Various methods of nutritional status assessment

1. ASSESSMENT OF NUTRITIONAL STATUS
Presented by:- Dr. Suchitra Sharma (JR3)
Community Medicine
Grant Government Medical
College Mumbai

2. DEFINITION OF NUTRITIONAL STATUS
• Nutritional status is the current body status of a person or population
group, related to their state of nourishment (the consumption and
utilization of nutrients).
• Influenced by the adequacy of food intake both in terms of quantity
and quality and also by the physical health of the individual.

3. People can have an optimal nutritional status or they can be
under-, over-, and /or malnourished.
Severe underweight
(Under-nourished)
Healthy baby
(optimal nutritional
status)
Morbid obesity
(Over-nourished)

4. Consequences of the nutritional status of an
individual:
• An optimal nutritional status is a powerful factor for health and well-being. It is a
major, modifiable, and powerful element in promoting health, preventing and treating
diseases, and improving the quality of life.
• Malnutrition may increase the risk of (susceptibility to) infection and chronic
diseases:
Undernutrition may lead to increased infections and decreases in physical and mental
development,
overnutrition may lead to obesity as well as to metabolic syndrome or type 2 diabetes.

5. PORPOSE OF NUTRIONALASSESMENT
• Identify individual or population groups at risk of becoming
malnourished.
• Identify individuals and populations who are malnourished.
• To develop a health care program that meets the needs defined by the
assessment.
• To measure the effectiveness of the nutritional programs and
interventions once initiated.

6. Methods of Nutritional Assessment
1. Clinical examination
2. Anthropometry
3. Laboratory and biochemical evaluation
4. Functional assessment
5. Assessment of dietary intake
6. Vital and health statics
7. Ecological studies
Direct method
Indirect Method

7. 1. Anthropometric Methods
• Anthropometric measurements such as height, weight, skin fold
thickness, arm circumference, and proportions, are valuable indicators
of nutritional status.
• These measurements are compared to reference data (standards) of the
same age and sex group, in order to evaluate the nutritional status.

8. Measurement for adults
Height measurement
• The subject stands erect and
barefooted on a stadiometer with
a movable headpiece.
• The head piece is levelled with a
skull vault and the height is
recorded.

9. Measuring length in infants and standing
height in children

10. Weight measurement
• Use a regularly calibrated electronic or balanced-beam scale. Spring
scales are less reliable. Weight in light clothes, no shoes.

11. Nutritional Indices In Adults
• The international standard for assessing body size in adults is the body
maas 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 and high risk of cardiovascular morbidity and morbidity.

12. Example:
• Weight = 68 Kg, Height = 165 cm (1.65m)
BMI = 68 ÷ (1.65)2 = 24.98 Kg/ m2

13. WHO Classification of adults according to
BMI
Classification BMI Risk of Comorbidities
Underweight < 18.50 Low (but risk of other clinical
problems increased)
Normal range 18.50 to 24.99 Average
Over weight: ≥ 25.00
Pre-obese 25.00-29.99 Increased
Obese class I 30.00-34.99 Moderate
Obese class II 35.00-39.99 Severe
Obese class III ≥ 40.00 Very severe

14. Waist circumference
• Waist circumference is measured at midpoint
between the lower border of the rib cage and
the iliac crest.
• The subject stand erect with relaxed
abdominal muscles, arm at the side, and feet
together.
• The measurement should be taken at the end
of a normal expiration

15. • Waist circumference ≥ 102 cm in men
• Waist circumference ≥ 88 cm in Women
Reflect change in risk
factor for cardiovascular
diseases and another form
of chronic diseases.

16. Hip Circumference
• It is measured at the point of greatest
circumference around hips and buttocks to the
nearest 0.5 cm.
• The subject should be standing.
• Both measurements (waist and hip) should be
taken with a flexible, non-stretchable tape in a
close contact with the skin, but without
indenting the soft tissue.

17. Interpretation of Waist / Hip Ratio (WHR)
• A high WHR > 1.0 in men and > 0.85 in women indicates abdominal
fat accumulation

18. Body mass index for children and teens
• The criteria used to interpret the meaning of the BMI number for
children and teens are different from those used for adults. For
children and teens, BMI age and sex-specific percentiles are used for
two reasons:
1. The amount of body fat changes with age.
2. The amount of body fat differs between girls and boys.

