This document discusses nutrition assessment and measurement. It describes taking a nutrition history including growth, weight changes, illnesses, medications, and diet. Anthropometric measurements should be taken including height, weight, BMI, waist circumference, and skinfold thickness. Macronutrients (carbohydrates, proteins, fats) and micronutrients roles and recommendations are reviewed. Methods for assessing diet adequacy include 24-hour recalls and food diaries. Laboratory values provide additional information about nutritional status.

1. S
Chapter 7
Nutrition
Sarah Loch RN MSN
Fall 2015

2. Nutrition
S The science of food as it relates to optimal health
and performance

3. Nutrition in the health history
S From the history and physical examination, assess the
patient’s nutritional status, including the following:
S Recent growth, weight loss, or weight gain
S Chronic illnesses affecting nutritional status or intake
S Medication and supplement use
S Nutrition screen
S Assessment of nutrient intake
S Clinical signs or symptoms of nutrient or energy deficiency
S Laboratory values

4. Nutrition assessment
S Obtain the following anthropometric measurements and
compare them to standardized tables:
S Standing height
S Weight
S Calculate body mass index
S Waist circumference
S Calculate waist-hip ratio
S Triceps skinfold (TSF) thickness and mid–upper arm
circumference (MAMC) measurements; calculate midarm
muscle circumference/midarm muscle area (MAMA)

5. Review: macronutrients
S Carbohydrate, protein, and fat are referred to as macronutrients
because they are required in large amounts.
S These three macronutrients provide the calories needed to
produce energy in the human body.
S Carbohydrate, a nutrient found mostly in plants and in milk, is
considered the body’s main source of energy.
S About 365 g is stored as glycogen in the liver and muscle
tissues, which provides energy for only about 13 hours of
moderate activity.

6. Review: CHO
S If more carbohydrates are eaten than are needed for
energy, the excess is stored in fatty tissues throughout
the body.
S It is recommended that carbohydrate content of the diet
be at least 50% of total calories, with no less than 100 g
being consumed per day.

7. Review: CHO
S Carbohydrates also serve major functions in vital organs:
S Liver
S Sparing the use of protein for energy and participating in
specific detoxifying metabolic pathways
S Heart
S As glycogen stored in cardiac muscle
S Central nervous system
S As the only energy source to the brain

8. Review: Proteins
S Protein, present in all animal and plant products, is essential to
life.
S It is a part of more than half the organic matter in the body.
S Twenty different amino acids combine in different ways to form
proteins.
S Nine amino acids are considered essential because they
cannot be manufactured by the body and are essential for
normal growth and development.

9. Review: Proteins
S The major functions of protein include the following:
S Building and maintaining tissues
S Regulating internal water and acid-base balances
S Acting as a precursor for enzymes, antibodies, and several
hormones
S If more protein is eaten than is needed for these major
functions, the surplus either is used to supply energy or is
stored as body fat if total calorie intake is in excess of
needs.

10. Review: Proteins
S It is recommended that protein content of the diet be 14%
to 20% of total calories, or a daily minimum of:
S 13 g in infants
S 25 g in children
S 45 g in adults

11. Fats
S Fat, which is present in fatty fish, animal, and some plant
products (particularly the seeds of plants), is necessary
as the main source of:
S Linolenic acid (omega-7 fatty acid)
S -Linolenic acid (omega-3 fatty acid)
S Fatty acids are essential for normal growth and
development.

12. Fat
S Other major functions of fat include the following:
S Synthesis and regulation of certain hormones
S Maintenance of tissue structure
S Nerve impulse transmission
S Memory storage
S Energy metabolism
S If more fat is eaten than is needed for these functions,
the extra is stored in fatty tissues in the body.

13. Fat
S Some fatty tissues, especially those under the skin and
around the abdominal organs, serve additional purposes:
S As a reserve store of fuel to be used when calorie intake
does not meet needs
S Support and protect organs from injury
S Prevent undue loss of heat from the body surface
S It is recommended that fat content of the diet be 25% to
35% of total calories, or at least 20 to 35 g/day.

