UNIT-XI NUTRITION ASSESSMENT-2ND SEM BSc NURSING

UNIT-XI NUTRITION ASSESSMENT-2ND SEM BSc NURSING

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  ASSESSMENT OF NUTRITIONAL STATUS
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  INTRODUCTION The nutritional statusof an individual is often the result of many inter-related factors. It is influenced by food intake, quantity & quality, & physical health. The spectrum of nutritional status spread from obesity to severe malnutrition
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  DEFINITION It is definedas a comprehensive analysis of an person’s nutritional status that uses historical information, food intake data , anthropometric measurement, physical examination and biochemical data.
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  • To assessthe health of the individuals by assessment • To identify possible nutrient deficiencies in an individual • To evaluate the treatment • To monitor progress • To prevent malnutrition • To promote healthy lifestyles
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  Identify individuals orpopulation groups at risk of becoming malnourished Identify individuals or population groups who are malnourished OBJECTIVES OF NUTRITIONAL ASSESSMENT
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  To develop healthcare programs that meet the community needs which are defined by the assessment To measure the effectiveness of the nutritional programs & intervention once initiated
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  Methods of NutritionalAssessment Nutrition is assessed by two types of methods; direct and indirect. The direct methods deal with the individual and measure objective criteria, while indirect methods use community health indices that reflects nutritional influences.
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  Direct Methods ofNutritional Assessment These are summarized as ABCD • Anthropometric methods • Biochemical, laboratory methods • Clinical methods • Dietary evaluation methods
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  METHODS OF NUTRITIONALASSSSMENT
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  Indirect Methods ofNutritional Assessment 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
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  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 , etc…,
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  CLINICAL ASSESSMENT Good nutritionalhistory should be obtained 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
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  Clinical Examination ADVANTAGES :- Fastand Easy to perform Inexpensive Non-Invasive LIMITATIONS :-  Did not detect early cases
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  Clinical signs ofnutritional deficiency HAIR Spare & thin Protein, zinc, biotin deficiency Easy to pull out Protein deficiency Corkscrew Coiled hair Vit C & Vit A deficiency
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  Clinical signs ofnutritional deficiency MOUTH Glossitis Riboflavin, niacin, folic acid, B12 , pr. Bleeding & spongy gums Vit. C,A, K, folic acid & niacin Angular stomatitis, cheilosis & fissured tongue B 2,6,& niacin leukoplakia Vit.A,B12, B-complex, folic acid & niacin Sore mouth & tongue Vit B12,6,c, niacin ,folic acid & iron
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  Clinical signs ofnutritional deficiency EYES Night blindness, exophthalmia Vitamin A deficiency Photophobia- blurring, conjunctival inflammation Vit B2 & vit A deficiencies
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  Clinical signs ofnutritional deficiency NAILS Spooning Iron deficiency Transverse lines Protein deficiency
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  Clinical signs ofnutritional deficiency SKIN Pallor Folic acid, iron, B12 Follicular hyperkeratosis Vitamin B & Vitamin C Flaking dermatitis PEM, Vit B2, Vitamin A, Zinc & Niacin Pigmentation, desquamation Niacin & PEM Bruising, purpura Vit K ,Vit C & folic acid
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  Clinical signs ofnutritional deficiency Thyroid gland • in mountainous areas and far from sea places Goiter is a reliable sign of iodine deficiency.
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  Clinical signs ofnutritional deficiency Joins & bones • Help detect signs of vitamin D deficiency (Rickets) & vitamin C deficiency (Scurvy)
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  ANTHROPOMETRIC MEASUREMENT Anthropometry isa very valuable index for evaluation of nutritional status. It include measurement of height, weight, skin fold thickness, mid -arm circumference , head and chest circumference, Body mass index, and waist circumference. It is used to evaluate both under and over nutrition
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  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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  • 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
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  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
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  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).
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  ANTHROPOMETRIC MEASUREMENT • MID– UPPER ARM CIRCUMFERENCE (MUAC) :- Estimates skeletal muscle mass and fat storage.
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  ANTHROPOMETRIC MEASUREMENT
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  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
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  LIMITATIONS :- • LimitedNutritional diagnosis. • Inter – observers errors in measurement. • Problems with reference standard i,e. Local versus international standards. ANTHROPOMETRIC MEASUREMENT
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  Initial Laboratory Assessment Hemoglobinestimation is the most important test, & useful index of the overall state of nutrition. Beside anemia it also tells about protein & trace element nutrition. Stool examination for the presence of ova and/or intestinal parasites • Urine dipstick & microscopy for albumin, sugar and blood
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  Specific Lab Tests Measurementof individual nutrient in body fluids (e.g. serum retinol, serum iron, urinary iodine, vitamin D) Detection of abnormal amount of metabolites in the urine (e.g. urinary creatinine/hydroxyproline ratio) Analysis of hair, nails & skin for micro- nutrients.
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  Advantages of BiochemicalMethod 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 e.g. comparing salt intake with 24-hour urinary excretion.
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  Limitations of BiochemicalMethod Time consuming Expensive They cannot be applied on large scale Needs trained personnel & facilities
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  Biochemical tests usedin 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
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  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
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  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
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  • Human dietaryintake is assessed by five different methods they are: ASSESSMENT OF DIATERY INTAKE
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  Nutritional intake ofhuman is assessed by five different methods. They are ASSESSMENT OF DIATERY INTAKE
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  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
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  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
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  Food Frequency Questionnaire • Inthis 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
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  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
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  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
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  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
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  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 maintain ASSESSMENT OF DIATERY INTAKE
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  Observed Food Consumption • Themost 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
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