FINAL PROJECT

NUTRITIONAL ASSESSMENT

Submitted To: Ma’am Syeda Aliya Sherazi

Submitted By: Noor Ul Ain Fatima
Kashf Nadeem
Laiba Akhtar
Dua Mirza
Submission Date: Friday – 21st May,2021.
Section: B
Course Title: Community Nutrition
Semester: 4

KINNAIRD COLLEGE FOR WOMEN UNIVERSITY, LAHORE.

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Table of Content
NUTRITION ASSESSMENT ...................................................................................................... 3
Introduction: .............................................................................................................................. 3
A) Twenty-four Hour Recall - ..................................................................................................... 3
B) Multiple-day Food Diary:........................................................................................................ 4
C) Diet History: ............................................................................................................................. 4
D) Food Frequency Questionnaires (FFQ): ................................................................................ 4
..................................................................................................................................................... 4
Quantitative Dietary Assessment:............................................................................................ 4
Preparation Phase: .................................................................................................................... 5
ANTHROPOMETRIC FEEDBACK .......................................................................................... 6
NUTRITION ALGORITHM FLOWCHART ........................................................................... 7
Involving phase: ........................................................................................................................ 7
Exploration-Education phase: ................................................................................................. 7
Closing phase: .......................................................................................................................... 10
REPORT WRITING .................................................................................................................. 11
THE END..................................................................................................................................... 21

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 NUTRITION ASSESSMENT
Introduction:
A standard assessment takes into account various parameters such as anthropometrics, medical
history, diet history, laboratory values, and any factors compromising nutrition intake. Energy and
nutrient requirements are estimated and specific recommendations are made. The parameters that
are monitored and/or documented can be tailored for our study.
There are a variety of techniques to assess dietary intake, each with their own strengths and
weaknesses. All dietary assessment methods are limited and absolute validity is difficult to
determine. However, this limits all researchers and it sometimes makes sense to collect dietary
intake data, even if the information is flawed. Some techniques allow for a quantitative assessment
using our nutritional analysis software.
 Twenty-four Hour Recall
 Multiple-day Food Diary
 Diet History
 Food Frequency Questionnaire (FFQ)

A) Twenty-four Hour Recall -

A retrospective detailed interview conducted by a Registered Dietitian to determine a subject's
dietary intake from the preceding 24-hour period. The burden to the volunteer is low but you have
to collect serial recalls to adequately characterize usual intake. A quantitative assessment is
possible with 24-hour recalls. 24hour recall to the related case study is attached below:

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B) Multiple-day Food Diary:
Volunteers are asked to measure or weigh everything they eat for a specified number of days.
Subject burden is high but food diaries are useful for motivating people in intervention studies and
are considered the gold standard in dietary assessment. A quantitative assessment is possible with
food diaries.

C) Diet History:
An-depth interview conducted by a Registered Dietitian to
determine the volunteer’s usual meal patterns and other
details of dietary intake. Diet histories typically provide
qualitative rather than quantitative information. The type of
information collected can be tailored to meet the needs of
your study. The journal is attached below:

D) Food Frequency Questionnaires (FFQ):

FFQs are standardized forms inquiring about the frequency of
intake of different foods or food groups. They are not as
accurate as other measures but are useful in large population
studies or when studying the association of a specific food(s)
and a disease. The form related to the case study is attached
alongside.

Quantitative Dietary Assessment:

Twenty-four hour recalls or multiple-day food diaries are
analyzed on the computer using The Food Processor or the
Food Intake Analysis System (FIAS). A spreadsheet is
generated detailing the intake of a variety of macro and
micronutrients.

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Preparation Phase:
Mrs Pervaiz entered and explained her history that she had a cholesterol issue, lungs infection,
pain in body ,lethargy .she was doing little activities . We assessed the motivational interviewing
algorism by their phases in detail that given below. We also asked about her consent.
Valid informed consent must include three major elements:
 Disclosure of information,
 Competency of the patient (or surrogate) to make a decision, and
 Voluntary nature of the decision.
Then we had taken diet history interview by not interrupting or changing our expression. We tried
to calm her and build a relationship between me and Mrs. Pervaiz. We obtained details of
individual foods, and comprehensive information about foods eaten less regularly. It is used to
describe usual food and / or nutrient intakes over months or a year.

