The document discusses nutrition assessment, which is the first step in planning and evaluating nutritional care. Nutrition assessment involves obtaining and interpreting multiple types of information, including anthropometrics, biochemistry, clinical factors, and dietary intake. Anthropometrics measures body size, shape, and composition using tools like BMI, waist circumference, and skin fold thickness. Biochemistry involves analyzing blood, urine, tissues, and functional tests. Clinical assessment obtains medical history and examines signs and symptoms. Dietary intake methods measure usual food and nutrient consumption. Together, this comprehensive assessment identifies nutritional risks and needs.

1. Week 4

2. WHAT IS NUTRITION ASSESSMENT?
 The first step before planning and evaluating the
nutritional care of individuals or groups
 Determined on the basis of multiple kinds of
information
 A systematic method for obtaining, verifying &
interpreting information

3. Individual
Nutrition Assessment
Biochemistry
Energy
Anthropometry (Laboratory Clinical Dietary
Requirements
analysis)
Population
Assessment & Monitoring
Birth Monitoring
Food Household Mortality &
Food Anthropom wt, infant &
Supply & Dietary Morbidity
Prices etric Data feeding & Surveillanc
Data Surveys Data
mortality e System

4. ASSESSMENT OF INDIVIDUALS

5. ANTHROPOMETRY
 Study of physical dimensions of the body
 Standardised equipment & procedures essential
 Body size
 direct measurements
 height, weight, circumferences
 derived values
 Body shape
 Waist hip ratio, body weight distribution
 Body composition
 size of lean tissue and fat compartments

6. BODY MASS INDEX (BMI)
 One of the most commonly used measurements for
assessing nutritional status
 Ratio of weight to height
 Caution – BMI not ideal for determining health risk
as it does not reflect amount of muscle compared to
fat

7. CLASSIFICATION OF OBESITY IN CAUCASIAN ADULTS
Classification # BMI (kg/m2) IBW % * Risk of Chronic
Disease
Underweight <18.5 >10% below* Low (but other
risks)
Normal range 18.5-24.9 desirable Average
Overweight >25
pre-obese 25.0-29.9 (10-19% above*) Increased
obese class I 30.0-34.9 (>20% above*) Moderate
obese class II 35.0-39.9 Severe
obese class III >40 Very severe
# WHO 2000, AIHW (2004)
* Ideal body wt (IBW) or desirable wt for ht (US Metropolitan Life Insurance data)
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8. OBESITY CLASSIFICATION - OTHER ETHNIC GPS
BMI classification in kg/m2
Asian Pacific Is.
<18.5 <19.9 Underweight
18.5-23.9 20.0 - 26.9 Normal
weight
24.0-26.0 27.0-32.9 Overweight
27.0-39.0 33.0-39.9 Obesity
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9. ANTHROPOMETRY - CIRCUMFERENCES
1. Waist circumference (AIHW, 2005) > 18 y
 >94 cm (M) >80 cm (F) – abdominal
overweight
 >102 cm (M) >88 cm (F) – abdominal
obesity
2. Waist: hip ratio
 visceral fat around organs vs.
subcutaneous fat on hips
 optimal WHR is < 1 (M) or < 0.8 (F)
 varies with: genes, age, ethnicity, sex
 increased by 'stress', smoking, alcohol
 decreased by physical activity
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10. BIOCHEMISTRY
 Blood tests
 Readily obtained (so often used)
 Vary little (homeostatic control)
 Should be used in conjunction with nutrient and
supplementation history
 Tissue testing
 May include hair & nails for information about trace
elements
 Other tissues only acceptable under exceptional
circumstances (invasive)
 Urine testing
 Varies between nutrients and influenced by variety
of factors (including volume of urine)
 Multiple samples required
 Functional tests
 Ability to perform specific functions (e.g. muscle
response, immunological response)

11. BIOCHEMISTRY
 Advantages:
 Provide the earliest indications
of some nutrient deficiencies &
excesses
 Relatively accurate & unbiased
(although not perfect)
 Can provide evidence for a
nutritional diagnosis made on
the basis of signs & symptoms
 Can be used to assess the
effect of some nutritional
therapy

12. CLINICAL
 Information obtained includes:
 Socio-demographic details (age, gender, occupation)
 Medical history (including family history)
 Medications
 Physical functioning/activity
 To help identify patients at risk of nutritional
deficiency, excess or requiring specialised nutrition
therapy
 Signs & symptoms important

13. WHAT GROUPS MIGHT BE AT RISK OF
NUTRITIONAL DEFICIENCY?

14. DIETARY INTAKE
 Usual intake more informative than one day snapshot
 Methods of measuring dietary intake include
 Diet History
 24hr recall
 Food frequency questionnaire
 Food diaries
 Duplicate meals
 Covered in week 3 lecture (last week)
 Used to investigate quality of diet (core-foods) and energy
intake

15. ESTIMATING ENERGY - UNITS OF ENERGY
 Unit of energy = the Calorie OR the Joule
 Calorie is older unit of measurement
 One calorie = the heat energy required to:
 the temperature of 1g of H2O by 1 C
 in Australia, we use kilojoules (kJ)
1 calorie = 4.18 kilojoules
http://www.youtube.com/watch?v=AA1mBek0gsQ

16. WHERE DOES ENERGY COME FROM?
 Macronutrients in food
 Carbohydrates (found in
breads, cereals, fruits, vegetables, dairy and snack
foods)
 Protein (meat, eggs and dairy)
 Fat (meat, full-cream dairy, snack foods)
 Alcohol
 Each macronutrient provides a different amount
of energy per gram (the value of energy
provided is termed the ‘Atwater factor’)

