Nutritional assessment

Assessment of Nutritional Status
Presented by: Abdurehman A.
December,2020
Dessie , Ethiopia
27 February 2021
Assessment of Nutrition
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Presentation Outline
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Nutritional Assessment
Introduction
Purpose
Methods of Nutritional Assessment

Objectives
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At the end of this session you will be able to :
 Assess nutritional status of patients/clients
 Evaluate the different methods for assessing the
nutritional status
 Recognize the basic anthropometric techniques,
applications, & reference standards

Introduction
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Brain storming
What is the clinical importance of nutritional
assessment?

Introduction
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Nutrition plays a great role in maintaining health and
preventing disease
 Under feeding, over feeding or feeding the wrong
food are all harmful nutritional habits
The nutritional status of individual is often the result
of many inter-related factors.

Introduction…
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It is influenced by food intake, quantity and quality &
physical health
Certain signs and symptoms that suggest possible
nutritional deficiency are easy to note because they are
specific.
The spectrum of nutritional status spreads from obesity
to sever malnutrition.

Malnutrition in Hospitalized
Patients
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Consequences:
Poor wound healing
Higher rate of infections
Greater length of stay (readmission)
Increased costs
Increased morbidity and mortality
Suboptimal surgical outcome

Purpose of nutritional assessment
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Identify individuals or population groups at risk of
becoming malnourished
Identify individuals or population groups who are
malnourished
To develop health care programs that meet the
community needs which are defined by the
assessment
To measure the effectiveness of the nutritional
programs & intervention once initiated

Methods of Nutritional Assessment
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Nutrition is assessed by two types of methods;
direct and indirect.
The direct methods deal with the individual and
measure objective criteria
 indirect methods use community health indices
that reflects nutritional influences.

Direct Methods of Nutritional
Assessment
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 A= Anthropometrical measurement
 B = Biochemical, laboratory methods
 C = Clinical examination of findings
 D = Dietary evaluation

Indirect Methods of Nutritional
Assessment
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These include three categories:
 Ecological variables including crop production
 Economic factors e.g. per capita income,
population density & social habits
 Vital health statistics particularly infant & under 5
mortality & fertility index

I. Anthropometric method
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Anthropometry is the measurement of body height,
weight & proportions.
It is an essential component of clinical examination
of infants, children and pregnant women.
 Used to evaluate both over and under nutrition
The measured value reflects the current nutritional
status and doesn’t differentiate between acute and
chronic changes

Con’t…
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Mid-arm circumference
Skin fold thickness
Head circumference
Head/chest ratio
Hip/waist ratio

Height
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The subject stands erect & bare footed on a
stadiometer with a movable head piece.
The head piece is leveled with skull vault &
height is recorded to the nearest 0.5 cm.
Decrease Ht may be considered as an Indication of
osteoporosis, an important problem related to
nutrition, especially in old women.
Loss of 5-7.5 cm of height indicates an
osteoporosis

Height Measurements
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Weight
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Use a regularly calibrated electronic or balanced-beam
scale. Spring scales are less reliable. Weigh in light
clothes, no shoes Read to the nearest 100 gm (0.1kg)
weight loss is an extremely important measurement
because it reflects inadequate caloric intake.
Weight loss indicates an increased loss of protein from
the body cell mass
Weight should be interpreted in relation to age, sex, and
body frame.

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Ideal Body Weight (IBW)
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To calculate the ideal body weight for females
Allow 100 lbs for 5 ft of height
Add 5 lbs for each additional inch over 5 ft
Subtract 10% for small frame
Add 10% for large frame

Con’t…
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To calculate the ideal body weight for males
Allow 106 lbs for each 5 ft of height
Add 6 lbs for each additional inch over 5 ft
Subtract 10% for small frame
Add 10% for large frame

Guideline to estimate frame size
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Measure height in cm
Measure wrist circumference in cm
Calculate the ratio of height to wrist circumference to
estimate frame size (170/17=10)
1 pound (lb) = 0.453 kg. (1kg=2.2 pounds (lb)
1 feet (ft) = 12 inches = 30.48 Cm (1 inch = 2.54cm)
80Kg=176lbs 1ft=12inch=30.48cm
170cm=5ft +7 inch = ? =170cm
1ft=30.48cm
5ft=152.4cm
170-152.4= 17.6 cm( 7inch)

Standard Range
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Frame Female Male
Small >11 >10.4
Medium 10.1-11 9.6-10.4
Large <10.1 <9.6

Interpretation
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Body wt 10% above to 10% below the ideal
weight for the individual is normal
Body weight less than 10-20% of the ideal
weight is under nutrition
Body weight greater than 10% of the ideal
weight is overweight.
Body weight greater than 20% of the ideal
body weight is obesity.

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Body mass index /BMI/
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The international standard for assessing body size in
adults is the body mass index (BMI).
BMI=
𝑊𝑒𝑖𝑔ℎ𝑡 𝑖𝑛 𝐾𝐺
𝐻𝑒𝑖𝑔ℎ𝑡 𝑖𝑛 𝑚𝑒𝑡𝑒𝑟 2
The obtained value is then compared with established
standards
The BMI is highly correlated with body fat
Evidence shows that high BMI (obesity level) is
associated with type 2 diabetes & high risk of
cardiovascular morbidity & mortality

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Waist/Hip Ratio
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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.
Waist circumference predicts mortality better than any
other anthropometric measurement.
It has been proposed that waist measurement alone can be
used to assess obesity.