 A dietary history is a retrospective structured interview

method consisting of questions about habitual intake of foods
from the core food groups (e.g. meat and alternatives, cereals,
fruit and vegetables, dairy and ‘extras’) and dietary behaviors
(e.g. skipping breakfast, dieting).
 We asked open ended questions to determine foods and
drinks consumed at each meal, followed by specification of
amounts. This is followed by a ‘cross check’ to clarify
information about usual intake in the past 3, 6, or 12 months.
It can be combined with a 3-day record or a 24-hour recall.
 We recommended her low fat food and motivated her towards
30 min brisk walk initially. Afterward we took waist
circumference protocol to measure obesity and morbidity. We
gave some forms of food frequency, client assessment, life
style management and its feedback form to client. We
calculated her body mass index.
BMI= weight of person kg divided by height of person in meter
square
BMI calculated considering her weight and height was 25.4 which identified that she was obese.

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 ANTHROPOMETRIC FEEDBACK

It shows that she is overweight. For the measurement of the BMI we needed tape or weight
machine. Afterward, we asked some question to determine in which phase my patient stand.

1. How high is your overall diet in fat? Is it..

 Low

 Very low

 In the middle

 High

 Very high

Patient replied she has consumed “high” fat food

2. In the past 6 month, have you tried to eat less fat?

 Yes

 No

The patient responded as “Yes”

3. How successful were you?

 Very successful

 Somewhat successful

 Not successful

Mrs Pervaiz said “Somewhat successful”

4. Are you seriously thinking about eating less fat overall next 6 months?

 Yes

 No

She said “Yes” which means she is in preoperational phase

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 5. Do you plan to eat less fat over next 6 months?

 Yes (Preparation)

 No (Contemplation)

She responded as “Yes”

Analysis:

It means Mrs. Pervaiz khan was in preparation phase.

NUTRITION ALGORITHM FLOWCHART

Involving phase:
When Mrs. Pervaiz entered, she greeted us with a smile, we thanked her for agreeing to sharing
her personal information with us. We explained her about our project and how we have to do
this for our counselling program after that we shared the consent form with her. We explained
each and every point with her and then she signed the form given below

Exploration-Education phase:
So in this phase a client is basically asked
to describe himself and then if any
nutritional concerns are present there, then
those are discussed, we asked the client to
describe herself, her cultural background,
interests and occupation. She is a 55 year
old woman, from D.G KHAN. She is a
housewife, and loves taking care of her
home and family. She loves reading books
and trying new dishes in the kitchen.
When I asked about nutritional concerns,
MRS.PERVAIZ AHMED KHAN has

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 an issue in selecting the food options she doesn’t know that what kind of foods she should be
opting, she just needed a diet plan. Since she had lung infection and cholesterol related
problems, she wanted to know more about diet that are good for her medical issues. Complete
Client Assessment Questionnaire with Mrs. Pervaiz

I said:

“I am satisfied that you filled out the assessment form. What have been you questioning at the
same time as filling out the assessment form? What subjects in this form have particular
significance on your food and fitness troubles?”

Mrs. Pervaiz responded:

“I had no issues while filling out the forms, everything was mentioned clearly in the forms.”

While going through the forms we noticed that the client is not doing any sort of physical
activity at all, since she has an issue of cholesterol as well we asked her to involve physical
activity in her diet. Reviewing the diet history portion, everything was clearly mentioned. The
client was willing to adapt to a new diet pattern. She just wanted to eat better and improve her
cholesterol. She was willing to take small steps, by setting dietary goals, which would lead her
to improved health.

After that all we asked our client to tell us about her daily routine that what she does in a day
and what she eats in a day.

She said:

“I wake up 6:30 in the morning, offer my prayer and then make breakfast for my family, my
husband and my kids leave for work and school at 8:00 in the morning. After that I do my
breakfast and after that I do house chores. Around 12 in the noon I take 1 hour nap and after
that I prepare lunch for my family. At 3 in the noon I help my kids in doing their homework,
after that we have a little tea snack party, dinner by 8 in the night and I do more house chores
and I go to my bed for sleeping by 11 at night.”

