Nutritional Assessment of the Community

1. NUTRITIONAL ASSESSMENT
OF THE COMMUNITY
Dr. Avinash Kavi MD, DNB,
Asst. Professor,
Department of Community Medicine,
J. N. Medical College, Belagavi
4 August 2022
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2.  Introduction
 Need for the Nutritional Assessment
 Nutrition status Indicators
 Direct Assessment
 Indirect assessment
 Vital statistics, Ecological factors
 Nutritional Surveillance
 Summary
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3. INTRODUCTION
Nutritional status of community is sum
of the Nutritional status of individuals
It is often the result of many inter-
related factors which are predominantly
influenced by food intake, quantity &
quality, & physical health.
The spectrum of nutritional status
spreads from severe malnutrition to
obesity
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4.  42.5 % of children under five years are underweight.
 48 % of children are stunted (chronically malnourished)
 19.8 % of children are wasted (acutely malnourished)
NFHS – 3 (INDIA) data reveals……
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5. Special Vulnerable Population
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6. Malnutrition
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7. Need for Nutritional Assessment
1. Map out distribution and geography.
2. Identify high risk groups w. r. t. nutritional vulnerability.
3. Assess various epidemiological factors
4. Make recommendations to rectify shortcomings.
5. Project for financial allocations and budget for food
materials at a large administrative level.
6. Measure the effectiveness of the nutritional programs &
intervention once initiated.
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8. Types of Nutritional Assessment
Indirect Assessment
Direct Assessment
1. Clinical Assessment
2. Laboratory Tests
3. Functional status
4. Anthropometry
5. Dietary Assessment
1. Vital Statistics
- Age Specific Mortality
- Cause specific Morbidity
2. Ecological factors
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9. ABCDEF..H of Nutritional assessment
 Anthropometry
 Biochemical analysis
 Clinical examination
 Dietary habits
 Ecological Studies
 Functional Assessment
 Health related Vital Statistics
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10. DIRECT ASSESSMENT
OF NUTRITIONAL STATUS
 ‘Direct assessment’ refers to methods in which
individuals or communities are investigated
directly.
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11. Assessment using Clinical Signs
 A widely practiced direct method to assess the nutritional
status – Individuals and Communities.
 Based on the examination for changes believed to be related
to inadequate or excessive nutritional intake.
 Observed in superficial tissues (skin, eyes, hair, mouth) or
Organs close to the surface (thyroid, skull).
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12. Classification of Clinical signs
Potentially Nutritionally Significant
(Signs ‘strongly suggestive’ of dietary deficiency or excess)
Ex:
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13. Clinical signs of Deficiency
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14. Assessment using Biochemical and
Laboratory Methods
 Biochemical changes are expected to take place prior to
clinical manifestations.
 Measurements – Nutrients
Metabolites
Enzymes with Vitamin co-factor.
 Easily accessible body fluids (blood and urine), can help
to detect disease at a sub-clinical level even in a
community setting.
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15. Biochemical and Laboratory Methods
1. HAEMATOLOGICAL TESTS
 Serum Hemoglobin(g/dL) – Anemia
 Serum Ferritin, Transferrin, TIBC, RBC Count
2. PARASITOLOGICAL TESTS
 Stools – for intestinal parasite infestations
 Urine – for albumin (PEM), schistosomiasis.
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16. Biochemical and Laboratory Methods
3. BIOCHEMICAL TESTS:
 Precise and may be applied to measure individual nutrient
concentration in body fluids (Sr. Retinol) or
 Detection of abnormal amounts of metabolites in urine
(Urine iodine N-methionine (Niacin), etc.,
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17. Biochemical tests used in nutritional surveys
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18. Functional Assessment
Indicators of nutritional status
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19. Anthropometric Assessment
 Measurements of the variations of the physical
dimensions and the gross composition of the human
body at different age levels and degree of nutrition.
 Principle: Appropriate measurements should reflect any
morphological variation occurring due to a significant
functional physiological change.
 Added Advantage - It identifies even subclinical changes
resulting from nutritional variations
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20. Body weight
 Reflection of total body mass comprising of all body
constituents
 Commonest and simplest measure - children and
adults.
