Week 4
WHAT IS NUTRITION ASSESSMENT? The first step before planning and evaluating the  nutritional care of individuals or group...
Individual                              Nutrition Assessment                     Biochemistry                             ...
ASSESSMENT OF INDIVIDUALS
ANTHROPOMETRY Study   of physical dimensions of the body     Standardised equipment & procedures essential Body   size ...
BODY MASS INDEX (BMI)   One of the most commonly used measurements for    assessing nutritional status   Ratio of weight...
CLASSIFICATION OF OBESITY IN CAUCASIAN ADULTSClassification #         BMI (kg/m2)                   IBW % *               ...
OBESITY CLASSIFICATION - OTHER ETHNIC GPSBMI classification in kg/m2Asian             Pacific Is.<18.5             <19.9  ...
ANTHROPOMETRY - CIRCUMFERENCES1.   Waist circumference (AIHW, 2005) > 18 y        >94 cm (M) >80 cm (F) – abdominal      ...
BIOCHEMISTRY   Blood tests       Readily obtained (so often used)       Vary little (homeostatic control)       Should...
BIOCHEMISTRY        Advantages:            Provide the earliest indications             of some nutrient deficiencies & ...
CLINICAL   Information obtained includes:      Socio-demographic details (age, gender, occupation)      Medical history...
WHAT GROUPS MIGHT BE AT RISK OF   NUTRITIONAL DEFICIENCY?
DIETARY INTAKE   Usual intake more informative than one day snapshot   Methods of measuring dietary intake include     ...
ESTIMATING ENERGY - UNITS OF ENERGY   Unit of energy = the Calorie OR the Joule       Calorie is older unit of measureme...
WHERE DOES ENERGY COME FROM?   Macronutrients in food     Carbohydrates (found in      breads, cereals, fruits, vegetabl...
ENERGY FROM MACRONUTRIENTSCarbohydrates       Protein       16 kJ/gram             17 kJ/gramFats                     Alco...
WHAT IS ENERGY DENSITY   To compare products we can calculate energy    density   Energy density = the amount of energy ...
ENERGY DENSITY OF COMMON FOODS         Food       Energy (kJ/g)     Why?pure fat e.g. oil        37          100% fatbutte...
ENERGY EXPENDITURE Basal    Metabolic Rate (BMR)   Min amount of energy required to maintain vital functions   60-70% o...
ESTIMATING ENERGY REQUIREMENTS   Estimating BMR     Prediction equations used     Based on:         age         sex  ...
SCHOFIELD EQUATIONS      Males      10-18        (0.074 x wt) + 2.754                 18-30        (0.063 x wt) + 2.896   ...
ENERGY EXPENDITURE   Calculating total energy expenditure     Need to take into account minimum amount required (BMR) an...
SCHOFIELD ACTIVITY FACTORSActivity Level          Males         FemalesBed rest                        1.2         1.2Very...
ENERGY BALANCE
INTEGRATING INFORMATION ON          NUTRITIONAL STATUS    Nutrition Assessment involves integratinginformation from a numb...
FOOD SUPPLY DATA   Provide information on:       Long-term trends in the availability of the major commodity groups     ...
MORTALITY & MORBIDITY DATA Provide information on:   diseases & conditions that are    reported as causes of    death/ho...
MORTALITY & MORBIDITY DATA Only provide information on:    Indirect measures of the kinds of nutritional     problems mo...
ANTHROPOMETRIC DATA   Weight & height are used in population studies as they:     provide an overall measure of nutritio...
DATA FOR CHILDREN   Infant birth weight       Provides information on:         maternal health & nutritional status    ...
INFANT FEEDING PRACTICES   Inappropriate infant feeding practices influences growth &    development esp. in the 1st 4 to...
MONITORING & SURVEILLANCE SYSTEM   A National Food & Nutrition Monitoring & Surveillance System    needs to collect data ...
MONITORING & SURVEILLANCE SYSTEM DATANEEDS TO    be relevant to the major nutritional problems     encountered    be ava...
XNB151 Week 4 Nutrition Assessment
XNB151 Week 4 Nutrition Assessment
XNB151 Week 4 Nutrition Assessment
XNB151 Week 4 Nutrition Assessment
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XNB151 Week 4 Nutrition Assessment

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  • Because fats are the macronutrient providing the highest amount of energy per gram, foods that are high in fats have higher energy densities. Where as foods that are high in water content, like fruits, vegetables and milks, have low energy densities, because water contains no kilojoules.