We discussed the “24-Hour Recall” and “Anthropometric Feedback Form”, point by point in
a non-judgmental and casual way.

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 Comment: “Mrs. Pervaiz, you are slightly overweight and there is lack of proper protein and
physical activity in your diet, you should start doing some basic exercises or walk to improve
your heart health , you will enjoy all these things, you know that exercise produces pleasure
produces hormones in your body named endorphins, you will feel very relaxed after a walk”

We did a little educational session in which we discussed that how she should be selecting
healthier food options, she has an issue of high cholesterol so education was provided about good
and bad fats that she should be knowing while selecting a particular food item, like she should be
avoiding high saturated fats, should be opting for olive oil instead of regular canola and cooking
oil because both differs in terms of fat types and content, secondly short term goals were discussed
like for the next 15 days she will be trying her best to avoid unnecessary fat in her diet and would
be going for mostly low fat options whenever she will be selecting dairy options and food options,

In the last I asked her about her view about the consultation session to which she said:

“I am so happy that you introduce me to the importance of physical activity in my life and also
gave me some good nutritional knowledge Solving issues by altering diet does not have any side
effects. This will help me to achieve a healthy lifestyle.at last, we decided a 15day goal plan in
which she will not skip her walk and will make positive diet changes”

Following this, we discussed the physical activity plan and a form was filled out:

The goals that we planned were written on a paper and she was asked to place these goals in her
fridge that will remind her daily that she has to achieve them. she was given much motivation and
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at the end of the session she was motivated enough for the upcoming positive changes in her diet
as she was told that how these little lifestyle changes would be a road to freedom from her
cholesterol issue and from daily depending on the medicines and how these changes would bring
a positive change in her overall personality. Her basic strengths and plus points were also
discussed. The relevant form is as follows:

On showing her the “Readiness-to-change Assessment Graphic” and asking where she would rate
herself, in showing her readiness to make a change. She highlighted the “Number 9”.

1 2 3 4 5 6 7 8 9 10

Closing phase:
Closing phase is basically the last phase in which a client is pumped enough to believe in her
abilities and support self-efficacy. a phase in which client’s strengths and weakness are measured
and according to that positive strategies are made like from the above case study the client
MRS.PERVEIZ has an issue that she finds it difficult to manage to take some time out of her

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daily routine to go for a physical activity she physical activity was very important as physical
activity would make her heart health better, so initially she was just asked to take out 30 minutes
from her daily routine and try to indulge herself in some sort of physical activity, she was motivated
enough from the counsellor side that she can do all the changes that are required by just introducing
some sort of discipline in her life. She actively participated in the counselling sessions aswell
which shows that shows that she was herself very much involved in the session. at first only 15
days goals were discussed which involved 30 minute walk and avoiding foods that were high in
saturated fats so that she will not fill any burden and can easily achieve them, she wasn’t judged
at all by any of her talk which increased her self-confidence as well.

REPORT WRITING

1. Record the name of the person interviewed and location, time and date of the meeting.
Ans. The record is given below:
Name: Mrs. Pervaiz
Location: House No. 135 Dera Ghazi Khan
Time: 6:00p.m.
Date: 6th May,2021
2. Describe the person you interviewed – age, cultural group, gender, occupation.
Ans. The description of the client is as follows:
Age: 55 Years
Cultural Group: Pathan
Gender: Female
Occupation: House Wife
3. Write a narration of the experience. There should be four titled sections to the
narration – Preparation, Opening Phase, Exploration Phase and Closing Phase.
Summarize what occurred in each phase.
Ans. The experience with client during different phases is summarized as follows:
Preparation:
In the first session, the client was ready to learn and explore what was needed. For this,
some questions were asked to have an idea of as to how well aware she is of the nutritional
information. Discussion regarding her preferences was done and as to how there is a need
to bring dietary and physical lifestyle interventions. In the next session, there will be