14. Micronutrients
S Substances that are required and stored in very small
quantities by the body
S Vitamins
S Minerals (elements)
S Electrolytes
S Not used as a source of energy but are essential for:
S Growth
S Development
S Hundreds of metabolic processes that occur daily

15. Micronutrients
S Vitamins and minerals must be taken in either through
food or by supplement.
S Micronutrients cannot be metabolized by the body,
except:
S Vitamin K and biotin (produced by certain intestinal
microorganisms)
S Vitamin D (synthesized from cholesterol)
S Niacin (synthesized from tryptophan)

16. Water
S Most vital nutrient; adult body is 55% to 65% water.
S An individual can exist without food for several weeks, but
without water, an individual would last only a few days.
S Major functions:
S Provide turgor to body tissues
S Alter configuration of substances for metabolic processes
S Transport body nutrients and wastes
S Maintain stable body temperature

17. Water
S There is a continual loss of water from the body by the:
S Kidneys as urine
S Lungs as water vapor in expired air
S Skin as perspiration
S Approximately 2 to 2½ L of water are lost daily, which are
replaced by:
S Fluids taken in
S Water contained in solid foods eaten
S Water produced in the body as a result of oxidative processes

18. Ways to measure
S Procedures for accurately measuring:
S Height
S Weight
S Triceps skinfold
S Table of norms for relevant age and gender groups
S These measurements are useful in assessing patients’
nutritional status and risk for disease.

19. Ways to measure
S Body mass index (BMI)
S Formula used to assess nutritional status and total body fat
S Waist circumference
S Large waist circumference often associated with increased
risk for type 2 diabetes, dyslipidemia, hypertension, and
cardiovascular disease
S Monitoring over time may aid in predicting disease risk for
cardiovascular and obesity-related diseases

20. Ways to measure
S Waist-to-hip circumference ratio
S Not as helpful as the body mass index in assessing total
body fat
S An excess proportion of trunk and abdominal fat (e.g.,
apple-shaped body) has a higher risk association with
diabetes mellitus, dyslipidemia, metabolic syndrome, stroke,
and ischemic heart disease than does a larger proportion of
gluteal fat (e.g., pear-shaped body).

21. Measurement of waist
circumference (A)
and hip circumference (B)
to calculate the waist-to-hip
circumference ratio: waist
circumference (cm)/hip
circumference (cm) = waist-
to-hip ratio.

22. Assessing diet adequacy
S The history of an individual’s food intake allows
estimation of the adequacy of the diet.
S 24-hour recall diet
S Most simple method for food intake history
S Food diary
S Most accurate and time-consuming method

23. Measures of diet adequacy
S Computerized nutrient analysis programs offer quickest
and most efficient method of analyzing nutrient intake.
S Quickest method of estimating adequacy is simply
comparing individual intake with recommended servings
and portions listed in the MyPyramid food guide.

24. Resource

25. Measures of Nutrient Analysis
S MyPyramid food guide
S Indicates number of servings from each food group
S Food-based guidance to help implement recommendations
for the 2010 Dietary Guidelines for Americans
S Focus on nutrient dense food.
S Balancing calories
S Avoid oversize portions
S Half of the plate fruits and veggies
S Water instead of sugary drinks

26. Measures of Nutrient Analysis
S Vegetarian diets
S Can meet all the recommendations for nutrients
S Key is variety, as well as amounts to meet calorie needs
S Five nutrients may be deficient: protein, calcium, iron,
vitamin B12, and vitamin D
S Ethnic food guide pyramids
S Food guide pyramids for ethnic populations are available
(e.g., Mediterranean, Indian, Mexican, and Asian)

27. Special Procedures
S Triceps skinfold thickness
S Approximately 50% of the body
fat is present in the
subcutaneous tissue layers
S Correlation exists between the
triceps skinfold thickness and the
bodys fat content

28. Other Special procedures
S Mid–upper arm circumference
(MAMC)
S Estimate of muscle mass and
available fat and protein stores
S Midarm muscle
circumference/midarm muscle area
(MAMA)
S Sensitive index of body protein
reserves

29. Labs
S Hemoglobin (g/100 mL)
S Hematocrit (%)
S Serum albumin (g/100 mL)
S Serum cholesterol (CHOL) (mg/100 mL)
S Serum triglycerides (TRI) (mg/100 mL)

30. Labs
S High-density lipoproteins (HDL) (mg/100 mL)
S Low-density lipoproteins (LDL) (mg/100 mL)
S Serum glucose (mg/100 mL)
S Hemoglobin A1c (%)
S Serum folate (ng/mL)