This document provides an overview of nutritional assessment methods. It discusses direct methods like anthropometric, biochemical, clinical and dietary assessments. Anthropometric methods measure body height, weight and proportions to evaluate undernutrition and overnutrition. Biochemical tests measure nutrient levels in the body. Clinical assessment examines physical signs associated with malnutrition. Dietary assessment evaluates food intake. Indirect methods include analyzing ecological, economic and vital health statistics that reflect nutritional influences. The document outlines each assessment method in detail and their advantages and limitations. The goal of nutritional assessment is to identify individuals and groups at risk of malnutrition and to evaluate nutritional programs.
Nutritional assessment using anthropometric, biochemical, clinical, and dietary methods with a larger understanding of anthropometric methods used in Ethiopia
Most of the foods we eat, provide several nutrients. So to make a wiser diet plan, it is prudent to select a combination of foods that deliver a full contingent of nutrients for good health. Our major focus should be on selecting foods that will deliver all the essential nutrients without excessive energy intake. Food choices made over years influence the body’s health, and consistently poor choices increase the risks of developing chronic diseases.
Nutritional assessment using anthropometric, biochemical, clinical, and dietary methods with a larger understanding of anthropometric methods used in Ethiopia
Most of the foods we eat, provide several nutrients. So to make a wiser diet plan, it is prudent to select a combination of foods that deliver a full contingent of nutrients for good health. Our major focus should be on selecting foods that will deliver all the essential nutrients without excessive energy intake. Food choices made over years influence the body’s health, and consistently poor choices increase the risks of developing chronic diseases.
Basic concepts of Nutrition: Food, nutrition, and health
What is Food? What is Nutrition? malnutrition, undernutrition, overnutrition, functional food.
if it's useful then please like it...
This was done as a student presentation using photographs & content from various web sites & textbooks on the assumption of fair usage for studying & is for NON-COMMERCIAL purposes.
Assessment Methods For Nutritional StatusDrSindhuAlmas
By the end of this lecture the you should be able:
To know the different methods for assessing the nutritional status To understand the basic anthropometric techniques, applications, & reference standards
Life cannot be sustained without adequate nourishment.
Man needs adequate food for growth and development and to lead an active and healthy life.
Food plays an important role in maintaining a person's nutritional and health status.
PLANTS
Many plant & plant part are eaten as a food.
Seeds are good source of food for animals including humans because they contain nutrients.
All seeds are not healthy. Eg- apple seeds & cherry seeds contains cyanide.
Basic concepts of Nutrition: Food, nutrition, and health
What is Food? What is Nutrition? malnutrition, undernutrition, overnutrition, functional food.
if it's useful then please like it...
This was done as a student presentation using photographs & content from various web sites & textbooks on the assumption of fair usage for studying & is for NON-COMMERCIAL purposes.
Assessment Methods For Nutritional StatusDrSindhuAlmas
By the end of this lecture the you should be able:
To know the different methods for assessing the nutritional status To understand the basic anthropometric techniques, applications, & reference standards
Life cannot be sustained without adequate nourishment.
Man needs adequate food for growth and development and to lead an active and healthy life.
Food plays an important role in maintaining a person's nutritional and health status.
PLANTS
Many plant & plant part are eaten as a food.
Seeds are good source of food for animals including humans because they contain nutrients.
All seeds are not healthy. Eg- apple seeds & cherry seeds contains cyanide.
This ppt was prepared by Mohammed Seid Ali (Researcher, Educator, Clinician; Assistant professor) from Gondar, Ethiopia. The ppt contains 52 slides about nutritional assessment in children. The topic is very important for all readers across the world to identify nutritional problems easily, design appropriate interventions, implement nutritional-related health policies, and for the clinicians as a baseline to treat nutritional abnormalities
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
1. ASSESSMENT OF NUTRITIONAL STATUS
Prepared by : Mrs. Namita Batra Guin
Associate Professor, Community Health Nursing
INTRODUCTION
Nutrition may be defined as the science of food and its relationship to the health. It is
concerned primarily with the part played by the nutrients in the body growth, development
and maintenance. Good nutrition means “maintaining a nutritional status that enables us to
grow well and enjoy good health.
Nutritional status is the balance between the intake of nutrients by an organism and
the expenditure of these in the processes of growth, reproduction, and health maintenance.
