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Nutritional assessment
This document outlines various methods used for nutritional assessment, including clinical examination, anthropometric measurements, biochemical evaluation, dietary intake assessment, and analysis of vital statistics. Clinical examination involves a head-to-toe physical exam to detect signs of nutritional deficiencies. Anthropometric measurements provide objective data on height, weight, skin folds, and body mass index. Biochemical tests evaluate nutrient levels through blood and urine samples. Dietary intake is assessed through methods like 24-hour recalls, food frequency questionnaires, and food diaries. Vital statistics can identify at-risk groups and nutritional issues in a community.
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Nutritional assessment
- 2. DEFINITION It is definedas a comprehensive analysis of a person’s nutritional status that uses historical information, food intake data , anthropometric measurement, physical examination and biochemical data.
- 3. PURPOSES • Identify individualswho are malnourished or are at risk for developing malnutrition. • Provide data for designing a nutrition plan of care to prevent or minimize development malnutrition. • Establish baseline data for evaluating the efficacy of nutritional care.
- 4. OBJECTIVES OF NUTRITIONALASSESSMENT • To obtain precise information on the Prevalence and Geographical distribution of nutritional problems of a given community. • To identify the population group ‘at risk’ or in greatest need of assistance. • To develop a health care programme that meets the needs defined by the assessment.
- 5. OBJECTIVES OF NUTRITIONALASSESSMENT • To evaluate the failure or success of health Programmes and health services. • To assess the degree of malnutrition (PEM) of pre-school and school going children.
- 6. METHODS OF NUTRITIONALASSSSMENT Clinical Examination Anthropometric measurement Biochemical Evaluation Functional Assessment Assessment of dietary intake Vital and health Statistics Ecological Studies
- 8. Clinical Examination • Itis the simplest and the most practical method for assessment of nutritional status of individuals. • It is used to detect the level of health status of the individual in relation to the food consumption. • Head to toe examination should be performed to detect the signs of nutritional deficiency states such as hair changes, anemia , edema , xerosis , etc…,
- 9. Clinical Examination ADVANTAGES :- Fastand Easy to perform Inexpensive Non-Invasive LIMITATIONS :- Did not detect early cases
- 10. CLINICAL EXAMINATION BODY SYSTEM OR REGION SIGNSOR SYMPTOMS IMPLICATIONS 1. Look : Fatigue / Weekness Anemia or Electrolyte imbalance 2. Body Built : Normal body built / Thin body built Protein nergy malnutrition GENRAL APPEAR ANCE 3.MuscleWasting:Absence / wasted Calorie loss 4.Appetite : Good / Loss of appetite Protein nergy malnutrition 5. Weight loss : Absent / Present Decreased Calorie intake or Increased calorie use or inadequate absorption
- 11. SKIN BODY SYSTEM OR REGION SIGNS ORSYMPTOMS IMPLICATION 1. Psoriassiformrash, Eczematous Scaling : Absent / Present 2. Pallor : Absent / Present 3. Follicular hyperkeratosis : Absent / Present Zinc, Vitamin A, Essential fatty acid deficiency Vitamin B12, Iron, Folate, Copper deficiency Vitamin A & C Deficiency 4. Flaking dermatitis: Absent / Present Protein energy malnutrition, Niacin, Riboflavin, zinc deficiency CLINICAL EXAMINATION
- 12. CLINICAL EXAMINATION SKIN BODY SYSTEM OR REGION SIGNSOR SYMPTOMS IMPLICATION 5. Bruising : Absent / Present 6. Scrotal dermatosis : Absent / Present 7. Pigmentation Changes : Absent / Present Vitamin C & K Deficiency Riboflavin Deficiency Niacin and Protein Deficiency 8. Thickening and dryness of skin : Absent / Present Protein energy malnutrition
- 13. 1. Temporal musclewasting : Absent / Present Protein energy malnutrition BODY SYSTEM OR REGION SIGNS OR SYMPTOMS IMPLICATION 1. Diffuse depigmentation : Absent / Present 2.Naso - labial Dyssebacea : Absent / Present 3. Moon face : Absent / Present Vitamin (Cobalamin) Deficiency Niacin( Vitamin B12 ) deficiency Protein energy malnutrition FACE HEAD CLINICAL EXAMINATION
- 14. CLINICAL EXAMINATION Body systemor Region Signs or Symptoms Implication 1. Conjunctival inflammation : Present or Absent Vitamin A Deficiency 2. Corneal Vascularization : Present or Absent Riboflavin deficiency EYES 3. Xerosis, Bitot’s spot, Keratomalacia : Present or absent Vitamin A Deficiency 4. Night Blindness History : Present or absent Vitamin A and Zinc Deficiency
