The document discusses various methods of nutritional assessment including clinical, biochemical, anthropometric, and dietary assessments. It describes nutritional surveys, surveillance, and screening and their purposes. Key factors that influence the choice of assessment method are discussed such as the objectives, population, resources available, and types of information needed. Clinical signs, biochemical tests, and interpretation guidelines for various nutrient deficiencies are provided.

2.  the evaluation of the nutritional status of individuals or
populations through anthropometry, biochemical, clinical
and dietary measurements.
 the measurement of indicators of dietary status and nutrition-
related health status to determine the possible
occurrence, nature and extent of impaired nutritional status
which can range from deficiency to toxicity (US Department
of Health and Human Services).
Types or Forms of Nutritional Assessment Systems
1. Nutritional survey - an epidemiological investigation of the
nutritional status of a population by various methods; may
include an evaluation of factors affecting nutritional status.
 useful in establishing baseline nutritional status and/or
ascertaining the overall nutritional status of the population;
 if cross-sectional, can identify and define those population
sub-groups at risk of chronic malnutrition.

3.  less likely to identify acute malnutrition
 if socio-economic, ecologic and demographic information
are simultaneously collected, possible causes of malnutrition
may be identified through statistical analysis of data.
2. Nutritional surveillance - continuous monitoring of the
nutritional status selected population groups.
 unlike surveys, data are collected, analyzed and utilized for
an extended period of time.
 useful in identifying causes of malnutrition, hence can be
used in formulating and initiating intervention measures.
3. Nutrition screening - involves comparing an individual’s
measurements with predetermined risk levels or “cut-off”
points.
• usually less comprehensive than survey or surveillance;
• useful in identifying individuals in need of immediate
intervention. Operation Timbang collects only age and
weight data, targets only preschoolers, and is used to screen
children for inclusion in food assistance programs.

4. Purposes of Nutritional Assessment
1. Define nutritional problems that need attention; as an integral
part of situational analysis, it is the first step in the nutrition
program planning and management cycle.
2. Provide baseline data for planning and evaluation of programs.
3. Help identify priorities and responsibilities of the public health
system at all administrative levels (i.e. from national to barangay
level).
Methods of Nutritional Assessment
1. Methods that provide direct information on nutritional status
a) clinical examination
b) biochemical examination
c) anthropometry
d) biophysical methods (e.g. measures of body composition, bone
density)
2. Methods that provide indirect information
a) food consumption studies
b) studies on health conditions and vital statistics (special on infant
and child mortality rates)
c) studies on the food supply situation

5. d) studies on socio-economic conditions
e) studies on cultural and anthropological influences
Factors Affecting Choice of Nutritional Assessment System
and Method
1. Objectives of nutritional assessment, e.g.
• to define current overall nutritional status, a nutrition survey
using clinical, biochemical, anthropometric and dietary
(food consumption) methods is essential.
• to evaluate the impact of nutrition intervention, a monitoring
system is used and the choice of method depends on the
objective of the intervention, e.g.,
- anthropometric methods for feeding programs;
- clinical or biochemical methods for nutrient
supplementation programs.
• to identify malnourished or individuals needing immediate
intervention, a screening system using indices of past and
present nutrition must be used.
2. Unit to be assessed, e.g. household, individuals, population
groups
• biochemical methods may not be feasible for household
level assessment.

6. 3. Type of information required for program planning and
evaluation purposes, e.g.
• for nutrition education, food consumption data
4. Degree of reliability and accuracy required – usually requires
a combination of at least two methods
(clinical, biochemical, anthropometric, dietary
methods), preferably all four.
5. Facilities and equipment available. Biochemical and
biophysical methods require facilities and equipment which
may not be readily available.
6. Manpower resources and training required, e.g.
• clinical methods require a medical nutritionist trained in the
detection of deficiency signs and symptoms;
• biochemical methods require a biochemist, chemist or
medical technologist;
• anthropometric methods require trained technicians;
• dietary methods require nutritionist-dietitians trained in food
consumption data collection and analysis methods.

7. 7. Time reference: season of the year, week-end, week
day, numbers of days of data collection.
8. Funding and financial support available.
CLINICAL ASSESSMENT
A. Description : deals with the examination of changes that can
be seen or felt in superficial tissues, such as
skin, eyes, hair, etc.
B. Advantages
 more coverage in a short time
 inexpensive, no need for sophisticated equipment
C. Disadvantages
1. non-specificity of signs (signs may be due to non-nutritional
causes)
2. Overlapping of deficiency states (dietary deficiencies are
not restricted to an isolated nutrient)
3. Bias of the observer (observations of two examiners are most
often not consistent with each other)

8. Clinical Signs of Value in Nutrition Assessment and Their
Interpretation
Tissue/body part Signs Associated Disorder or
Nutrient
1. Hair Lack of lustre Kwashiorkor, less
Thinness and sparseness commonly, marasmus
Straightness
Dyspigmentation
Flag sign
Easy pluckability
naso-labial dyssebaccea
2. Face Moon-face Riboflavin
Kwashiorkor
Pale conjunctiva Anemia (iron etc.)
Bitot’s spots
3. Eyes Conjunctival xeroxis
Corneal xeroxis
Keratomalacia Vitamin A
Angular palpebritis
Angular stomatitis
Angular scars
4. Lips Cheilosis Riboflavin