Because this process is highly complex and quite individualized, nutritional status assessment
can be directed at a wide variety of aspects of nutriture. These range from nutrient levels in
the body, to the products of their metabolism, and to the functional processes they regulate.
CHANGING TRENDS
History of man to a large extent has been struggle to obtain food. Until the turn of the
century the science of Nutrition had a limited range. Great advancement have been made
during last 50 years in knowledge of nutrient as in the practical application.
Specific nutritional diseases were identified and technologies are developed to control them,
as per example, protein energy malnutrition, endemic goitre, nutritional anaemia, nutritional
blindness and diarrhoeal disease. Studies of the diet and state of nutrition of people in India
showed that poorer section of population continued to suffer from malnutrition despite
increased food production.
The association of nutrition with infection, immunity, fertility, maternal and child health and
family health have engaged scientific attention. Now the nutrition has linked itself to
epidemiology and various newer concept in nutrition has come up:- epidemiological
assessment of nutritional status of communities, nutritional and dietary surveys, nutritional
surveillance, nutritional and growth monitoring, nutritional rehabilitation, nutritional
indicators and nutritional interventions – all are parts of what is broadly known as nutritional
epidemiology.
In global campaign of health for all, promotion of poorer nutrition was one of the 8
elements of primary Health Care – nutritional indicators have been developed to monitor
Health for all.
2. NUTRITIONAL ASSESSMENT
The nutritional status of an individual is often the result of many interrelated factors. It is
influenced by the adequacy of food intake both in terms of quantity and quality and also by
physical health of the individual. The nutritional status of the community is the some of the
nutritional status of the individuals who constitute the community.
Main objective of nutritional surveys is to obtain precise information on the prevalence and
geographic distribution of mal-nutrition problem of a given community and identification of
individuals or population groups ‘at risk’ or in the greatest need of assistance. In the absence
of this information, problem cannot be defined and policies formulated.
In nutritional surveys, it is not necessary to examine all the persons in a given community.
Examination of a random a representative sample of population covering all ages and both
sexes in different socio-economic groups is sufficient to be able to draw valid conclusions.
Purpose of Nutritional Assessment
1. Identify individuals or population groups at risk of becoming malnourished.
2. Identify individuals or population groups who are malnourished.
3. To develop health care programs that meet the community needs which are defined by
the assessment.
4. To measure the effectiveness of the nutritional programs & intervention once
initiated.
NUTRITIONAL ASSESSMENT METHODS
Nutrition is assessed by two types of methods; i.e. direct and indirect.
1. Direct methods:- The direct method deal with the individuals and measure objective
criteria.
2. Indirect methods:- The indirect method use community health indices that reflects
nutritional influences.
3. DIRECT METHOD:-
These are summarized as ABCD:-
Anthropometric methods.
Biochemical, laboratory methods
Clinical methods
Dietary evaluation methods
INDIRECT METHOD:-
These include three categories:-
Ecological variables including crop production
Economic factors e.g. per capital income, population density & social habits
Vital health statistics particularly infant & under 5 mortality & fertility index.
DIRECT METHODS
1. Anthropometric method: Anthropometry is the measurement of body height, weight &
proportions. It is an essential component of clinical examination of infants, children&
pregnant women. It is used to evaluate both under & over nutrition. The measured values
reflects the current nutritional status & don’t differentiate between acute & chronic changes.
Other anthropometric Measurements
Mid-arm circumference
Skin fold thickness
Head circumference
Head/chest ratio
Hip/waist ratio
Anthropometry for children
4. Accurate measurement of height and weight is essential. The results can then be used
to evaluate the physical growth of the child.
For growth monitoring the data are plotted on growth charts over a period of time that
is enough to calculate growth velocity, which can then be compared to international
standards.
Anthropometry for adults
Height: The subject stands erect & bare footed on a stadiometer with a moveable head piece.
The head piece is levelled with skull vault & height is recorded to the nearest 0.5cm.
Weight:- Use a regularly calibrated electronic or balanced-beam scale. Spring scales are less
reliable. Weigh in light clothes, no shoes. Read to the nearest 100gm(0.1kg)
Nutritional indices:-
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(m?)
Evidence shows that high BMI (obesity level) is associated with type 2 diabetes &
high risk of cardiovascular morbidity & mortality
BMI (WHO-classification)
BMI<18.5 = Under Weight
BMI18.5-24.5= 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)
Waist/ Hip Ratio
5. 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.
