Nutrition Assessment
Nutrition Assessment
Nutrition Assessment
Abdelaziz Elamin, MD, PhD, FRCPCH College of Medicine Sultan Qaboos University, Oman
LEARNING OBJECTIVES
By the end of this lecture the reader should be able to:
To know the different methods for assessing the nutritional status To understand the basic anthropometric techniques, applications, & reference standards
INTRODUCTION
The nutritional status of an individual is often the result of many interrelated factors. It is influenced by food intake, quantity & quality, & physical health. The spectrum of nutritional status spread from obesity to severe malnutrition
CLINICAL ASSESSMENT
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, (specific & non specific), that are known to be associated with malnutrition and deficiency of vitamins & micronutrients.
CLINICAL ASSESSMENT/2
Good nutritional history 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
CLINICAL ASSESSMENT/3
ADVANTAGES
Fast
HAIR
Spare & thin Protein, zinc, biotin deficiency Protein deficiency
MOUTH
Glossitis Bleeding & spongy gums Angular stomatitis, cheilosis & fissured tongue leukoplakia Sore mouth & tongue Riboflavin, niacin, folic acid, B12 , pr. Vit. C,A, K, folic acid & niacin B 2,6,& niacin
Vit.A,B12, B-complex, folic acid & niacin Vit B12,6,c, niacin ,folic acid & iron
Transverse lines
Protein deficiency
in mountainous areas and far from sea places Goiter is a reliable sign of iodine deficiency.
Help detect signs of vitamin D deficiency (Rickets) & vitamin C deficiency (Scurvy)
Anthropometric Methods
Anthropometry is the measurement of body height, weight & proportions. It is an essential component of clinical examination of infants, children & pregnant women. It is used to evaluate both under & over nutrition. The measured values reflects the current nutritional status & dont differentiate between acute & chronic changes .
circumference
Head
Head/chest
Height:
The subject stands erect & bare footed on a stadiometer with a movable head piece. The head piece is leveled with skull vault & height is recorded to the nearest 0.5 cm.
WEIGHT MEASUREMENT
Use a regularly calibrated electronic or balanced-beam scale. Spring scales are less reliable. Weigh in light clothes, no shoes Read to the nearest 100 gm (0.1kg)
The international standard for assessing body size in adults is the body mass index (BMI).
BMI is computed using the following formula: BMI = Weight (kg)/ Height (m)
F1
Evidence shows that high BMI (obesity level) is associated with type 2 diabetes & high risk of cardiovascular morbidity & mortality
Slide 25 F1
FSC, 1/2/2002
Waist/Hip Ratio
Waist
circumference is measured at the level of the umbilicus to the nearest 0.5 cm. The subject stands erect with relaxed abdominal muscles, arms at the side, and feet together. The measurement should be taken at the end of a normal expiration.
Waist circumference
Waist circumference predicts mortality better than any other anthropometric measurement. It has been proposed that waist measurement alone can be used to assess obesity, and two levels of risk have been identified MALES FEMALE LEVEL 1 LEVEL2
> >
80cm 88cm
Waist circumference/2
Level 1 is the maximum acceptable waist circumference irrespective of the adult age and there should be no further weight gain. Level 2 denotes obesity and requires weight management to reduce the risk of type 2 diabetes & CVS complications.
Hip Circumference
Is measured at the point of greatest circumference around hips & buttocks to the nearest 0.5 cm. The subject should be standing and the measurer should squat beside him. Both measurement should taken with a flexible, non-stretchable tape in close contact with the skin, but without indenting the soft tissue.
Interpretation of WHR
High risk WHR= >0.80 for females & >0.95 for males i.e. waist measurement >80% of hip measurement for women and >95% for men indicates central (upper body) obesity and is considered high risk for diabetes & CVS disorders. A WHR below these cut-off levels is considered low risk.
ADVANTAGES OF ANTHROPOMETRY
Objective with high specificity & sensitivity Measures many variables of nutritional significance (Ht, Wt, MAC, HC, skin fold thickness, waist & hip ratio & BMI). Readings are numerical & gradable on standard growth charts Readings are reproducible. Non-expensive & need minimal training
Limitations of Anthropometry
Inter-observers
errors in
measurement
Limited
nutritional diagnosis
Problems
with reference standards, i.e. local versus international standards. statistical cut-off levels for what considered as abnormal values.
Arbitrary
DIETARY ASSESSMENT
hours dietary recall Food frequency questionnaire Dietary history since early life Food dairy technique Observed food consumption
DIETARY HISTORY
It is an accurate method for assessing the nutritional status. The information should be collected by a trained interviewer. Details about usual intake, types, amount, frequency & timing needs to be obtained. Cross-checking to verify data is important.
FOOD DAIRY
Food intake (types & amounts) should be recorded by the subject at the time of consumption. The length of the collection period range between 1-7 days. Reliable but difficult to maintain.
The most unused method in clinical practice, but it is recommended for research purposes.
The meal eaten by the individual is weighed and contents are exactly calculated.
The method is characterized by having a high degree of accuracy but expensive & needs time & efforts.
using the food pyramid & the basic food groups method. Different nutrients are classified into 5 groups (fat & oils, bread & cereals, milk products, meat-fishpoultry, vegetables & fruits) determine the number of serving from each group & compare it with minimum requirement.
The amount of energy & specific nutrients in each food consumed can be calculated using food composition tables & then compare it with the recommended daily intake. Evaluation by this method is expensive & time consuming, unless computing facilities are available.