19. Body mass index for children and teens
BMI for Age Percentile
Less then 5th percentile Underweight
5th percentile to less than the 85th percentile Healthy weight
85th percentile to less that the 95th percentile Overweight
95th percentile Has obesity

21. Other anthropometric Measurements
• Mid-arm
circumference
• Skin fold thickness
• Head circumference
• Head/chest ratio
• Hip/waist ratio

22. Advantages of Anthropometry
• Objective with high specificity and
sensitivity.
• Measures many variables of nutritional
significance (Ht., Wt., MAC, HC, skin flod
thickness, waist & hip ratio BMI).
• Reading are numerical and gradable on
standard growth chart.
• Readings are reproducible.
• Non-expensive & need minimal training.
Limitation of Anthropometry
• Inter observers errors in
measurement.
• Limited nutritional diagnosis
problems with reference
standards, i.e. local versus
international standards.
• Arbitrary statistical cut-off
levels for what is considered
abnormal values.

23. 2. Clinical Examination
• 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, bone,
and thyroid gland.
• Detection of relevant signs helps in establishing the nutritional
diagnosis.

24. Examples of illnesses caused by improper nutrient consumption

25. Vitamin A deficiency
•Xeropthalmia
Bitot’s spot

26. Vitamin A Deficiency

27. Vitamin B1 (Thiamine) Deficiency- Beri Beri

28. Vitamin B2 deficiency (Ariflavinosis)

29. Pellagra
Vitamin B3 (Niacin) Deficiency
Clinical- 4D’s: Dermatitis, Diarrhoea, Dementia, Death

30. Scurvy: Vitamin C deficiency

31. Vitamin D deficiency: Rickets

32. Goitre ( Iodine deficiency disorder)

33. Protein Energy malnutrition
Marasmus Kwashiorkor

34. Protein Energy Malnutrition (PEM)

35. Clinical Assessment
Advantages
• Fast & Easy to perform
• Inexpensive
• Non- invasion
Limitation:
• Did not detect early cases

36. 3. Laboratory and biochemical assessment
a) Laboratory tests:-
 Haemoglobin level
 Stool and urine
b) Biochemical test:-
• Vitamin and Minerals level in blood and urine.
• Detection of abnormal amount of metabolites in the urine (urinary
creatinine/ Hydroxyproline ratio)
• Analysis of hair, nails, and skin for micronutrient and diseases.

37. Biochemical Methods
Advantages of Biochemical Methods
• Useful in detecting early changes in body metabolism and 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 hrs urinary excretion.

38. Biochemical Methods
Limitations of Biochemical Methods
• Time consuming
• Expensive
• Cannot be applied on large community scale
• Need trained personnel and facilities.a

39. 4. Functional Indicator
System Nutrition
1. Structural integrity
Erythrocyte fragility Vit. E, Se
Capillary fragility Vit. C
2. Host defence
Leucocyte phagocytic capacity P/E, Fe
Leucocyte bactericidal capacity P/E, Fe, Se
3. Haemostasis
Prothrombin time Vit. K
4. Reproduction
Sperm count Energy, Zn
5. Nerve conduction
Nerve conduction P/E, Vit B1, B12
Dark adaptation Vit A, Zn

40. 5. Assessment of dietary intake
1. Weighment of raw foods
2. Weighment of cooked foods
3. Oral questionnaire method (24 hours recall method)
A dietary survey may also include a collection of data relating to dietary
patterns, specific foods consumed, and estimated nutrient intakes.

41. 6. Vital Statistics
• Mortality and Morbidity Data- will identify groups at high risk and indicate the
extent of risk to the community.
• Mortality under 1 to 4 years particularly related to malnutrition.
Other rates:-
1. Infant mortality rate
2. Low birth weight babies
3. Life expectancy
( Influenced by nutritional status)

42. 7. Assessment Of Ecological Factors
1. Food balanced sheet: A comprehensive compilation of a pattern of food
supply, production, and consumption in terms of per capita supply
availability.
2. Socio-Economic factors: Family size, occupation, income, cultural
patterns, education.
3. Health and Educational services: PHC services, feeding, and
immunization program.
4. Conditioning Influences: Parasitic, bacterial, and viral infection.