17. ENERGY FROM MACRONUTRIENTS
Carbohydrates Protein
16 kJ/gram 17 kJ/gram
Fats Alcohol
37 kJ/gram 29 kJ/gram

18. WHAT IS ENERGY DENSITY
 To compare products we can calculate energy
density
 Energy density = the amount of energy per
gram of food
 Foods that have higher fat contents tend to
have higher energy density (e.g. take-away/
snack foods, fatty meats, fats & oils)
 Foods that are low in fat but have a high water
content have lower energy densities (there are
no kJ in water) (e.g. fruits and vegetables)

20. ENERGY DENSITY OF COMMON FOODS
Food Energy (kJ/g) Why?
pure fat e.g. oil 37 100% fat
butter, margarine 30 83% fat
chocolate 23
cheese 17 50% fat
bread 10 50% H2O
steak 9 > 50% H2O
soft drink 2 mainly H2O
celery 0.2 >90% H2O

21. ENERGY EXPENDITURE
 Basal Metabolic Rate (BMR)
 Min amount of energy required to maintain vital functions
 60-70% of total energy exp.
 dependent on
 body size
 body composition
 Gender
 Age
 other factors
 BMR lowest when resting
 Increases steeply as energy is used by muscles (i.e. during
exercise)

22. ESTIMATING ENERGY REQUIREMENTS
 Estimating BMR
 Prediction equations used
 Based on:
 age
 sex
 height
 Weight
 Commonly used in Australia are the Schofield equations
although there are many others

23. SCHOFIELD EQUATIONS
Males 10-18 (0.074 x wt) + 2.754
18-30 (0.063 x wt) + 2.896
30-60 (0.048 x wt) + 3.653
Over 60 (0.049 x wt) + 2.459
Females 10-18 (0.056 x wt) + 2.898
18-30 (0.062 x wt) + 2.036
30-60 (0.034 x wt) + 3.538
Over 60 (0.038 x wt) + 2.755
Important – These are estimations only. There is considerable
variation between individuals & even within individuals over time

24. ENERGY EXPENDITURE
 Calculating total energy expenditure
 Need to take into account minimum amount required (BMR) and
multiply by a factor to take daily activities and exercise into
account
 BMR estimated  multiply by activity factor
 Range of activity factors (resting  very heavy activity)
Resting Very heavy
Activity factor continuum activity
1.2
6 - 12
 TEE = BMR x av. activity factor across the 24-hr day

25. SCHOFIELD ACTIVITY FACTORS
Activity Level Males Females
Bed rest 1.2 1.2
Very sedentary 1.3 1.3
Sedentary/Maintenance 1.4 1.4
Light 1.5 1.5
Light/Moderate 1.7 1.6
Moderate 1.8 1.7
Heavy 2.1 1.8
Very heavy 2.3 2.0

26. ENERGY BALANCE

29. INTEGRATING INFORMATION ON
NUTRITIONAL STATUS
Nutrition Assessment involves integrating
information from a number of different sources to
define the specific problem & also how it might be
addressed

31. FOOD SUPPLY DATA
 Provide information on:
 Long-term trends in the availability of the major commodity groups
(grain, dairy, meat, F & V)
 The types of nutritional problems that are likely in different
countries
 e.g. where energy supply available is:
 ≥ 12000kJ/person/day  obesity & heart disease are common
 < 8000kJ/person/day  under-nutrition is likely
 The types of foods that supply energy

32. MORTALITY & MORBIDITY DATA
 Provide information on:
 diseases & conditions that are reported as causes of
death/hospital admissions
 possibly on chronic conditions such as cancer &
diabetes
 Reflect:
 the major social & health problems of the community
 And can be used as:
 clues to the most likely causes of mortality &
morbidity
 measures of the prevalence of specific nutrition
related conditions

33. MORTALITY & MORBIDITY DATA
 Only provide information on:
 Indirect measures of the kinds of nutritional
problems most likely to be encountered in a
population
 Multi-factorial aetiology of conditions in
developed countries
 Current burden of disease statistics available
from the AIHW
Disability adjusted life years (DALYs) are the years of life lost
due to premature mortality & disability & measure the number
of healthy years of life lost as a consequence of death or
newly diagnosed disease or injury in the population.

34. ANTHROPOMETRIC DATA
 Weight & height are used in population studies as they:
 provide an overall measure of nutritional status
 are non-invasive
 are quick to carry out
 use minimal (& cheap) equipment
 Provide information on:
 the growth of children
 the prevalence of obesity or underweight

35. DATA FOR CHILDREN
 Infant birth weight
 Provides information on:
 maternal health & nutritional status
 risk of infant mortality
 Is influenced by:
 maternal body size, infection, smoking, alcohol consumption, maternal
nutrition during pregnancy
Also
affects
 Infant mortality data
 % related to prevalence of low birth weight (populations with
high rates of low birth weight usually have high rates of infant
mortality) e.g. Indigenous Australians

36. INFANT FEEDING PRACTICES
 Inappropriate infant feeding practices influences growth &
development esp. in the 1st 4 to 6 months
 Decrease in breastfeeding at 3 months since 1945 (21% 1971,
above 50% since 1985)
 Breastfeeding or correctly prepared infant formula  infant
morbidity & mortality

37. MONITORING & SURVEILLANCE SYSTEM
 A National Food & Nutrition Monitoring & Surveillance System
needs to collect data on:
 Food supply & expenditure
 Mortality & morbidity
 Weight & height
 Plus extra information on
Nutritional issues of particular
concern via specific nutrition
surveys (see week 3 lecture)

38. MONITORING & SURVEILLANCE SYSTEM DATA
NEEDS TO
 be relevant to the major nutritional problems
encountered
 be available to decision-makers within a
reasonable timeframe
 be available on a regular basis
 be collected by standard methods to enable
trends over time to be established
 be presented appropriately
 contain information relevant for changes to be
made