 Indicator of ‘current’ nutritional status of the individual.
 A sensitive indicator for acute disorders.
 The ideal weighing instrument is the lever actuated
balance or a beam balance.
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21. Total Height
 Indicator of the ‘linear growth’ of the individual.
 Genetically determined
 Environmental factors – Nutrition and Morbidity,
decide the maximum possible height.
 Growth retardation resulting in stunting affected
by long standing nutritional deprivation –
Chronic PEM.
 Measured using Stadiometer
or Infantometer 
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22. Mid-Upper Arm Circumference (MUAC)
 Mid-upper arm circumference indicates the muscle
development, correlating well with clinical signs of
malnutrition
 Age group: 1 – 5 years.
 An efficient technique for ‘screening large population’ of
children for malnutrition. (Shakir’s tape)
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23. Children
Aged 1 to
5 years
>13.5 cm Normal
12.5 to 13.5
cm
At risk / moderate
malnutrition
< 12.5 cm Severe acute malnutrition
 Principle: MUAC remains almost constant between 1 to
5 years of age and thus gives ‘a measure of wasting’
which is almost age-independent.
 MUAC
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24. Head and Chest circumference
 Useful in children.
 At birth Head Circumference : 32 - 34cm
 The chest grows faster than the head in a normally
nourished child in the 2nd and 3rd years of life.
(CC overtakes the HC by about 9 – 12 months of age)
 In PEM, the chest grows at a lower rate and it remains
smaller which indicates a poor state of nutrition.
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25. Head and Chest circumference
 Measured using a fiberglass tape.
 HC – measured at the supra-orbital ridges of the frontal
bone in front and the most protruding point of the occiput
in the back.
 CC – measured at the level of the nipples in mid
inspiration
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26. Weight for Age
Indian Academy of Paediatrics Classification for malnourishment.
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27. Height for age
 Height is a stable measurement of growth which indicates the
past events of chronic protein energy deficiency.
 A given child’s height (for his particular age),
Is compared to the ‘standard’ height of a ‘normal’ child.
(i.e., as per the 50th centile of the Boston standard)
Height for age(%) = Height of child X 100
Height of 'normal child' of same age
Low height-for-age  Stunting
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28. Body Mass Index (Kg/m²)
 Body Mass Index (BMI) is the ratio of weight in Kg to square
of height in meter.
BMI = Mass (Kg)
Height (m)²
 It gives an indication of the nutritional status, esp. obesity.
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29. Advantages of Nutritional Anthropometry
 Procedures use simple, safe and non-invasive
 Relatively unskilled personnel can perform measurement
 Quantify the degree of under-nutrition (or over-nutrition)
 Suitable for large sample sizes such as representative
population samples
 Used to monitor and evaluate changes over time,
seasons, generations, etc.
 Can be adapted to develop high risk screening tests
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30. Limitations of Nutritional Anthropometry
 Relatively insensitive to detect changes in
nutritional status following acute shortage
of food.
 The inability to distinguish the effect of
specific nutrient deficiencies
(e.g. zinc deficiency)
 The inability to prove causality of under-
nutrition, and other factors responsible.
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31. GROWTH MONITORING AND PROMOTION
It can be performed at the individual level, or at a
group level. It can also be:
Growth monitoring is a ‘preventive’ and ‘promotive’ strategy which
involves continuous watch on the growth of the children to detect early
deviation from normal path of growth and ensure prompt action.
1. Clinic-based growth monitoring
(conducted by health professionals at Maternal
and Child Health clinics),
2. Community-based growth monitoring
(conducted by trained members of the
community in villages )
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32. GROWTH MONITORING
 Periodicity: Birth weight (essential component)
1st yr: every month; 2nd yr: every 2 months; 3rd yr onwards:
every 3 months until 5 years.
 Approach: Integrated with primary health care (IMNCI) and
Anganwadi (ICDS).
 Tool: New WHO Child Growth Standards (April, 2006)
Available for both Boys
and girls, below 5 years
weight for age, height
for age, weight for age,
BMI for age and six
motor development
indicators.
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33. Dietary Assessment
 Dietary survey is the scientific assessment of food
consumption, and using this data for various purposes
including assessment of nutritional status.