- 15. CLINICAL EXAMINATION Body system orRegion Signs or symptoms Implication 1, Glossitis : Present or absent Riboflavin, niacin, folic acid, vitamin B12 Pyridoxine deficiency 2. Bleeding Gums : Present or Absent Vitamin C , Riboflavin Deficiency MOUTH 3.Chelilosis : Present or Absent Riboflavin, pyridoxine, niacin deficiency 4.Angular Stomatitis: Present or Absent Riboflavin, pyridoxine, niacin deficiency 5. Tongue fissuring: Present or Absent niacin deficiency 6.Tongue Atrophy: Present or Absent Riboflavin, iron, niacin deficiency
- 16. CLINICAL EXAMINATION Body system orRegion Signs or symptoms Implication 6, Magenta Tongue : Present or absent Riboflavin deficiency MOUTH 7. Beefy Red tongue : Present or Absent vitamin B12 Deficiency 8. Sore mouth and tongue : Present or Absent vitamin B12 , B6 Niacin Folic acid Iron And vitamin – C Deficiency 9. Leukoplakia: Present or Absent vitamin B12 , B complex Niacin, Folic acid And vitamin – A Deficiency
- 17. CLINICAL EXAMINATION Body system orRegion Signs or symptoms Implication MOUTH 10, Naso labial seborrhea : Present or absent Pyridoxine deficiency 11. Hypogeusia: Present or Absent Zinc Deficiency 12 . Poor dentition : Present or Absent Overconsumption of refined sugar or acidic carbonated beverages, illicit drug use NECK 1.Goiter : Present or Absent Iodine deficiency 2. Parotid Enlargement: Present or Absent Protein deficiency
- 18. CLINICAL EXAMINATION Body system orRegion Signs or symptoms Implication 1, Diarrhea : Present or absent Niacin, folate, vitamin B12 deficiency ABDOMEN 2.Distension : Present or Absent Protein Energy Deficiency 3.Hepatomegaly : Present or Absent Protein Energy Deficiency EXREMITIES 1. Edema: Present or Absent Protein , Thiamine deficiency 2. Softening of bones: Present or Absent Vitamin - D , Calcium, Phosphorus deficiency
- 19. CLINICAL EXAMINATION Body system orRegion Signs or symptoms Implication 3, Bone tenderness : Present or absent Vitamin – D deficiency 4.Bone ache , Joint Pain : Present or Absent Vitamin - C Deficiency EXREMITIES 5.Muscle wasting & weakness : Present or Absent Protein , Calorie, Vitamin - D, selenium, Sodium chloride Deficiency 6. Muscle Tenderness and Muscle Pain: Present or Absent Thiamine deficiency
- 20. CLINICAL EXAMINATION Body system orRegion Signs or symptoms Implication NAILS 1, Koilonychia ( Spooning) : Present or absent Iron deficiency 2. Transverse line: Present or Absent Protein Deficiency NEUROLOGIC 1.Tetany: Present or Absent Calcium , magnesium deficiency 2 .Paresthesias : Present or Absent Thiamine , Vitamin - B12 deficiency 3. Loss of reflexes, Wrist drop, Foot drop : Present or Absent Thiamine deficiency
- 21. CLINICAL EXAMINATION Body system orRegion Signs or symptoms Implication 4, Loss of Vibratory and Position sense: Present or absent vitamin B12 deficiency NEUROLOGIC 5. Ataxia : Present or Absent vitamin B12 deficiency 6. Dementia , Disorientation: Present or Absent Niacin deficiency BLOOD 1.Anemia : Present or Absent vitamin B12 ,Folate, pyridoxine, deficiency 2. Hemolysis : Present or Absent Phosphorus , Vitamin - E deficiency
- 23. ANTHROPOMETRIC MEASUREMENT Anthropometry isa very valuable index for evaluation of nutritional status. It include measurement of height, weight, skin fold thickness, arm circumference , head and chest circumference, Body mass index, elbow breadth and waist circumference. It is used to evaluate both under and over nutrition
- 24. ANTHROPOMETRIC MEASUREMENT • WEIGHT:- Use a regularly calibrated electronic or balanced –beam scale . Wear only light clothes, no shoes. • HEIGHT :- The subject stand erect and bare footed on a stadiometer with a movable head piece. The head piece is leveled with skull vault and height is recorded to the nearest 0.5cm
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- 26. • WAIST –HIP RATIO :- Used to assess body fat distribution. WHR = Waist circumference Hip circumference 1.0 or more in men the person is obese 0.8 or more in women is obese ANTHROPOMETRIC MEASUREMENT
- 27. ANTHROPOMETRIC MEASUREMENT • BODYMASS INDEX:- It is a practical marker of optimal weight for height and indicator of obesity or under nutrition. BMI = Weight in (kg) Height in (M2) BMI Weight Status Below 18.5 Underweight 18.5 – 24.9 Normal 25- 29.9 Over weight 30 & above Obese
- 28. ANTHROPOMETRIC MEASUREMENT • SKINFOLD THICKNESS :- Measurement provide an estimate of body fat stores or the extend of obesity or under nutrition. (biceps, subcapsular, suprailiac skin fold).
- 29. ANTHROPOMETRIC MEASUREMENT • MID– UPPER ARM CIRCUMFERENCE (MUAC) :- Estimates skeletal muscle mass and fat storage.
