Nutritional Assessment

Nutritional assessment
Nutritional assessment is the systematic process of collecting and interpreting information in

order to make decisions about the nature and cause of nutrition related health issues that affect an
individual (British Dietary Association (BDA) 2012). Anthropometric measurements provide
important information on the growth and nutritional status of a child. Anthropometric
measurements are non-invasive quantitative measurements of the body or can also be referred to
as the use specific tools to collect data needed to assess the health and growth status of the
human body. Core elements of anthropometric measurements are height, weight, head
circumference, body surface area (BSA), body mass index (BMI), body circumferences to assess
for adiposity (waist, hip and limbs) and skinfold thickness. For the nutritional assessment of
pediatric patients, we are going to focus on weight, height, BSA, mid-arm circumference and
triceps skin fold.
Weight:
The method and equipment for weighing vary with the child’s age. All scales must be balanced
or zeroed first before weight is measured. Infants are placed in a lying position on a regular baby
scale with all their clothing removed. Older children who are able to stand or walk without
support may be weighed on the adult standing scale. On the older child, remove all clothing
except underwear. It is important to check the weight of the child on admission and daily in the
ward.
Height:
The methods of measuring a child’s height vary with the child’s age. Infant and toddler length is
best measured with the child lying down on a flat measuring board. This method is used until the
child is able to stand independently. The child’s head is held securely to the headboard, and the
movable footboard is stretched to touch the child’s heel. If a measuring board is not available for
the infant and young child, it is possible to position the child’s body on a flat surface, mark the
point where the heel touches the surface, and then mark the point where the top of the head is
lying on the surface, taking care to ensure that the child’s legs and body are straight on the
surface. The examiner then removes the child and measures the distance between the two points
with a measuring tape. Measuring the length of the child in this manner is not as accurate as
using a measuring board. Height is used to assess protein energy malnutrition.
Weight and height are always measured in children and are compared with averages for age-
group and gender.
Weight for height ratio:

Reflects body weight in relation to height. It is advisable to plot values for each child on growth
curves and compare changes in the child over time. This curve can reveal acute malnutrition
(wasting) and chronic malnutrition (stunted growth).
Body Mass Index (BMI):
BMI is used to measure the amount of body fat and it is calculated according to a simple
formula:
BMI=Weight(kg)Height(m)2
Midarm circumference:
Midarm circumference reflects muscle mass and fat. To measure midarm circumference, the
midpoint on the arm between the acromial process and the olecranon process is determined.
Then, with the arm hanging loosely at the side, the child’s arm is measured at the midpoint with
a MUAC tape measure. The measurement is recorded in centimeters. With a decrease in fat or
muscle atrophy, the midarm circumference decreases. It will increase with weight gain.
Triceps skin fold:
Triceps skinfold thickness indicates total body fat because at least half of body fat is directly
below the skin. Metal calipers are used to obtain this measurement. On the nondominant arm, the
midpoint of the arm is determined with the same method that is used for measuring midarm
circumference. With the arm hanging loosely at the side, a fold of skin at the midpoint on the
posterior aspect of the arm is grasped. To avoid error, the child is asked to flex the arm muscle
after the examiner grasps the skin. If contraction is felt, muscle as well as fat has been grasped.
The examiner applies the caliper and takes a reading after waiting 3 seconds. Fat stores decrease
with long-term under nutrition and malnutrition.
Midarm muscle circumference, skinfold thickness, and weight provide information about three
body tissues (subcutaneous tissue, muscle, and fat) altered by nutrition. Because children’s body
fat varies with age and gender, anthropometric measurements are most valuable when they are
plotted on a growth curve and evaluated serially so that trends can be monitored.
Anthropometric measurements reflect any change in the growth pattern and may be the first clue
to a serious problem. Measurements must be taken at every health care visit from birth to
adulthood. If a child’s weight or height stops following the child’s own growth curve, this is a
significant indicator of a change in health status.
Factors affecting accuracy of anthropometric measurements
 Technique
 Equipment
 Level of cooperation from the patient
Benefits of anthropometric measurements to nutritional status
 It helps identify patients at nutritional risk.

 Also helps to assess efficacy of nutritional support
 Helps to identify patients who require dietary counseling/support
It is important to asses at time of diagnosis and repeatedly over time.
Apart from anthropometric measurements, food history of pediatric clients can also be used for
nutritional assessment.
Dietary history
Dietary history should determine the quantity and quality of the food that is consumed by the
infant or child, the eating behaviors of the child, and the beliefs of the family. Nutrient intake is
then compared with the age-specific recommended intake to assess the likelihood of
undernutrition or overeating. Dietary history of a child can be assessed with a 24-hour dietary
recall or a food frequency questionnaire. These methods of dietary analyses can be misleading
because the child or caregiver must rely on memory to describe typical eating patterns.
24-hour dietary recall: the child or caregiver is asked to report the type and quantity of food
consumed in the last 24 hours. This approach provides some quantitative information. Through
the classes of food listed, nutrient deficit could be anticipated and corrected.
Food frequency questionnaire: this is more qualitative but may provide a better assessment of
the intake of episodically consumed foods. The questionnaires consist of a finite list of foods,
beverages, or supplements with response categories to indicate usual frequency of consumption
over a specific period of time. The questionnaire also elicits information on usual portion sizes
and, in some cases, includes portion size images to assist with accuracy. Food frequency data can
be used to assess total dietary intake and/or particular aspects of diet.
References
Casadei Kyle, John Kiel. Anthropometric measurement. 2022 Sep 26. In StatPearls [Internet].
Treasure Island (FL): StatPearlsPublishing; 2023 Jan – PMID: 30726000.
Green Corkins K, Teague EE. Pediatric Nutrition Assessment. Nutr Clin Pract. 2017 Feb; 32(1):
40-51. doi: 10.1177/088433616679639. Epub 2016 Dec 5. PMID: 27913773.
Sarah M Phillips, Craig Jensen, Kathleen J Motil. ( Sep 2022). Dietary history and recommended
dietary intake in children.
British Dietetics Association (BDA) (2012) Model and process for Nutrition and dietetic
Practice. https://www.bda.uk.com/publications/professional/model.

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Nutritional assessment

Nutritional assessment is the systematic process of collecting and interpreting information in

Weight for height ratio:

Body Mass Index (BMI):

Triceps skin fold:

Factors affecting accuracy of anthropometric measurements

Benefits of anthropometric measurements to nutritional status

 It helps identify patients at nutritional risk.

It is important to asses at time of diagnosis and repeatedly over time.

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