Waist circumference
Waist circumference predicts mortality better than any other anthropometric
measurement. It has been proposed that waist measurement alone can be used to
assess obesity, and two levels of risk have been identified.
MALES FEMALE
LEVEL 1 >94 cm >84 cm
LEVE 2 >102 cm >88cm
Level 1 is the maximum acceptable waist circumference is the maximum
acceptable waist circumference irrespective of the adult age and there should be
no further weight gain.
Level 2 denotes obesity and requires weight management to reduce the risk of
type 2 diabetes & CVS complications.
Hip Circumference:-
Is measured at the point of greatest circumference around hips & buttocks to
the nearest 0.5 cm.
The subject should be standing and the measurer should squat beside him.
Both measurement should taken with a flexible, non-stretchable tape in close
contact with the skin, but without indenting the soft tissue.
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.
6. A WHR below these cut-off levels is considered low risk.
ADVANTAGES OF ANTHROPOMETERY
Objective with high specificity & sensitivity
Measures many variables of nutritional significance(Ht,Wt, MAC,HC,
skin fold thickness, waist & hip ratio & BMI).
Readings are numerical & gradable on standard growth charts
Readings are reproducible.
Non-expensive & need minimal training
LIMITATIONS OF ANTHROPOMETRY:-
Iner-observers errors in measurement
Limited nutritional diagnosis
Problems with reference standards, i.e. local versus international
standards.
Arbitrary statistical cut-off levels for what considered as abnormal
values.
2. Laboratory assessment & Bio-chemical Method
A. Laboratory Test
Haemoglobin estimation is the most important test, & useful index of the
overall state of nutrition. Beside anemia it also tells about protein & trace
element nutrition.
Stool examination for the presence of ova and/ or intestinal parasites
Urine dipstick & microscopy for albumin, sugar and blood.
B. Bio-chemical Tests
Measurement of individual nutrient in body fluids (e.g. serum, retinol, serum
iron, urinary iodine, vitamin D)
7. Detection of abnormal amount of metabolites in the urine (e.g. urinary
creatinine/hydroxyproline ratio)
Analysis of hair, nails & skin for micro-nutrients.
Some bio-chemical tests used in nutrition surveys:-
Nutrient Method Normal value
Vitamin A Serum retinol 20 mcg/dl
Thiamine Thiamine
pyrophosphate(TPP)
stimulation of RBC
transketolase activity
1.00-1.23(ratio)
Riboflavin RBC glutathione reductase
activity stimulated by flavine
adenine dinucleotide
1.0-1.2 ratio
Niacin Urine N-methyl nicotinamide (not very reliable)
Folate Serum folate
red cell folate
6.0 mcg/ml
160 mcg/ml
Vitamin B 12 Serum vitamin B 12
concentration
160 mg/L
Vitamin C Leucocyte ascorbic acid 15 mcg/108 cells
Vitamin K Prothrombin time 11-16 sec
Protein Serum albumin(g/L)
Transferrin(g/L)
Thyroid-binding pre-
albumin(mg/L)
35
20
250
Advantages of Biochemical Method:-
8. It is useful in detecting early changes in body metabolism & nutrition before
the appearance of overt clinical signs.
It is precise, accurate and reproducible.
Useful to validate data obtained from dietary methods e.g. comparing salt
intake with 24-hour urinary excretion.
Limitation of Biochemical Method
Time consuming
Expensive
They cannot be applied on large scale
Needs trained personnel & facilities
3. Clinical Assessment: It is an essential features of all nutritional surveys. It is the simplest
& most practical method of ascertaining the nutritional status of a group of individuals. It
utilizes a number of physical signs,(specific & non specific), that are known to be associated
with malnutrition and deficiency of vitamins & micronutrients. 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.
ADVANTAGES:-
Fast & easy to perform
Inexpensive
Non-invasive
LIMITATIONS:-
Did not detect early cases
Many deficiencies are unaccompanied by physical signs
Lack of specificity and subjective nature of most of the physical signs
and
Malnutrition cannot be quantified on the basis of clinical signs.
9. CLINICAL SIGNS OF NUTRITIONAL DEFICIENCY:
HAIR
Spare & thin Protein, zinc, biotin deficiency
Easy to pull out Protein deficiency
Corkscrew Coiled hair Vit C & A deficiency
MOUTH
Glossitis Riboflavin, niacin, folic acid, B12,pr.