12. Predominant Clinical Symptoms of Common Nutritional Problems
1. Protein-energy malnutrition
a) Mild to moderate – low weight and/or height for age
b) Severe (marasmus and kwashiorkor)
2. Xerophthalmia – affects the eyes, gradually beginning with
an impairment of night vision. Symptoms include:
a) Night blindness
b) Cornea softening and ulceration
c) Skin changes are usually non-specific
3. Anemia – clinical symptoms are non-specific (may be due to
other conditions) and should be confirmed with biochemical
test, e.g. for blood hemoglobin level. Symptoms include:
a) Paleness under the eyelids
b) Paleness under the nails

13. 4. Beriberi – symptoms include:
a) Muscle weakness, fatigability
b) Heart enlargement, tachycardia, edema (in wet type)
5. Goiter – symptoms include:
a) Swelling of the neck
b) Lassitude and easy fatigability
6. Ariboflavinosis – symptoms are non-specific and may
include:
a) Magenta red tongue
b) Sores at the angles of the mouth and folds of the nose.
Interpretations Guides
1. WHO Criteria for determining whether a significant public
health problem of xerophthalmia and vitamin A deficiency
exists in a population

14.  Night blindness (XN) – greater than 1%
 Bitot’s spots (XIB) – greater than 0.5%
 Corneal xeroxis/corneal ulceration/keratomalacia
(X2/X3A/X3B) – greater than 0.05%
 Plasma vitamin A of less than 10 ug/dl – greater than 5%

16. Biochemical Assessment
Description: estimation of tissue desaturation, enzyme activity or
blood composition.
1. Tests are confined to two fairly easily obtainable fluids; blood
and urine.
2. Results are generally compared to standards, i.e., normal
levels for age and sex.
Advantages
1. objectivity, i.e., independent of the emotional and
subjective factors than usually affect the investigator.
2. can detect early subclinical states of nutritional deficiency
(i.e., before clinical symptoms appear).
Disadvantages
1. costly, usually requiring expensive equipments
2. time consuming
3. difficulty in collecting samples
4. lack of practical standards of sample collection

17. Factors Affecting Accuracy of Results
1. method of sample collection
2. method of transport and storage of samples
3. techniques employed
Biochemical Measurements Which May be Done in Nutritional
Status Surveys
1. Protein status
a. Urea nitrogen/creatine nitrogen ratio – determined from a 3
to 4 hour or 24 hours urine sample
• A ratio of 30 or lower is indicative of malnutrition
b. Amino acid imbalance test – the ratio of four dispensable
amino acids and four indispensable amino acid is
determined by paper chromatography.
• A high ratio of 5-10 is indicative of kwashiorkor.
• The ratio is low (less than 2) in well-fed children.
c. Hydroxyproline excretion in random urine sample.
• Low (0.5 – 1.5) in clinically malnourished
• Normal level: 2.0 – 2.5

18. d. Serum albumin – most common biochemical test for protein nutriture.
• Guide to interpretation (g/100ml):
- High: 4.25
- Acceptable: 3.52 – 4.24
- Low: 2.80 – 3.51
- Deticient: less than 2.80
2. Protein – Energy status:
3. Vitamin A status
a. Serum vitamin A
• Guide to interpretation: a serum level of 10-20 ug/dl is considered low,
while <10 ug/dl is considered deficient.
• A prevalence rate of 10% for “deficient” serum levels and 15% of “low”
serum levels indicate the existence of a public health problem in the
community.
b. Serum carotene
• Guide to interpretation. A serum level of equal or less than 39 ug/dl is
considered low.
• Low serum carotene levels per se are not indicative of vitamin A
deficiency but reflect current intake of carotene which is a precursor of
the vitamin.

19. 4. Thiamine status
a. Urinary thiamine – less preferred test.
b. Erythrocyte transketolase activity (ETKA) with and without
addition of thiamine triphosphate (TPP) in vitro.
c. Blood pyruvate level – increased I thiamine deficiency.
5. Riboflavin status
a. Urinary riboflavin – less preferred test
b. Erythrocyte glutathione reductase activity coefficient (EGR-
AC)
• Guide to interpretation: normal EGR-AC value is 1.0 – 1.3;
higher values indicate riboflavin deficiency.
6. Ascorbic acid status
a. Serum ascorbic acid
• Interpretation guide: a serum ascorbic acid level of 0.8
mg/dl is considered “acceptable” or “ good”. Lower levels
indicate ascorbic acid deficiency.

20. 7. Iron status
a. Hemoglobin
• Values below which anemia is said to exist
- infants and children, 6 mos. To 6 years: 11 grams %
- children and adolescents, 6 years to 14 years: 12 grams %
- adult males: 12 grams %
- adult females, non-pregnant: 12 grams %
- adult females, pregnant: 11 grams %
b. Hematocrit
• Normal values
- females: 37-47%
- males: 45-52%
c. Total iron binding capacity (TIBC)
• Normal value: 250-425 mg/dl
d. Transferrin saturation
• Normal value: 20-50%
e. Ferritin
• Normal level: 30-250 mg/dl

21. Iodine status
a. Urinaru iodine
• Guide to interpretation – epidemiological criteria for
assessing severity of IDD based on median urinary iodine
levels.

22. Median ug/L

23. ANTHROPOMETRY
 The measurement of variations of physical dimensions and
gross composition of the human body at different age levels
and degrees of nutrition.
Common Anthropometric Measurements
1. Weight (for age)
 Uses weighing scales such as beam balance scales or
clinical scales which are ideal, but a bar scale could be used
in their absence.
 Assesses body mass; an indicator of current nutritional status
of preschoolers.
 Advantages: