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1. Advanced Nursing Health Assessment of Adult
Assignment on Nutritional Assessement
By Geleto Hinika
2023,FITCHE,
ETHIOPIA
16/06/2023 1

2. Presentation outline
• Objectives
• Overview nutritional assessment
• Methods of nutritional assessment
• Summary
• References
16/62023 2

3. Objectives
After completion of this topic learners will be able to;
• Define nutritional assessment
• Identify whether a person is well nourished or
malnourished
• Identify methods of nutritional assessment
• Use nutritional assessment in the provision of health
care
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4. Overview
• Proper nutrition is important to maintain health and
prevent illness.
• When obtaining a patient’s health history, it is
important to assess and document the nutritional
status.
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5. CON…
• Nutrition is critical in maintaining a healthy weight
and to prevent conditions such as cardiovascular
disease and diabetes. In addition, adequate nutrition is
vital to healing and recovery from illness and injury
(Hinkle, 2021
• A complete nutritional assessment helps clinicians
evaluate overall dietary status, and identify
malnutrition and its underlying causes. Malnutrition
can be both an inadequate or excessive intake of
nutrients.
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6. Definition
 Nutritional assessment is an interpretation of
anthropometric, biochemical (laboratory), clinical
and dietary survey data to tell whether a person/
group of people is well nourished or malnourished
(Over nourished or under nourished).
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7. Methods of Nutritional Assessment
Involve the direct measurement of body dimensions and
proportions, determination of tissue or body fluid
concentrations of nutrients, dietary intake, appearance
of the clinical symptoms and signs related to a specific
nutrient dependent functional impairment.
Direct methods abbreviated as the ABCDs
 A=Anthropometry
 B= biochemical/Biophysical
 C= Clinical
D= Dietary
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8. A. ANTHROPOMETRIC ASSESSMENTS
Anthropometry comes from two words: Anthropo =
Human, and Metry = measurement.
Definition: - Anthropometry refers to measurement of
variations of physical dimension and gross composition
of human body at different levels and degrees of
nutrition.
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9. Anthropometric Assessments
Anthropometric measurements could be used both
in the clinical and field set-ups. In the clinical
set-ups they are used to assess the nutritional
status of:
 post-operative patient,
 post traumatic patient (after acute trauma or
surgery),
chronically sick medical patient,
patient preparing for operation,
severely malnourished patient to assess the impact
of nutritional intervention.
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10. Purposes Of Anthropometric Measurements
Anthropometric measurements are performed for
two major purposes in mind:
IN CHILDREN: to assess physical growth
IN ADULTS: to assess changes in body
composition or weight
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11. ASSESSMENT OF BODY COMPOSITION
• Linear growth ceases(bring to an end) at around the
age of 25-30 years.
• Therefore, the main purpose of nutritional assessment
of adults using Anthropometry is determination of the
changes of body weight and body composition.
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12. Composition
Using
Anthropometry
 In assessing body
composition we
consider the body to
made up of two
compartments:
 The fat mass and the
fat free mass.
Total body mass= Fat
mass + fat free Mass.
 Therefore different
measurements are used
to assess these two
compartments:
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13. Measurements used for assessing fat free mass:
Mid upper arm circumference***
Mid upper arm Muscle area
Mid thigh circumference
Mid thigh muscle area
Mid calf circumference
Mid calf muscle area
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14. Measurements Used To Assess
Fat Mass:
 Body mass index ( Quetelet’s index ) = Wt/(Height in
meters)2
 Waist to Hip circumference ratio
 Skin fold thickness
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15. Waist/Hip Ratio
• Waist circumference is measured at the level of the
umbilicus to the nearest 0.5 cm.
• The subject stands erect with relaxed abdominal
muscles, arms at the side, and feet together.
• The measurement should be taken at the end of a
normal expiration.
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16. Waist circumference
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17. Interpretation of WHR
• High risk WHR= >0.80 for females & >0.95 for
males i.e. waist measurement >80% of hip
measurement for women and >95% for men indicates
central (upper body) obesity and is considered high
risk for diabetes & CVS disorders.
• A WHR below these cut-off levels is considered low
risk.
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18. Measurements for adults
Height:
The subject stands erect & bare footed on a
stadiometer with a movable head piece. The head
piece is leveled with skull vault & height is
recorded to the nearest 0.5 cm
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19. WEIGHT MEASUREMENT
• Use a regularly calibrated electronic or balanced-beam
scale. Spring scales are less reliable.
• Weigh in light clothes, no shoes
• Read to the nearest 100 gm (0.1kg)
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20. Indices Derived From These Measurements
What is an index? It is a combination of two
measurements
The international standard for assessing body size
in adults is the body mass index (BMI).
BMI is computed using the following formula:
BMI = Weight (kg)/ Height (m²)
Evidence shows that high BMI (obesity level) is
associated with type 2 diabetes & high risk of
cardiovascular morbidity & mortality 20

