ALMOST 100% OF THE PATIENTS SEEKING FOR TREATMENT IN ALL HEALTH FACILITIES HAVE NUTRITION PROBLEM. IT CAN BE EXCESS OR INADEQUATE NUTRITIENTS. IF ALL NUTRITIONIST DO MORE ON EARLY ASSESSMENTOF INDIVIDUALS THE WORST CAN BE PREVENTED. KINDLY VISIT A CLINICAL NUTRITIONIST FOR MORE INFORMATION

1. NUTRITION ASSESSMENT IN KAPKATET COUNTY
HOSPITAL , KERICHO COUNTY
SPECIAL NUTRITION ASSESSMENT DONE
BY
CHERUIYOT SAMBU
CLINICAL NUTRITIONIST
MSCN/BSCN/DCM

2. DEFINITION: NUTRITION ASSESSMENT:
Is
A comprehensive analysis of a
person’s nutrition status that
uses health, socioeconomic,
drug, and diet histories;
anthropometric measurements;
physical examinations; and
laboratory tests.

3. Type of History What It Identifies
Health history Current and previous health problems and
family health history that affect nutrient needs,
nutrition status, or the need for intervention to
prevent or alleviate health problems
Socioeconomic history Personal, cultural, financial, and environmental
influences on food intake, nutrient needs, and
diet therapy options
Drug history Medications (prescription and over-the-
counter), illegal drugs, dietary supplements, and
alternative therapies that affect nutrition status
Diet history Nutrient intake excesses or deficiencies and
reasons for imbalances
Historical Data Used in
Nutrition Assessments

4. 1. WAIST
CIRCUMFRENCE
2. TRICEPS SKIN
FOLD (TSF)
3. WAIST/HIB
4. PHYSICAL
EXAMINATION
5. CLINICAL
ASSESSMENT
6. HEAD
CIRCUMFRENCE

5. Anthropometric Measurements
Used in Nutrition Assessments
Type of Measurement What It Reflects
Abdominal girth
measurement
Abdominal fluid
retention and
abdominal organ size
Height-weight Over-nutrition and
under-nutrition;
growth in children
Head circumference Brain growth and
development in
infants and children
under age 2
Skin-fold Subcutaneous and
total body fat
Waist circumference Body fat distribution

6. The purpose of determining waist girth is to
gain a measure of the amount of abdominal
fat (visceral fat), which has been linked to
increased risk of coronary heart disease and
diabetes.
The waist measurement is taken by a tape
at the narrowest waist level, or if this is not
apparent, at the mid point between the
lowest rib and the top of the hip bone (illiac
crest).
Waist or Abdominal Girth
(circumference)
≥102cm (adult male) & ≥88 cm (adult female)
considered having abdominal obesity

7. A measure of subcutaneous fat stores
taken at the midpoint of the posterior
aspect of the humerus.
Correlates closely with percentage of
body fat and with total body fat.
Triceps skin-fold thickness varies
between
6 -12mm in lean individuals and
between
40 - 50mm in obese individuals.
Triceps skin-fold (TSF)

8. Men Women
Risk cm inches cm inches
Very High > 120 > 47 > 110 43.5
High 100 - 120 39.5 - 47 90 - 109 35.5 – 43
Low 80 - 99 31.5 - 39 70 - 89 28.5 – 35
Very Low < 80 < 31.5 < 70 < 28.5
Adapted from Ellie Whitney and Sharon
Rady Rolfes; Under standing Nutrition,
Twelfth Edition. 2011

9. Waist–hip ratio or waist-to-
hip ratio (WHR) is the ratio
of the circumference of the
waist to that of the hips.
Waist/hips
WHR is used as a
measurement of obesity,
Waist–hip ratio

10. Male Female
Health Risk Based
Solely on WHR
0.95 or below 0.80 or below Low Risk
0.96 to 1.0 0.81 to 0.85 Moderate Risk
1.0+ 0.85+ High Risk
The Waist to Hip Ratio Calculator indicates your
probable health risks. People with more weight around
the waist, face more health risks than people who carry
more weight around their hips

