Nut 1

Welcome in DPT
Basic Nutrition
Physical Therapy Department for surgery

Faculty of Physical Therapy- Cairo University
Teaching Prof. Dr /Wafaa H. Borhan
Staff Professor in Physical Therapy Department for surgery-Faculty of
Physical Therapy-Cairo University
Ass.Prof.Dr /Samah H. Nagib

Assistant Professor in Physical Therapy Department for surgery-
Faculty of Physical Therapy-Cairo University
Dr /Haidy N. Ashem
Lecturer in Physical Therapy Department for surgery-Faculty of
Physical Therapy-Cairo University
Assessment of Nutritional
Status
By
Ass.Prof.Dr /Samah H. Nagib
Assistant Professor in Physical Therapy
Department for surgery-Faculty of Physical
Therapy-Cairo University
The power of nutrition
By the end of this lecture, the students will be able to:
 Identify the important of the assessment
of nutritional status.
 Determine the different methods of
assessment of nutritional status
Definition
• Nutrition may be defined as the science of
food and its relationship to health. It is
concerned primarily with the part played
by nutrients in body growth, development
and maintenance .
• Good nutrition means “maintaining a
nutritional status that enables us to grow
well and enjoy good health.”
Important of Nutrition
Assessment
• For a person
• For groups or society.
Different Methods for Nutritional
Assessment
• Medical and social history
• Diet history and intake
• Clinical examination
• Anthropometrics
• Biochemical data
Medical and Social History
• Gathered from patient interview
• Medical history: diagnosis, past medical and
surgical history.
• Psychosocial data: economic status,
occupation and education level
• Other: age, sex, level of physical activity,
daily living activities
Dietary History and Intake
• Appetite and intake: taste changes, dentition,
dysphagia, feeding independence,
vitamin/mineral supplements
• Eating patterns: daily and weekend, diet
restrictions, ethnicity, eating away from home,
fad diets
• Estimation of typical calorie and nutrient intake:
RDAs, Food Guide Pyramid
– Obtain diet intake from 24-hour recall, food
frequency questionnaire, food diary,
observation of food intake
Dietary assessment methods
• Direct (food frequency,24 hour record,
dietary history, food intake record, food
consumption)
• Indirect
Methods of obtaining dietary intake
data: Food frequency questionnaire
Your
serving How often?
size
Food Medium
S M L Day Week Month Year Never
item serving
Coffee 1 cup x 3
Wheat
1 slice x 5
Bread
Ice
1/2 cup* x 1
cream
Other methods of obtaining dietary
intake data
• 24-hour recall:
http://www.niddk.nih.gov/health/nutrit/pubs/tipsforadults/tipsfor
memory-based
• diary: record
exact amounts
of foods
consumed
adults.htm
Evaluation of intake data
http://www.sharewarejunkies.com/02zwd8/kathleen_ss.htm
Clinical Examination
• Identifies the physical signs of malnutrition
– Temporal wasting
• Signs do not appear unless severe deficiencies
exist
• Most signs/symptoms indicate two or more
deficiencies
• Examples: see list attached
– Hair: easily plucked, thin; protein or biotin
deficiency
– Mouth: tongue fissuring (niacin), decreased
taste/smell (zinc)
www.healthchecksystems.com/ d6437.htm
Anthropometric methodes
www.healthchecksystems.com/ fattrack.htm
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 & sometimes differentiate
between acute & chronic changes .
Advantages of Anthropometrics
• 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
Disadvantages of Anthropometrics
Inter-observers errors in measurement

Limited nutritional diagnosis
Problems with reference standards, i.e.
local versus international standards.
WEIGHT MEASUREMENT
Use a regularly calibrated electronic or

balanced-beam scale.
Weigh in light clothes, no shoes
Read to the nearest 500gm (0.5kg),in

infants and digital to the nearest 100gm.
Types of balance
• A. Beam balance
B. Bath Balance.
C. The electronic balance .
D. Salter Balance for children
HEIGHT MEASUREMENT
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.
Other anthropometric (Adult)
Measurements
• Mid-arm circumference
• Waist circumference
• Hip circumference
• Hip/waist ratio
• Skin fold thickness
Mid-arm circumference
Waist circumference
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 > 94cm > 80cm
LEVEL2 > 102cm > 88cm
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.
Waist/Hip Ratio
Waist circumference is measured as
mentioned before .
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.
Skin fold thickness
Body Mass Index (BMI)
• 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 (m²)
• Evidence shows that high BMI (obesity level) is

associated with type 2 diabetes & high risk of
cardiovascular morbidity & mortality
BMI (WHO - Classification)
 BMI < 18.5 = Under Weight
 BMI 18.5-24.5= Healthy weight range
 BMI 25-30 = Overweight (grade 1
obesity)
 BMI >30-40 = Obese (grade 2 obesity)
 BMI >40 =Very obese (morbid or
grade 3 obesity)
The importance of body mass index
1. Easy to measure and use with the

existence of tables
2. Its scope broader than "wide range"
3. Is one of the few factors that can be used
to predict the different diseases such as
diabetes, cancer, heart disease and pressure
Anthropometry for children
Accurate measurement of height and
weight is essential. The results can then be
used to evaluate the physical growth of the
child.
For growth monitoring the data are plotted

on growth charts over a period of time that
is enough to calculate growth velocity,
which can then be compared to
international standards .
Selection of indicators and standard
measures in children
• After taking physical measurements will
be compared by International Standard .
• It is recommended to use standard
measurements from the National Center for
Health Statistics (NCHS),if available.
Growth Monitoring Chart
Other anthropometric (pediatric)
Measurements
• Head circumference
• Chest circumference
• Head/chest ratio
Nnutritional assessment of
pregnant women
* Body mass index can be calculated with use of the following equation: weight (in
kilograms) / [height (in meters)]2. One pound 453.5 g.
Biochemical analysis
• Urine analysis.
• Stool analysis.
• Blood analysis.

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Welcome in DPT

Physical Therapy Department for surgery

Ass.Prof.Dr /Samah H. Nagib

Inter-observers errors in measurement

Use a regularly calibrated electronic or

Weigh in light clothes, no shoes

Read to the nearest 500gm (0.5kg),in

Level 2 denotes obesity and requires weight

• BMI is computed using the following formula:

• Evidence shows that high BMI (obesity level) is

1. Easy to measure and use with the

For growth monitoring the data are plotted

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