21. BMI (WHO - Classification)
BMI < 18.5 = Under Weight
BMI 18.5-24.5= Healthy weight range
BMI 25-30 = Overweight (grade 1
 obesity)
BMI >30-40 = Obese (grade 2 obesity)
BMI >40 =Very obese (morbid or
 grade 3 obesity)
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22. B. Biochemical/ Biophysical (Laboratory)
Methods
•It is measurement of either total amount of nutrient in the body, or
its concentration in a particular storage site (organ) in the body or
in the body fluids.
•Indicative of defect in intermediary metabolism when there is a
biochemical lesion (Depletion).
•The depletion could be detected by biochemical tests and/or by tests
that measure physiological or behavioral functions dependent on
specific nutrient.
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23. Biochemical Tests:-
Involves measurement of a nutrient or its metabolites in
pre-Selected biological material (blood, body fluids,
urine, hair, fingernails etc.)
Example, Biochemical Tests (laboratory)
1. Serum ferritin level
2. Serum HDL
3. Erythrocyte Folate
4. Tissue stores of Vit. A, Vit D
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24. Specific Lab Tests
• Measurement of individual nutrient in body fluids
(e.g. serum retinol, serum iron, urinary iodine,
vitamin D)
• Detection of abnormal amount of metabolites in the
urine (e.g. urinary creatinine/hydroxyproline ratio)
• Analysis of hair, nails & skin for micro-nutrients.
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25. C. Clinical Methods/Assessement
• The patient’s nutritional status is often evident in the
head-to-toe physical assessment.
• These are detection of deviations from the normal state
of nutrition just by observing and interpreting clinical
signs and symptoms of deficiency
• It utilizes a number of physical signs, (specific & non
specific), that are known to be associated with
malnutrition and deficiency of vitamins &
micronutrients. 25

26. CON…
• Good nutritional history should be obtained
• General clinical examination, with special attention to
organs like hair, angles of the mouth, gums, nails,
skin, eyes, tongue, muscles, bones, & thyroid gland.
• Detection of relevant signs helps in establishing the
nutritional diagnosis
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27. History and Physical Examination
• Comprehensive nutritional assessment begins with a
history and physical examination.
• History should consist of hospitalizations, changes in
appetite, availability and preparation of food,
medications, and details regarding weight change.
Weight loss is perhaps the most validated parameter
of nutritional status.
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28. Health history
• Food allergies
• Medical dietary requirements (for
example, Gluten-free diet for
history of celiac disease)
• Dietary supplements (for
example, vitamins or protein
drinks)
• Cultural/ethnic/religious need
• Dietary intake history (for
example, eating habits, like and
dislike foods
• Dietary and nutritional
differences can be found
among racial and
socioeconomic groups.
• Dietary selections can be
affected by religious,
spiritual, or philosophical
beliefs
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29. Obtain chief complaints
 Pain?
 Changes in the taste of
food?
 Feeling tiredness?
 Recent changes in
appetite?
 Nausea? Vomiting?
 Change in bowel habit?
 Involuntary weight
loss? Recent changes in
weight?
• Chief complaints should
be considered because it
may indicate the patient to
be at risk for nutritional
deficits.
• Problems with intake
such as indigestion,
heartburn, bloating,
difficulty chewing or
swallowing will affect
nutritional status.
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30.  Following the history, a thorough physical
examination may be
performed.
 Attention should be directed toward findings
of soft-tissue wasting, hydration status,
evidence of vitamin and mineral
deficiencies, height, weight, and body mass
index (BMI)
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31. General inspection and
examination
 General appearance
 Integumentary – hair
and skin
 GI & GU – frequency of
bowel movement and
urination
• Neuro and
Musculoskeletal –
assessing for any
physical problems for
eating and drinking
• Many diseases are
directly or indirectly
caused by a lack of
essential nutrients in the
diet. Changes in the skin
and mucosal membranes
can offer valuable clues to
the presence of nutritional
deficiencies. For example,
gingivitis and bleeding
gums may cause by
vitamin C deficiency. 31

