9
● 35.0-39.9
● Above 40
Adult Nutritional
Status
● Underweight
● Normal weight
● Pre-obesity
● Obese class I
● Obese class II
● Obese class III 15

16. MID-UPPER ARM CIRCUMFERENCE:
● An accurate way to measure fat-free mass (muscle mass).
● MUAC tapes with three color bands: Shakir Strip.
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17. 3. LABORATORY AND
BIOCHEMICAL ASSESSMENT
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● Haemoglobin estimation- useful index of the overall state of
nutrition irrespective of its significance in anemia.
● Stool examination- for intestinal parasites.
● Urine examination- for albumin and sugar.
● Individual nutrient concentration in body fluids (serum retinol,
serum iron).
● Abnormal metabolites in urine (urinary iodine, urinary
creatinine).

18. 4. DIETARY ASSESSMENT
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Nutrition intake of humans are assessed by 5 methods:
● 24 hours dietary recall
● Food frequency questionnaire
● Dietary history since early life
● Food dairy technique
● Observed food consumption

19. ● Ask what the family or the mother and the child have eaten over the
past 24 hours and use this data to calculate the dietary diversity score.
● Higher the dietary diversity score in a family, the more diversified
and balanced the diet is and the more food-secure the household.
● Check the salt iodine level of households using the single
solution kit (SSK).
● Normally, iodized salt should have iodine level of more than 15 PPM
to prevent iodine deficiency.
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20. Food Guide Pyramid
● Base/widest part- need for higher quantities
of consumption of carbohydrate source
foods.
● Tip/narrow part- need for eating only
smaller amounts of fats and sweets.
● If the person consumes any examples of the
food type from each of the six groups for 24
hours, their dietary diversity score is 6.
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21. 5. VITAL STATISTICS
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● Mortality and morbidity will identify groups at high risk and indicate
the extent of risk to the community.
● Mortality- in age group of 1-4 years is particularly related to malnutrition. Other
rates for this purpose- Infant mortality rate, second year mortality rate, rate of low-
birth weight , life expectancy.
● Morbidity- Data on morbidity in relation to PEM, anaemia, xerophthalmia,
other vitamin deficiencies, endemic goitre, diarrhoea provide additional
information to the nutritional status of the community.

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23. 6. ASSESSMENT OF ECOLOGICAL
FACTORS
● Food Balance Sheet: Gives an indication of the general pattern of food
consumption in the country.
● Socio-Economic Factors: Family size, occupation, income, education,
customs, cultural patterns in relation to feeding practices of children and
mothers
● Health and Educational Services: Primary health care services,
feeding and immunization programmes
● Conditioning Influences: Include parasitic, bacterial and viral infections which
precipitate malnutrition.
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24. SUMMARY
● Nutritional assessment is the interpretation of data to determine
whether a person or groups of people are well nourished or
malnourished (over nourished or undernourished).
● An index is the combination of two anthropometric measurements or an
anthropometric measurement plus age. An indicator = index + cutoff point.
● MUAC- community based screening of children (below 5 years of age) and
pregnant women. BMI- for non-pregnant adult nutritional status.
● Clinical signs and symptoms are important for assessing nutritional
deficiencies. 24

25. THANK YOU
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