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 discussion about how her diet can be modified in a healthy way and physical activity can
be increased by addition of physical exercise to the routine.
 During this phase, the client seemed interested to get the awareness but was not
welcoming questions to a larger extent.
Opening Phase:
Next, we entered the opening phase after having a healthy discussion in the preparation
phase. At this point of time, the client started to open up with the details of concerns she
had i.e. having no interest in strenuous exercises, body aches, cholesterol, joint pain, and
obesity were the few concerns shared by the client during this phase.
 During this phase, the client was willing to make a change but was not sure if she
will be able to make changes in her dietary habits which was the first step towards
a healthy lifestyle.
Exploration Phase:
Now that the client had opened up about her concerns, we get to understand the reasons
that could have come in line for those concerns;
 Consumption of High-Fat Food
 Low Physical Activity
 Less Nutritional Information
 No Nuts Intake
Recently, she had suffered with a lung infection due to which she felt a little weak and lazy
while doing anything which was complimented by frequent stools. Now we were somehow
clear about all the concerns of the client and the reasons which were a hindrance to fitness,
we get to understand that consumption of High-Fat Food, Low Physical Activity while
being on medication and having less nutritional information made the decision towards
lifestyle change a bit harder.
 At this point, the client was well-educated of where the problem existed and the
changes that she was required to make in order to lead a healthy life.
Closing Phase:
As we entered the closing phase, the client was highly motivated and ready to bring a
change in her lifestyle while knowing about all the nutritional concerns which she was not
aware of earlier. This buckled her up to bring a healthy intervention in her lifestyle.
 This phase was ended on a good note where she was convinced to include healthy
lifestyle changes i.e. modifying her eating habits by incorporating “My Plate” in
her diet.

4. Compare a Client Concerns, Strengths Log, Lifestyle Management Form 5.6.

CLIENT CONCERNS STRENGTHS

Maintaining Health Good Cooking Skills
Controlling Cholesterol Level Good Listener
Easy Physical Activity Creative

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 Reduced Stamina to do Exercise Tolerant

5. Chart your experience using the SOAP and ADIME Format.

Ans. The two formats describing the experience are shared below:

SOAP
S: Diet/ Lifestyle/ Medical/ Learning and motivational related

Subjective information in client’s own words.

- Cannot exercise much due to joint pain and shortness of breath/ coughing
- Has less time for exercise and physical activity
- Need special diet for to reduce cholesterol and weight.
- Have recently recovered from lung infection thus has weakness.
- Might face difficulty in changing dietary behavior but will learn to cope with it.
- Age factor increase complications.

O: age/ gender/ ht/ wt/ BMI/ any anthropometry/ lab results

- Age: 55
- Height: 5’3
- Weight: 65kg
- BMI: 25.4
- Waist circumference: 34.1 inches
- Supplements/Medicines : EVEON capsule, Cefidon, Aptimax plus, PROGOD.
- Health issues: High cholesterol, High blood pressure, Overweight, Lung infection.
- Complaints: weakness, frequent stools, joint pain, shortness of breath, frequent
headaches, cough.

A: Nutrition Diagnosis

PES Statements:

- High blood pressure related to less physical activity and as evidenced by frequent
headaches.
- Inadequate nutrient intake related high fat and low vegetable consumption evidenced by
weakness and joint pain.

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 - Altered GI function related to frequent watery stools evidenced by excessive/frequent
gastric emptying.
- Overweight related to low physical activity and high fat intake evidenced by increased
waist circumference.

