Methods that are being used to assess the nutritional status of patients in hospitals and nursing homes

1. Nutritional
assessment of
patients in
clinical settings

2. “The evaluation of nutrition needs of
individuals based upon appropriate
biochemical, anthropometric, physical,
and dietary data to determine nutrient
needs and recommend appropriate
nutrition intake including enteral and
parenteral nutrition”
American Dietetic Association

4. Health
status
Alters
nutrition
needs
Leads to
malnutrition
Nutrition
status
Influences
the course
of disease
Influences
response to
treatment

5. Reduced food intake
Interference with
digestion & absorption
Alter metabolism &
Excretion

6.  The spectrum of nutritional status spreads
from obesity to severe malnutrition

7.  Identify patients who are malnourished
 Identify patients at risk of becoming
malnourished
 Develop nutrition intervention programs that
meet patients needs
 Reduce complications
 Improve patients health status
 Reduce hospital stay duration & costs
 Reduce mortality

8.  Malnutrition is associated with:
  Length of stay in hospital
  Complications
  Hospital costs
  Mortality rates

11. Fever
infection
Surgery
Trauma
Burns
Benign or malignant tumors

12. The Nutrition Care Process
Assessment Diagnosis Intervention Monitoring
& Evaluation

13. Nutrition Assessment
Direct
Indirect

14. This method deals with the individual and
measure objective criteria

15.  Use community health indices that reflects
nutritional influences.
These include the following categories:
Economic factors e.g. per capita income
Population density
Social habits

16. These are summarized as ABCDE
 Anthropometric measurements
 Biochemical, laboratory data
 Clinical data (symptoms)
 Dietary evaluation data
 Exercise tolerance

17.  Measurement of height, weight &
proportions
 BMI
 Skinfold thickness and fat content
 Head circumference
 Hip/waist ratio

18. © 2007 Thomson - Wadsworth

19.  BMI = Weight (kg)/ Height (m²)
 Evidence shows that high BMI (obesity level)
is associated with type 2 diabetes & high risk
of cardiovascular morbidity & mortality

23. Gender Normal Malnourished
Adults Males ≥ 23 < 23
Females ≥ 22 < 22
Children > 13.5 12.5-13.5 Risk
< 12.5

28.  Provides information about
 Protein-energy nutrition
 Vitamin & mineral status
 Fluid & electrolyte balance
 Organs functions
 Analysis of blood & urine
samples

29.  Ideal indicator or marker is sensitive
and specific to nutritional intake
Commonly Used “Nutritional
Indicators”
 Albumin
 Pre-albumin
 Transferrin
 Retinol-binding protein

30. Increased in:
 Dehydration, blood transfusions,
exogenous albumin
Decreased in:
 Overhydration, hepatic failure,
inflammation, infection, metabolic stress,
post-op, bed rest, pregnancy, nephrotic
syndrome.

31.  Also known as Transthyretin, thyroxine
binding protein.
 Synthesised in the liver
  with inflammatory response

32. Transferrin
 Involved with iron transport, influenced
by iron status
Retinol Binding Protein (RBP)
 Affected by renal function, Vitamin A and
Zn status

33.  Serum iron
 Vitamin D
 Vitamin B12
 Lipid profile
 Kidney function
 HbA1c
 Liver enzymes
 ……….more

34. 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 and
symptoms that are known to be associated
with malnutrition and deficiency of vitamins &
micronutrients.

35. General clinical examination, with special
attention to organs like:
Hair
Angles of the mouth
Gums
Nails, skin, eyes, tongue, muscles, bones,
& thyroid gland.

36. Clinical signs of nutritional
deficiency

37. Protein, zinc, biotin
deficiency

38. Vitamin C and / or A
deficiency

39. B2, B3, B9, B12 , protein

40. Vitamin C, A, K, B3, B9

41. Vitamin B2,B6,B3

42. Vitamin A deficiency

43. Vitamin B2 & A deficiency

44. Protein & Iron deficiency

45. PEM, Vitamin B2, B3 Vitamin A,
Zinc Vitamin C

46.  Goiter is a
reliable sign of
iodine deficiency.

47.  Edema
 Weight gain
 Facial puffiness
 Swelling limbs
 Abdominal distention
 Tight-fitting shoes
 Diseases of heart, kidney, liver,
lungs

48.  Dehydration
 Thirst
 Dry skin or mouth
 Reduced skin tension
 Dark yellow or amber urine with low
volume
 Fever, sweating, vomiting,
diarrhea, burns

49.  Nutritional intake is assessed by
different methods. These are:
 24 hours dietary recall
 Food frequency questionnaire
 Dietary history
 Food diary technique

51.  Nutrition and exercise closely
linked
 Correlation between muscle mass and
physical strength, nutritional status and
physical function

52.  Bed Rest / Inactivity
 Negative effects on muscles, bone and
CV system
 8 g protein loss / day of bed rest
 Exercise – affects on appetite, bowel
function

54.  Registered Dietitians
 Assess, diagnose, develop, implement &
evaluate nutrition care plans
 Provide medical nutrition therapy
 Plan & approve menus
 Provide nutrition education

55.  Physicians
 Diagnose & provide treatment
 Prescribe diet orders
 Nurses
 Assist in treatment
 Participate in nutrition assessments
 Provide direct nutrition care
 Other team member i.e. pharmacist

57. Malnutrition Screening Tool (MST)
Have you lost weight recently without trying?
If NO
If unsure
If YES, how much weight have you lost?
1 – 5 kg (2 – 11 lb)
6 – 10 kg (1 – 1½ st)
11 – 15 kg (1¾ - 2⅓ st)
> 15 kg (> 2⅓ st)
Unsure
0
2
1
2
3
4
2
Have you been eating poorly because of a
decreased appetite?
If NO
If YES
0
1
Total
score is 2 or more please refer to the dietitian.
(Ref: Ferguson M et al, Nutrition 15: 458-464, 1999)

58. Question
Score
Did you lose weight unintentionally?
>6kg in the past 6 month 3
>3kg in the past month 2
Did you experience a decreased appetite
over the past month?
1
Did you use supplemental drinks or tube
feeding over the past month?
1

59. THANKYOU
FOR
LESTENING