  • XNB151 Week 4 Nutrition Assessment

    1. 1. Week 4
    2. 2. WHAT IS NUTRITION ASSESSMENT? The first step before planning and evaluating the nutritional care of individuals or groups Determined on the basis of multiple kinds of information A systematic method for obtaining, verifying & interpreting information
    3. 3. Individual Nutrition Assessment Biochemistry Energy Anthropometry (Laboratory Clinical Dietary Requirements analysis) Population Assessment & Monitoring Birth Monitoring Food Household Mortality & Food Anthropom wt, infant &Supply & Dietary Morbidity Prices etric Data feeding & Surveillanc Data Surveys Data mortality e System
    4. 4. ASSESSMENT OF INDIVIDUALS
    5. 5. ANTHROPOMETRY Study of physical dimensions of the body  Standardised equipment & procedures essential Body size  direct measurements  height, weight, circumferences  derived values Body shape  Waist hip ratio, body weight distribution Body composition  size of lean tissue and fat compartments
    6. 6. BODY MASS INDEX (BMI) One of the most commonly used measurements for assessing nutritional status Ratio of weight to height Caution – BMI not ideal for determining health risk as it does not reflect amount of muscle compared to fat
    7. 7. CLASSIFICATION OF OBESITY IN CAUCASIAN ADULTSClassification # BMI (kg/m2) IBW % * Risk of Chronic DiseaseUnderweight <18.5 >10% below* Low (but other risks)Normal range 18.5-24.9 desirable AverageOverweight >25pre-obese 25.0-29.9 (10-19% above*) Increasedobese class I 30.0-34.9 (>20% above*) Moderateobese class II 35.0-39.9 Severeobese class III >40 Very severe # WHO 2000, AIHW (2004) * Ideal body wt (IBW) or desirable wt for ht (US Metropolitan Life Insurance data) 7
    8. 8. OBESITY CLASSIFICATION - OTHER ETHNIC GPSBMI classification in kg/m2Asian Pacific Is.<18.5 <19.9 Underweight18.5-23.9 20.0 - 26.9 Normal weight24.0-26.0 27.0-32.9 Overweight27.0-39.0 33.0-39.9 Obesity 8
    9. 9. ANTHROPOMETRY - CIRCUMFERENCES1. Waist circumference (AIHW, 2005) > 18 y  >94 cm (M) >80 cm (F) – abdominal overweight  >102 cm (M) >88 cm (F) – abdominal obesity2. Waist: hip ratio  visceral fat around organs vs. subcutaneous fat on hips  optimal WHR is < 1 (M) or < 0.8 (F)  varies with: genes, age, ethnicity, sex  increased by stress, smoking, alcohol  decreased by physical activity 9
    10. 10. BIOCHEMISTRY Blood tests  Readily obtained (so often used)  Vary little (homeostatic control)  Should be used in conjunction with nutrient and supplementation history Tissue testing  May include hair & nails for information about trace elements  Other tissues only acceptable under exceptional circumstances (invasive) Urine testing  Varies between nutrients and influenced by variety of factors (including volume of urine)  Multiple samples required Functional tests  Ability to perform specific functions (e.g. muscle response, immunological response)
    11. 11. BIOCHEMISTRY  Advantages:  Provide the earliest indications of some nutrient deficiencies & excesses  Relatively accurate & unbiased (although not perfect)  Can provide evidence for a nutritional diagnosis made on the basis of signs & symptoms  Can be used to assess the effect of some nutritional therapy
    12. 12. CLINICAL Information obtained includes:  Socio-demographic details (age, gender, occupation)  Medical history (including family history)  Medications  Physical functioning/activity  To help identify patients at risk of nutritional deficiency, excess or requiring specialised nutrition therapy Signs & symptoms important
    13. 13. WHAT GROUPS MIGHT BE AT RISK OF NUTRITIONAL DEFICIENCY?
    14. 14. DIETARY INTAKE Usual intake more informative than one day snapshot Methods of measuring dietary intake include  Diet History  24hr recall  Food frequency questionnaire  Food diaries  Duplicate meals Covered in week 3 lecture (last week) Used to investigate quality of diet (core-foods) and energy intake
    15. 15. ESTIMATING ENERGY - UNITS OF ENERGY Unit of energy = the Calorie OR the Joule  Calorie is older unit of measurement One calorie = the heat energy required to:  the temperature of 1g of H2O by 1 C  in Australia, we use kilojoules (kJ) 1 calorie = 4.18 kilojoules http://www.youtube.com/watch?v=AA1mBek0gsQ
    16. 16. WHERE DOES ENERGY COME FROM? Macronutrients in food  Carbohydrates (found in breads, cereals, fruits, vegetables, dairy and snack foods)  Protein (meat, eggs and dairy)  Fat (meat, full-cream dairy, snack foods)  Alcohol Each macronutrient provides a different amount of energy per gram (the value of energy provided is termed the ‘Atwater factor’)
    17. 17. ENERGY FROM MACRONUTRIENTSCarbohydrates Protein 16 kJ/gram 17 kJ/gramFats Alcohol 37 kJ/gram 29 kJ/gram
    18. 18. WHAT IS ENERGY DENSITY To compare products we can calculate energy density Energy density = the amount of energy per gram of food Foods that have higher fat contents tend to have higher energy density (e.g. take-away/ snack foods, fatty meats, fats & oils) Foods that are low in fat but have a high water content have lower energy densities (there are no kJ in water) (e.g. fruits and vegetables)