P: (Nutrition Intervention) Goals/Education

- Raise awareness & providing education over assessed problems

- Food journaling to asses daily food intake
- Improving diet by including all groups to achieve balanced diet and help select healthy
options to help reduce the risk of disease and overcome it.
- Follow DASH diet to overcome high blood pressure.
- Increasing fruit and vegetable intake at least 3 servings per day.
- Replace unhealthy foods with healthy ones; replacing saturated fat with unsaturated fat;
such as replacing butter/ ghee for cooking with olive oil. Taking low fat food such as
skimmed milk, lo fat yogurt, cottage cheese, omega-3 to improve cholesterol.
- Increase fiber intake by consumption of whole grains instead of refined products to
maintain GI functioning and healthy weight reduction
- Reducing sugar in diet, gradually step by step to avoid relapse and to cope with obesity.
- Increase physical activity by starting with less time and extending it gradually; start by at
least 15mins walk on first day and increasing to as much possible.
- Reducing the use of salt, while cooking by adding flavor through herbs and spices.
- Using healthy cooking methods; Boiling, baking, grilling instead of frying to reduce fat.
- Increasing fluid intake by tracking water intake through app/general or measured by
water bottle per day – at least 2 liter of fluid per day to prevent dehydration.
- Take foods high in iron to improve oxygen supply to the body as she suffer from lung
infection. These foods include beetroot, carrot, and liver.
- Take green tea twice a day, start with one cup, this will add antioxidants in diet which
will help prevent further spread of infection and green tea improves metabolism, reduce
cholesterol and help reduce extra weight.

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 ADIME
ASSESMENT
Food/Nutrition Related History: Nutrition Focus Physical Findings:
Client does not follow any specific diet to Client has weakness, finds herself lethargy,
improve her health problems. Instead, pass frequent stools, and experience sudden
consumes high fat diet. weight change.
She consume 7 servings of refined grains, 21 Her appetite is good, there is no signs of
servings of fruits and vegetables, 40 servings bleeding gums, menstrual difficulties and
of meat, and 7 servings of fat (mainly edema.
saturated) per week. She consumes high fat
dairy, meat and has little knowledge about
food selection.

Anthropometric Measurements: Comparative Standards:

Age: 55 years She is overweight, her BMI is 25.4 is a little
Weight: 65 kg higher than normal range. She needs to
Height: 5’3 change her diet in order to reduce weight and
BMI: 25.4 cholesterol.
Waist circumference: 34.1 inches.
Biomedical Data/Medical Nutrition Assessment, Monitoring &
Tests/Procedures: Evaluating Tools:
CBC: Lifestyle management form
Hemoglobin: 13.3 – normal 24hours recall/usual diet form.
Total WBC: 7900 – Normal Food frequency questionnaire.
Platelets: 261000 – Normal Anthropometric feedback form.
RBC Count: 5.72 – Normal Clients concerns and strength log
Hematocrit : 42.2 – Normal
Serology
Typhoid lgM – Negative
Urine report:
Physical Examination.
Colour – P.Yellow
Reaction/PH – 8 – Above normal
Albumin/blood/ketone – Absent

Client History:
Mrs. Pervaiz, age 55, weight 65kg, height 5’3,
is a house wife, who had lung infection from
which she has recovered recently and now has
cholesterol and is overweight. She have a
family history of diabetes, High cholesterol,
and hypertension.

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 DIAGNOSIS
Problem:
Cholesterol: excess intake of saturated fat leading to cholesterol levels high.
Obesity: Excess intake of fat and low physical activity leads to obesity.
Inadequate nutrient intake: has less nutritional information evidenced by her diet recall and
weakness.
Digestive problems: evidenced by frequent watery stools.
Bone weakness; evidenced by joint pain, especially during exercise.
Lung infection: evidenced by X-ray report and frequent coughing.
Etiology:
Cholesterol: Eating foods high in cholesterol, saturated and trans fats, little to no exercise
Hypertension: Lack of physical activity and high sodium intake
Lack of nutrient intake: due it imbalance diet; less whole grains, fruits and vegetables and more
fat diet.
Signs and Symptoms:
Blood pressure: client has frequent headaches and pounding feeling in head along with high
pressure value.
Low nutrient intake: weakness, bone and muscle pain, shortness of breath during exercise.
PES Statement:
High blood pressure related to less physical activity and as evidenced by frequent headaches.
Inadequate nutrient intake related high fat and low vegetable consumption evidenced by
weakness and joint pain.
Altered GI function related to frequent watery stools evidenced by excessive/frequent gastric
emptying.
Overweight related to low physical activity and high fat intake evidenced by increased waist
circumference.