11. OBESITY
Waist/hip ratio - divide the waist circumference
by the hip circumference. Above 0.95 for men
(or 0.8 in women) indicative of a health risk
WHO states that abdominal obesity is defined
as a waist–hip ratio above 0.90 for males and
above 0.85 for females, or a body mass index
(BMI) above 30.0

12. Physical examinations
Body System Healthy Findings Malnutrition Findings What the
Findings Refl
ect
Hair Shiny, firm in the scalp Dull, brittle, dry, loose;
falls out
PEM
Eyes Bright, clear pink membranes
adjust easily to light
Pale membranes; spots;
redness adjust slowly to
darkness
Vitamin A, B
vitamin, zinc,
and iron
Teeth and
gums
No pain or caries, gums firm
teeth bright
Missing, discolored,
decayed teeth; gums
bleed easily and are
swollen and spongy
Mineral and
vitamin C
status
Glands No lumps Swollen at front of neck PEM and
iodine status
Tongue Red, bumpy, rough Sore, smooth, purplish,
swollen
B vitamin
status

13. Physical examinations
ADVANTAGES
Fast & Easy to perform
Inexpensive
Non-invasive
LIMITATIONS
Did not detect early cases
Trained staff needed

14. Skin Smooth, firm,
good color
Off-color, scaly, fl aky,
cracked, dry rough,
spotty; “sandpaper” feel
orsores; lack of fat under
skin
PEM,
essential
fatty acid,
vitamin A,
B vitamin,
and
vitamin C
status
Nails Firm, pink Spoon-shaped, brittle, ridged, pale Iron status
Internal
systems
Regular heart rhythm,
heart rate, and blood
pressure; no
impairment of digestive
function, reflexes, or
mental status
Abnormal heart rate, heart
rhythm, o rblood pressure;
enlarged liver, splee nabnormal
digestion; burning, tingling of
hands, feet; loss of balance,
coordination, mental confusion,
irritability, fatigue
PEM and
mineral status
Muscles
and bones
Muscle tone; posture,
long bone development
appropriate for age
“Wasted” appearance of muscles
swollen bumps on skull or ends of
bones; small bumps on ribs;
bowed legs or knock-knees
PEM, mineral,
and vitamin D
status
Physical examinations CONT…

15. Vitamin B complex deficiency
• Glossitis
• Cheilosis
• Stomatitis
• Neurological problems
• Anaemia
• Ariboflavinosis (Riboflavin)
• Beri beri (Thiamine)
• Pellagra (Niacin)
• Birth defects (Folate)
• Infertility (Folate + B12)

16. Clinical assessment …
Iodine deficiency disorder
• Deficiency of micronutrient iodine
• Thyroid hormone deficiency
• Features:
• Goitre
• Swelling over legs (myxoedema)
• Voice change
• Skin changes
• Abortions

17. Clinical assessment …
• Lesions on the back
of the hands and
‘Casal’s necklace’
Pellagra

18. Clinical assessment …
ANGULAR
CHEILITIS
Ariboflavinosis

19. Clinical assessment …
Vitamin D (Rickets)
• bony deformities
• rickety rosary
• tetany
• osteomalacia

20. HEAD
CIRCUMFERENC
E• Brain growth takes place 70% during fetal
life, 15% during infancy and remaining 10%
during pre-school years.
• Head circumference are routinely recorded until 5 years of age.
• If scalp edema or cranial moulding is present , measurement of
scalp edema may be inaccurate until fourth or fifth day of life .
•The head circumference is measured by placing the tape over the
occipital protuberance at the back and just over the supraorbital
ridge and the glabella in front.

21. Age Head circumference
(cm)
At birth 34 – 35
2 months 38
3 months 40
4 months 41
6 months 42 - 43
1 year 45 - 46
2 years 47 - 48
5 years 50 - 51
• During first year there is 12
cm increase in head
circumference , while 1 – 5
year age , only 5 cm gain
occur in head size.
• Adult head size is achieved
between 5 to 6 years .
Expected head
circumference in children