TYPES:
 1. Qualitative – Type of food, frequency, KAP about food.
 2. Quantitative – Amount of food consumed in terms of
grams or litres and estimation of nutrient content.
a) At Institutional / Community level.
b) At Individual / Household level.
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34. Dietary Assessment
Quantitative Methods of diet surveys :
Institutional /
community
Individual /
Household
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35. 24 hour Recall (or Questionnaire) Method
 Relatively easy and most commonly used method based on
the recall capabilities of the individual over a period of the
past 24 hours.
 The cooked food items are noted in terms of these cups. The
intake of each food item by the specific individual.
 Merits : Fairly Accurate; less time consuming
 Demerits: Likelihood of ‘inaccurate recall’ and error in
derivation of nutrients and a cumbersome process.
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36. INDIRECT ASSESSMENT OF
NUTRITIONAL STATUS
 The term ‘indirect assessment’ refers to methods in
which individuals or communities are investigated
indirectly without any intervention.
 The various methods that are available for the
indirect assessment
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37. Vital Health Statistics
 Analysis of vital statistics - mortality and morbidity
data - will identify groups at high risk and indicate the
extent of risk to the community.
 These rates are influenced by nutritional status and may
thus be indices of nutritional status.
 Source of data:
1. Analysis of birth and death records
2. Calculation from census figures
3. Questionnaire at field level
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38. Age/ Cause specific mortality rates
 2 to 5 months Mortality Rate
- relative high mortality due to Infantile beriberi.
 Infant Mortality Rates (< 1 year)
- LBW combined with RTI, Acute GE  PEM
 1 to 4 Year Mortality Rate (CDR)
- Pre school age: Rapid growth and high nutritional needs
- Nutritional, infective, parasitism and malnutrition.
 Cause specific deaths - PEM (Kwashiorkor, Marasmus),
Diarrheal disease, ARI, Measles, Whooping cough,
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39. Ecological factors
 Socio economic status
- Family : size, stability, interval between children,
- Housing: type floor, ventilation, kitchen, food storage
- Education : Literacy of parents, Accessibility to
knowledge, school attendance.
- Occupation: primary, secondary, income, budgeting
 Cultural factors
- Age group, sex, disease linked, celebration, modern
prestige foods, super food..
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40. Ecological factors
 Health and educational service utilization
- Hospital and Health centres
- Educational facilities (School, clubs, voluntary organization,
mass media)
 Food production
- Land (fertility) Family food supply, farming methods,
livestock availability, finance, distribution
 Nutrition related infections
- Intestinal helminthes, Malaria, Tuberculosis, Measles, etc.,
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41. Nutritional surveillance
 This on-going process of constant scrutiny of the
nutritional situation and factors influencing them and its
application in the public health.
 Vital to keeping a constant watch over all the factors, to
identify early warning and take appropriate decisions
 Commonly used approaches:
1. Longitudinal incidence studies
2. Cross sectional prevalence studies
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42. Nutritional surveillance
The various steps of nutritional surveillance are :
 a) Identify community/population (biological / physiological)
 b) Data collection (sources)
 c) Data transit
 d) Data processing
 e) Interpretation (causal factors)
 f) Responses and Planning
 g) Improvement (recommendation)
 h) Further implementation and Evaluation
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43. National sources of anthropometric data and
nutrition status information - INDIA
 National Family Health Survey – 3 (2005-06) – Status of
children, pregnant women, feeding practices,
 National sample survey organization (NSSO) –
Expenditure of food at family level
 Periodic surveys from National Nutrition Monitoring Bureau
(NNMB) by NIN-ICMR, Hyderabad – feed back and
recommendation.
 National Food and Nutrition Board – Effective planning
 ICDS – Regular data on under 5 nutrition – take appropriate
action to improve the nutritional status.
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44. Summary
Nutritional status assessments enables to determine whether
a population group is well-nourished or undernourished or
over nourished.
The main data collection methodologies that provide
anthropometric information are: Population-Based Surveys,
growth monitoring (ICDS), and sentinel site and school
census data.
There are Direct as well as Indirect methods of Nutritional
Assessments  ABCDEF…H
Special consideration for the vulnerable groups is essential.
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45. Thank You
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