32. 32

33. 33

34. Thyroid gland
• In mountainous areas
and far from sea places
Goiter is a reliable sign
of iodine deficiency
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35. Joints & bones
• Help detect signs of
vitamin D deficiency
(Rickets) & vitamin C
deficiency (Scurvy)
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36. • Conversely, these physical signs may indicate
overnutrition (Chu & Delmore, 2020; Cleveland
Clinic, 2022):
Obesity ;Is adipose tissue distributed evenly,
concentrated over the upper torso, or around the hips?
High blood pressure
Insulin resistance and hyperglycemia
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37. D. Dietary assessment methods
Dietary assessment of past or current intakes of nutrients from food
intake
Nutritional intake of humans is assessed by five different methods.
These are:
 24 hours dietary recall
 Food frequency questionnaire
 Dietary history since early life
 Food dairy technique
 Observed food consumption 37

38. 24 Hours Dietary Recall
• A trained interviewer asks the subject to recall all
food & drink taken in the previous 24 hours.
• It is quick, easy, & depends on short-term memory,
but may not be truly representative of the person’s
usual intake
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39. Food Frequency Questionnaire
• In this method the subject is given a list of around
100 food items to indicate his or her intake
(frequency & quantity) per day, per week & per
month.
• inexpensive, more representative & easy to use.
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40. DIETARY HISTORY
• This method is used to assess the nutrient intake of an
individual or a group from food over a longer period
of time, usually to see the association between diet
and disease.
• It is an accurate method for assessing the nutritional
status.
• The information should be collected by a trained
interviewer.
• Details about usual intake, types, amount, frequency
& timing needs to be obtained.
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41. FOOD DAIRY
• Food intake (types & amounts) should be recorded by
the subject at the time of consumption.
• The length of the collection period range between 1-7
days.
• Reliable but difficult to maintain.
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42. Observed Food Consumption
• The most unused method in clinical practice, but it is
recommended for research purposes.
• The meal eaten by the individual is weighed and
contents are exactly calculated.
• The method is characterized by having a high degree
of accuracy but expensive & needs time & efforts.
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43. Cont…
Procedure for measuring energy and nutrient intake
involves:
• A report of all food consumed by an individual
• Quantification of the portion size of each food item
• Determination of the frequency with which each food
is eaten
• Calculation of the nutrient intake (portion size (g) x
frequency x the nutrient content per g)a 43

44. SUMMARY
• Nutritional assessment is an ongoing component for
daily assessment especial for patients with nutritional
concerns and patients who are at risk for nutritional
deficits and hospitalized patients.
• Through the assessment findings, if the patient is
suspected to have nutritional concerns such as
inadequate oral intake or poor wound healing, further
diagnostic and laboratory tests may be proceeded to
uncover the underlining causes and provide
nutritional support
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45. References:
• Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., &
Soriano, R. P. (2021). Bate’s Guide to Physical
Examination and History Taking (13th ed.). Wolters
Kluwer Health: Philadelphia.
• Chu, A.S. & Delmore, B. (2020). Parameters for
Nutrition Assessment. Advances in Skin & Wound
Care: The
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46. Thank you !
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