    19. 19. ENERGY DENSITY OF COMMON FOODS Food Energy (kJ/g) Why?pure fat e.g. oil 37 100% fatbutter, margarine 30 83% fatchocolate 23cheese 17 50% fatbread 10 50% H2Osteak 9 > 50% H2Osoft drink 2 mainly H2Ocelery 0.2 >90% H2O
    20. 20. ENERGY EXPENDITURE Basal Metabolic Rate (BMR)  Min amount of energy required to maintain vital functions  60-70% of total energy exp.  dependent on  body size  body composition  Gender  Age  other factors  BMR lowest when resting  Increases steeply as energy is used by muscles (i.e. during exercise)
    21. 21. ESTIMATING ENERGY REQUIREMENTS Estimating BMR  Prediction equations used  Based on:  age  sex  height  Weight  Commonly used in Australia are the Schofield equations although there are many others
    22. 22. SCHOFIELD EQUATIONS Males 10-18 (0.074 x wt) + 2.754 18-30 (0.063 x wt) + 2.896 30-60 (0.048 x wt) + 3.653 Over 60 (0.049 x wt) + 2.459 Females 10-18 (0.056 x wt) + 2.898 18-30 (0.062 x wt) + 2.036 30-60 (0.034 x wt) + 3.538 Over 60 (0.038 x wt) + 2.755Important – These are estimations only. There is considerablevariation between individuals & even within individuals over time
    23. 23. ENERGY EXPENDITURE Calculating total energy expenditure  Need to take into account minimum amount required (BMR) and multiply by a factor to take daily activities and exercise into account  BMR estimated  multiply by activity factor  Range of activity factors (resting  very heavy activity) Resting Very heavy Activity factor continuum activity 1.2 6 - 12  TEE = BMR x av. activity factor across the 24-hr day
    24. 24. SCHOFIELD ACTIVITY FACTORSActivity Level Males FemalesBed rest 1.2 1.2Very sedentary 1.3 1.3Sedentary/Maintenance 1.4 1.4Light 1.5 1.5Light/Moderate 1.7 1.6Moderate 1.8 1.7Heavy 2.1 1.8Very heavy 2.3 2.0
    25. 25. ENERGY BALANCE
    26. 26. INTEGRATING INFORMATION ON NUTRITIONAL STATUS Nutrition Assessment involves integratinginformation from a number of different sources todefine the specific problem & also how it might be addressed
    27. 27. FOOD SUPPLY DATA Provide information on:  Long-term trends in the availability of the major commodity groups (grain, dairy, meat, F & V)  The types of nutritional problems that are likely in different countries  e.g. where energy supply available is:  ≥ 12000kJ/person/day  obesity & heart disease are common  < 8000kJ/person/day  under-nutrition is likely  The types of foods that supply energy
    28. 28. MORTALITY & MORBIDITY DATA Provide information on:  diseases & conditions that are reported as causes of death/hospital admissions  possibly on chronic conditions such as cancer & diabetes Reflect:  the major social & health problems of the community And can be used as:  clues to the most likely causes of mortality & morbidity  measures of the prevalence of specific nutrition related conditions
    29. 29. MORTALITY & MORBIDITY DATA Only provide information on:  Indirect measures of the kinds of nutritional problems most likely to be encountered in a population  Multi-factorial aetiology of conditions in developed countries Current burden of disease statistics available from the AIHWDisability adjusted life years (DALYs) are the years of life lostdue to premature mortality & disability & measure the number of healthy years of life lost as a consequence of death or newly diagnosed disease or injury in the population.
    30. 30. ANTHROPOMETRIC DATA Weight & height are used in population studies as they:  provide an overall measure of nutritional status  are non-invasive  are quick to carry out  use minimal (& cheap) equipment Provide information on:  the growth of children  the prevalence of obesity or underweight
    31. 31. DATA FOR CHILDREN Infant birth weight  Provides information on:  maternal health & nutritional status  risk of infant mortality  Is influenced by:  maternal body size, infection, smoking, alcohol consumption, maternal nutrition during pregnancy Also affects Infant mortality data  % related to prevalence of low birth weight (populations with high rates of low birth weight usually have high rates of infant mortality) e.g. Indigenous Australians
    32. 32. INFANT FEEDING PRACTICES Inappropriate infant feeding practices influences growth & development esp. in the 1st 4 to 6 months  Decrease in breastfeeding at 3 months since 1945 (21% 1971, above 50% since 1985) Breastfeeding or correctly prepared infant formula  infant morbidity & mortality
    33. 33. MONITORING & SURVEILLANCE SYSTEM A National Food & Nutrition Monitoring & Surveillance System needs to collect data on:  Food supply & expenditure  Mortality & morbidity  Weight & height Plus extra information on Nutritional issues of particular concern via specific nutrition surveys (see week 3 lecture)
    34. 34. MONITORING & SURVEILLANCE SYSTEM DATANEEDS TO  be relevant to the major nutritional problems encountered  be available to decision-makers within a reasonable timeframe  be available on a regular basis  be collected by standard methods to enable trends over time to be established  be presented appropriately  contain information relevant for changes to be made

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