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- 31. ANTHROPOMETRIC MEASUREMENT MID– UPPERARM MUSCLECIRCUMFERENCE (MAMC):-
- 32. ADVANTAGES :- • Objectivewith high specificity and sensitivity. • Measure many variables of nutritional significance ( height, weight, MUAC, skinfold thickness, waist and hip ratio & BMI). • Reading are numerical & Gradable on standard growth chart. • Non – expensive & need minimal energy ANTHROPOMETRIC MEASUREMENT
- 33. LIMITATIONS :- • LimitedNutritional diagnosis. • Inter – observers errors in measurement. • Problems with reference standard i,e. Local versus international standards. ANTHROPOMETRIC MEASUREMENT
- 35. ADVANTAGES :- • Itis important because it can detect preclinical nutritional deficiencies and can be used to confirm subjective findings. DISADVANTAGES :- Time consuming and Expensive It can’t be applied on a large scal BIOCHEMICAL ASSESSMENT
- 36. Some Biochemical testsused in nutritional surveys NUTRIENT METHOD NORMAL VALUE Vitamin A Serum retinol 20mcg/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
- 37. Some Biochemical testsused in nutritional surveys NUTRIENT METHOD NORMAL VALUE Vitamin B12 Serum vitamin B12 Concentration 160mg/L Vitamin C Leucocyte ascorbic acid 15 mcg/108 cells Vitamin K Prothrombin time 11 – 16 seconds Protein Serum albumin serumTransferrin Thyroid – binding pre – albumin 3.5 – 5.5 g/dl 170 – 250 (mg/dl) 15 – 25 mg /dl
- 38. LABORATORY TEST Glucose :Plasma glucose level (60-110mg/dl). Hemoglobin : To detect iron deficiency anemia (M:14-18), (F: 12-16) Cholesterol : To evaluate the fat metabolism and to asses risk for CVD Normal (120-200), Moderate risk (200-239), High risk ( 240 and above). BIOCHEMICAL ASSESSMENT
- 40. • Human dietaryintake is assessed by five different methods they are: ASSESSMENT OF DIATERY INTAKE
- 41. Nutritional intake ofhuman is assessed by five different methods. They are ASSESSMENT OF DIATERY INTAKE 24 hours dietary recall Food frequency questionnaire Dietary history since early life Food dairy technique Observed food consumption
- 42. 24 Hours DietaryRecall • A trained interviewer asks the subject to recall all food & drinks taken in the previous 24 hours. • It is quick, easy and depends on short – term memory , but may not be truly representative of person’s usual intake. ASSESSMENT OF DIATERY INTAKE
- 43. 24 Hours DietaryRecall ADVANTAGES:- Easy to administer Easy for the client to Participate DISADVANTAGES :- Only assess one day intake Doesn’t reflect different season or holidays Relies on Memory ASSESSMENT OF DIATERY INTAKE
- 44. Food Frequency Questionnaire •In this method the subject is given a list of around 100 food items to indicate his or her intake (frequency &Quality) per day , per week or per month. ASSESSMENT OF DIATERY INTAKE
- 45. Food Frequency Questionnaire ADVANTAGES:- Inexpensive Easy to use LIMITATION :- Long Questionnaire Errors with estimating serving size. Needs updating with new commercial food product to keep pace with changing dietary habits. ASSESSMENT OF DIATERY INTAKE
- 46. Dietary History • Itis an interview method composed of two parts • FIRST PART :- It establishes the overall eating pattern and include a 24 hr recall. The subjects are asked to estimate portion size in household measures with the aid of standard spoons and cups, food photographs or food models ASSESSMENT OF DIATERY INTAKE
- 47. SECOND PART :-The second part is Cross – check This is the detailed list of food that are checked with the subject. ADVANTAGES :- Estimates nutrient intake over a long period of time. DISADVANTAGE :- Interviewer must be a nutritionist or dietitian experienced in obtaining diet histories. ASSESSMENT OF DIATERY INTAKE Dietary History
- 48. FOOD DIARY • Foodintake (type & 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 different to ASSESSMENT OF DIATERY INTAKE
- 49. Observed Food Consumption •The most unused method in clinical practice, but it is recommended for research purpose. • The meal eaten by the individual is weighted and contents are exactly calculated. • This method is having a high degree of accuracy but expansive & need time and efforts. ASSESSMENT OF DIATERY INTAKE
- 50. • An analysisof vital statistics mortality and morbidity data will identify groups at high risk and indicate the extend of risk to the community. • Mortality in the age group 1 to 4 yrs is particularly related to malnutrition. VITAL AND HEALTH STATISTICS
- 51. • The commonlyused rates are 1, Infant mortality rate 2, Second year mortality rate 3, Low birth weight babies Data on morbidity (e.g., hospital data or data from community health and morbidity surveys) particularly in relation to PEM, Anaemia, xerophthalmia , other vitamin deficiencies, goitre , diarrhoea etc... VITAL AND HEALTH STATISTICS
- 52. • Malnutrition isthe end result of many interacting ecological factors. A study of the ecological factors comprise the following ECOLOGICAL FACTORS Food Balance Sheet (People Food consumption in terms of per capita supply availability availability) Socio-economic factor Health and Educational services Conditioning Influences ( These include parasitic, bacterial and viral infection which precipitate malnutrition.)
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