Bleeding & spongy gums Vit.C, A, K, folic acid & niacin
Angular stomatitis, cheilosis & fissured
tongue
B2, 6,& niacin
Leukoplakia Vit.A, B12, B-complex, folic acid &
niacin
Sore mouth & tongue Vit. B12, 6. C, niacin, folic acid & iron
EYES
Night blindness, exophthalmia Vitamin A deficiency
Photophobia-blurring, conjunctival
inflammation
Vit B2 & vit A deficiencies
NAILS
Spooning Iron deficiency
Transverse lines Protein deficiency
When two or more clinical signs characteristic of a deficiency disease are present
simultaneously, their diagnostics significance is greatly enhanced. A WHO Expert
Committee classified signs used in nutritional surveys into three categories as those:
(a) not related to nutrition, e.g. alopecia, pyorrhoea, pterygium
10. (b) that need further investigation, e.g. malar pigmentation, corneal
vascularisation, geographic tongue.
(c) known to be value, e.g., angular stomatitis, Bitot’s spots, calf tenderness,
absence of knee or ankle jerks (beri-beri), enlargement of thyroid gland
(endemic goitre), etc.
NOTE:- to minimise subjective and objective errors in clinical examination, standard survey
forms or schedules have been devised covering all areas of the body.
4. Dietary Assessment:-
Nutritional intake of humans is assessed by five different methods. These are:
i) 24 hours dietary recall
ii) Food frequency questionnaire
iii) Dietary history since early life
iv) Food dairy technique
v) Observed food consumption.
i) 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.
ii) 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.
Limitations:
Long Questionnaire
11. Errors with estimating serving size.
Needs updating with new commercial food products to keep pace with
changing dietary habits.
iii) Dietary History:-
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.
Cross-checking to verify data is important.
iv) Food Dairy:-
Food intake(types & amount) 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.
v) 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.
Interpretation of Dietary Data:-
I. Qualitative Method
Using the food pyramid & the basic food groups method.
Different nutrients are classified into 5 groups(fat & oils, bread & cereals,
milk products, meat-fish-poultry, vegetables & fruits)
12. Determine the number of serving from each group & compare it with
minimum requirement.
I. Quantitative Method
The amount of energy & specific nutrients in each food consumed can be
calculated using food composition tables & then compare it with the
recommended daily intake.
Evaluation by this method is expensive & time consuming, unless computing
facilities are available.
INDIRECT METHODS
1. ASSESSMENT OF ECOLOGICAL FACTORS & ECONOMIC FACTORS
Malnutrition is the end result of many interacting ecological factors. A study of
ecological factors comprises the following:
Food balance sheet:- This is an indirect method of assessing food
consumption, in which supplies are related to census population to derive level
of food consumption in terms of per capita supply availability.
Socio-economic factors:- Food consumption patterns are likely to vary among
various socioeconomic groups. Family size, occupation, income, education,
custom, cultural patterns in relation to feeding practices of children and
mothers, all influence food consumption patterns.
Health and educational services:- Primary health care services, feeding and
immunization programs should also be taken into consideration.
Conditioning influences:- These include parasitic, bacterial and viral
infections which precipitate malnutrition.
It is necessary to make an “ecological diagnosis” of various factors influencing nutrition in
the community before it is possible to put into effect measures for the prevention and control
of malnutrition.
2. VITAL STATISTICS:-
13. An analysis of vital statistics mortality and morbidity data will identify groups at high
risk and indicate the extent of risk to the community. Mortality in the age group 1-4 yrs is
particularly related to malnutrition. The other rates commonly used for this purpose i.e, IMR,
rate of low birth weight babies and life- expectancy. These rates are influenced by nutritional
status and may thus be indices of nutritional status.
Data of morbidity particularly in relation to PEM, anaemia, xerophthalmia and other
vitamin deficiencies, endemic goitre, diarrhoea, measles and parasitic infestation can be of
value in providing additional information.
Bibliography:-
1. www.pitt.edu
2. www.answers.com
3. K. Park, Textbook of preventive and social medicine, 17th edition, Jabalpur, Banarasidas
Bhanot: 2003, 412, 413,444-446.
4. http://www.fao.org/3/t0807e/t0807e02.htm
5. http://ecoursesonline.iasri.res.in/mod/page/view.php?id=21129
6.https://apps.who.int/iris/bitstream/handle/10665/41780/WHO_MONO_53_%28part3%29.p
df?sequence=3&isAllowed=y