Nutritional Status

- Expresses the degree to which physiologic needs are met

- The spectrum of nutritional status spread from obesity to severe malnutrition
- optimal nutritional status

I. Influences
1. Socioeconomic status
2. Diseases
3. Cultural factors
4. Emotional factors
5. Stress
o Physiologic (pregnancy, growth, etc.)
o Physiological
o Pathological (fever, disease, etc.)
6. Food intake
7. Physical health

II. Balance Diet

 Fiber
 Protein
 Fat
III. Calculation of Nutrient Distribution
- Carbohydrate : 55-70%
- Protein: 10-15%
- Fat: 20-30%

IV. Deficiency Stages

Primary Deficiency caused by inadequate diet or Secondary deficiency cased by problem inside
the body Declining nutrient stores

V. What laboratory studies would help determine the patient’s nutritional status?
1. Serum Proteins (albumin, transferrin, prealbumin, retinol-binding protein)
o Most widely used laboratory measures of nutritional status
o Hepatically produced negative acute phase reactants with reduced levels during
systemic inflammation
2. Lipid panel
3. CBC (Complete blood count)
4. CMP (comprehensive metabolic panel)

VI. Conditions
 Marasmus
o Extremely sever type of nutrition disorder in which there is significant wasting of
fats, muscles, and tissues of body
o Risk factors:
1. Chronic starvation
 2. Adulterated water
3. Inadequate food intake
4. Vitamin deficiencies

 Kwashiorkor
o Caused by inadequate amounts of proteins in the body
o Found in countries where good food is not readily available

Nutritional Assessment

- Identify individuals or population groups at risk of becoming malnourished

- Identify individuals or population groups who are malnourished
- Develop healthcare programs that meet the community needs which are defined by the
assessment
- To measure the effectiveness of the nutritional programs and interventions once initiated

I. Methods of nutritional assessment

 Direct methods
o Individual and measure objective criteria
o Direct Method example:
A = anthropometric measurements
B = biochemical analysis
C = Clinical information
D = Dietary information
E = evaluation / environment
 Indirect Methods
o Community health indices that reflects nutritional influences
o Three categories;
1. Ecological variables including crop production
2. Economic factors (e.g. per capita income, population density and social habits)
3. Vital health statistics

Anthropometric measurements

o Anthropometry is the measurement of body, height, weight and proportions

o It is an essential component of clinical examination of infants, children and pregnant
women
o It is used to evaluate both under and over nutrition

I. Other anthropometric measurements

 Fatfolds – TSF (total subcutaneous fat) and total body fat
 MAC – midarm circumference; muscle mass of subcutaneous fat
 MAMC – midarm muscle mass/ circumference, skeletal muscle
 BMI – body mass index
 Head circumference
 Head / chest ratio
 Hip/waist ratio
 II. Measurement for adults
 Height
o The subject stands erect and base footed on a stadiometer with movable head piece
o True head piece is levelled with skull ____ and height is recorded to the nearest 0.5
cm
 Weight
o Use a regular calibrated weighing scale
 BMI
o The internal standard for assessing the body size in adults
o BMI = weight (kg) / height (m^2)
o Evidence shows that higher BMI (obesity level) is associated with type 2 diabetes
and high risk of cardiovascular morbidity and mortality
o Classification;
 BMI < 18.5 = Overweight
 BMI 18.5-24.5 = Healthy weight range
 BMI 25.30 = Overweight (Grade 1 obesity)
 BMI > 30-40 = Obese (Grade 2 obese)
 BMI > 40 = very obese (morbid or grade 3 obesity)

 Waist to hip ratio

How to measure
o Stand out straight and breathe out. Use a tape measure to check the distance
around the smallest part of your waist, just above your belly button (your waist
circumference)
o Then measure the distance around the largest part of your hips – the widest part of
your buttocks (your hip circumference)
o Calculate your WHR by dividing your waist circumference by your hip circumference
o Healthy WHR (WHO):
 0.9 or less in men
 0.85 or less for women

Health risk Women Men

Low 0.80 or lower 0.95 or lower
Moderate 0.81-0.85 0.96 -1.0
High 0.86 or higher 1.0 or higher

Biochemical Analysis

- Useful in detecting early changes in body metabolism and 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 dietary urinary excretion

I. Laboratory Studies
o Haemoglobin
 o Haematocrit
o Cholesterol
o Triglycerides
o Total lymphocyte count
o Serum proteins (serum albumin, serum transferrin, prealbumin)
o Nitrogen balance
o Creatinine height

Clinical Information

HAIR

Thin Protein, zinc, biotin deficiency

Easy to pull out Protein deficiency
Corkscrew or coiled hair Vitamin C and vitamin A deficiency

MOUTH

Glossitis Riboflavin, niacin, folic acid, B12, pr

Bleeding and spongy gums Vitamin C, A, K, folic acid and niacin
Angular stomatitis, cheilosis and fissured B2,6 and niacin
tongue
Leukoplakia Vitamin A, b12, B-complex, folic acid and niacin
Sore mouth and tongue Vitamin B12, 6 C, folic acid and iron

EYES

Night blindness, exophthalmia Vitamin A deficiency

Photophobia-blurring, conjunctival Vitamin b2 and vitamin A deficiencies
inflammation

NAILS

Spooning Iron deficiency

Transverse lines Protein deficiency

SKIN

Pallor Folic Acid, iron, B12

Flaking dermatitis PEM, Vitamin B2, Vitamin A, Zinc and niacin
Pigmentation, desquamation Niacin
Bruising, purpura Vitamin K and C and folic acid
Follicular hyperkeratosis Vitamin B and C

THYROID GLAND

- In mountainous areas and far from sea places, goiter is a reliable sign of iodine deficiency

JOINTS AND BONES

 - Help detect signs of vitamin D deficiency (Rickets) and vitamin C deficiency (Scurvy)

Dietary Information

- Nutritional intake of humans is assessed by five different methods. These are:

 24 hours dietary recall
o A trained interviewer asks the subject to recall all food and drink taken In the
continuous 24 hours
o It is quick, easy and depends on memory but may not be truly representative of the
person’s
 Food frequency questionnaire
o In this method the subject is given a list of around 100 food items to indicate his or
her intake (frequency and quantity) per day, per week and per month
o Inexpensive, more representative and easy to use
 Dietary history since early life
o An accurate method for assessing the nutritional status
o The information should be collected by a trained interviewer
o Details about usual intake, types, amount, frequency and timing needs to be
obtained
o Cross-checking to verify data is important
 Food dietary technique
o food intake (types and amounts) should be recorded by the subject at the time of
consumption
o the length of the collection period range between 1-7 days
o reliable but difficult to maintain
 Observed food consumption
o The most unused method in clinical practice, but it is recommended for research
purposes
o The meal eaten by the individual is weighed and contents are exactly calculated
o The method is characterized by having a high degree of accuracy but expensive and
needs time and efforts

EVALUATION/ ENVIRONMENT

- Summary of findings
- Recommendations
- Potential problems
- Socioeconomic concerns
- Psychosocial concerns
- Adequate housing
- Diseases state affects ability to prepare food
- Adequate food, storage, equipment to prepare food