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Hip Circumference
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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.
High risk WHR= >0.80 for females & >0.95 for
males (indicates central (upper body) obesity and is
considered high risk for diabetes & CVS disorders).

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Mid upper arm circumferences
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MUAC = mid upper arm circumferences
This helps to determine skeletal muscle mass.
 Used for those whose weight does not necessarily
indicate their nutritional status.
Used for pregnant women or
PLHIV with edema
 Used for patients who cannot stand to have their
weight and height measured

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Measurement of skinfold thickness
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A skinfold caliper is used to assess the skinfold thickness,
so that a prediction of the total amount of body fat can be
made.
This method is based on the hypothesis that the body fat
is equally distributed over the body and that the thickness
of the skinfold is a measure for subcutaneous fat.

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Skinfold thickness
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To estimate the total amount of body fat, four skinfolds
are measured:
 Biceps skinfold (front side middle upper arm)
 Triceps skinfold (back side middle upper arm)
 Subscapular skinfold (under the lowest point of the
shoulder blade)
 Suprailiac skinfold (above the upper bone of the hip)

Triceps skinfold
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The triceps skinfold is necessary for calculating the upper
arm muscle circumference.
 Its thickness gives information about the fat reserves of
the body, whereas the calculated muscle mass gives
information about the protein reserves.
Frisancho (1981) published tables showing percentiles for
the thickness of the triceps skinfold. Below P15, the
patient is malnourished.
It's better to repeat the measurements for a good
indication of changes in nutritional status and body fat
mass.

Triceps skinfold thickness…
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Biceps skinfold thickness measurement
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Subcapular skinfold thickness…
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Suprailiac skinfold thickness ….
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Advantage of anthropometric
measurements
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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 resources

Disadvantage
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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 considered as
abnormal values.

Biochemical Assessment
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Biochemical assessment reflects the tissue level of a given
nutrient
Any abnormality of metabolism in the utilization of
nutrient
These determinations are made from serum
 ( protein, albumin, globulin, hemoglobin, vitamin A, C
and iodine)
 urine (creatinine, thiamine, riboflavin, niacin, and iodine)
studies
This test is important when there are no clinical
symptoms of deficiency.

Biochemical Assessment
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Provides information about
Protein-energy nutrition
Vitamin & mineral status
Fluid & electrolyte balance
Organ functioning
Analysis of serum/blood & urine samples
Measurement of individual nutrient in body fluids (e.g.
serum retinol, serum iron, urinary iodine, vitamin D)

Advantages of Biochemical
Method
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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

Disadvantage of Biochemical Method
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Time consuming
Expensive
They cannot be applied on large scale
Needs trained personnel & facilities

Clinical assessment
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It is the simplest & most practical method
It utilizes a number of physical signs, (specific & non
specific), that are known to be associated with
malnutrition and deficiency of vitamins & micronutrients.
The state of nutrition is often reflected in the person’s
appearance.
Although the most obvious clinical physical sign of good
nutrition is a normal body weight with respect to age, sex
and height
 Other tissues can serve as indicators of general nutritional
status and adequate intake of specific nutrients.

Clinical assessment
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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
Disadvantage
Did not detect early cases

Clinical signs of nutritional deficiency
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Clinical signs of nutritional
deficiency
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Dietary assessment
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Nutritional intake of humans is assessed by five
different methods.
24 hours dietary recall
Food frequency questionnaire
Dietary history since early life
Food dairy technique
Observed food consumption
Estimation of typical calorie and nutrient intake:
Recommended Daily Allowances(RDAs)
Evaluate what and how much person is eating, as well
as habits, beliefs and social conditions that may put
person at risk

Con’t…
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24 hours dietary recall
A trained interviewer asks the subject to recall all food &
drink taken in the previous 24 hours.
Not be truly representative of the person’s usual intake.
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.
More representative & easy to use.

Con’t…
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Dietary history
 It is an accurate method for assessing the nutritional status.
 Details about usual intake, types, amount, frequency & timing
needs to be obtained.
Food dairy
 Food intake (types & amounts) should be recorded by the
subject at the time of consumption(between 1-7 days).
 Reliable but difficult to maintain.

Con’t…
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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
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1.Qualitative Method
 Using the food pyramid & the basic food groups method.
 Determine the number of serving from each group & compare
it with minimum requirement.
2. 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.

Food Frequency Questionnaire
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Hydration assessment
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Hydration is another important indicator of the client’s
general health status but may be overlooked or confused
with the signs and symptoms of nutritional changes.
The signs of hydration changes may also be confused with
certain disease states if only one or two indicators are
evaluated.
For this reason, the nurse needs to look for clusters of
signs &symptoms that may indicate changes in hydration

Con’t…
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Adequate hydration can be affected by various
situations.
Exposure to excessively high environmental temperatures
Inability to access adequate fluids, especially water (e.g.,
clients who are unconscious, confused, or physically or
mentally disabled)
Excessive intake of alcohol or other diuretic fluids (coffee,
sugar-rich and/or caffeine-rich soft drinks)
People with impaired thirst mechanisms
People taking diuretic medications, DM and high fever.

References
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1. Health assessment in nursing 4th edition
2. Jarvis physical examination and health assessment 8th edition
3. Advanced health assessment and diagnostic reasoning 4th
edition
4. https://nutritionalassessment.mumc.nl/en/skinfold-
measurements
5. https://www.sciencedirect.com/topics/nursing-and-health-
professions/skinfold-thickness

THANK YOU !!!
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