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 INTERVENTION
Nutrition Intervention/Prescription/Goals: Prescription:
Food and nutrient delivery, - Increase amount of vegetables, fruits
and whole grains
Client is advised to increase fruit and vegetable - Add variety of healthy protein sources
intake while reducing fat intake by choosing like fish, sea food, legumes nuts and
healthy fat options like skimmed milk, low fat seeds
yogurt, nuts and using olive oil instead of - Increase fiber intake for improving GI
butter and ghee while cooking functioning – by eating whole grains,
fruits and vegetables with skin.
Take vitamin D supplements along with food - Increase physical activity gradually.
source like salmon fish. - Add iron rich foods to improve oxygen
Take iron rich foods to increase oxygen supply to lungs – carrots ,beetroot, liver
supply. etc.

Nutrition Education: Example:

- Increase consumption of fruits and
Raise awareness and provide information over vegetables, slowly increasing amount
concerned assessment problems. Food either by consumption of raw fruit and
journaling to asses daily intake of food. 24 vegetable or by trying new recopies.
hour recall/usual intake to asses daily food - Replace food with better options, this
consumption and analyze if ways to improve include:
her diet by including recommended food,  Replacing white bread with bran
servings and providing food guide pyramid and whole grain bread
and my plate charts.  Replacing butter and ghee by
using olive oil, canola oil and
With each food consumed that is not healthy, other better options for cooking
educate her about her adverse effects on health  Replace high fat foods with low
and giver her better options to select healthy fat ones; skimmed milk, low fat
food. yogurt, cottage cheese, use nuts.
 Use spices and herbs for flavor
instead of salt.
Add omega – 3 through flex seeds, chia seeds
or fatty fish in died
- Increase physical activity gradually bu
starting with 15 mins walk on first day
and gradually increasing it to 40 mins
- As she is unable to exercise due to busy
routine and joint pain, start with simple
steps like using stairs instead of
elevator. Parking at a distance and
walking to destination etc.
- Cook at home, try new recepies, if
eating out, ask for healthy options and
make alterations like instead of fried
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 ask for baked potatoes of other
vegetables, go for without cheese
options and ask for fresh juice without
sugar or plain water with meals instead
of soda drinks

Nutrition Counselling: Goal:

Monitor her daily diet through journaling, Diet to improve cholesterol and overall body
weight.
Slowly replace high fat food with low fat and
then eventually decreasing its amount. Try Diet to improve weakness due to recently
new dishes at home to avoid fast food and recovered lung infection
reserved food as they are high in fat, Increase water intake to maintain fluid
cholesterol and sodium. volume as to prevent dehydration due to
watery stools.
No judgmental comments are made, education Add exercise and increase physical activity to
and better advice are given considering her reduce weight and cholesterol.
issues and concerns.
Coordination of Nutrition Planning: Plan:
Using charts and informative leaflets and DASH Diet can b used to improve blood
videos increase awareness along with help and pressure, reduce cholesterol and excessive
support of spouse and family. body weight.

Breakfast:
 1 cup cooked oatmeal* topped with 1
teaspoon cinnamon
 1 slice whole-wheat toast
 1 teaspoon trans-free margarine
 1 banana
 1 cup fat-free milk
Lunch:
 Tuna salad made with:
 1/2 cup drained, unsalted water-packed
tuna, 3 ounces
 15 grapes
 1/4 cup diced celery
 Served on top of 2 1/2 cups romaine
lettuce
 8 Melba toast crackers
 1 cup fat-free milk
Dinner:
 Chicken and vegetable kebab, made
with:
 3 ounces of chicken

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  1 cup of peppers, onions, mushrooms
and cherry tomatoes
 1 cup cooked wild rice
 1/3 cup pecans
 1 cup pineapple chunks
 Cran-raspberry spritzer made with:
4 ounces cran-raspberry juice
4 to 8 ounces sparkling water
Snack (anytime)
1 cup light yogurt
1 medium peach
 To further reduce sodium in diet, do not
add salt when cooking the oatmeal.

MONITORING AND EVALUATION

Follow Up: Includes:
Will follow up the client every month to asses Assessing eating patterns and monitoring
attempted dietary changes. cholesterol levels along with blood pressure
and also assess recovery from weakness due to
lung infection.

6. Complete an Interview Assessment Form, Lifestyle Management Form 7.5. Do not fill
out portion C of the checklist.

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 7. What did you learn from this experience?
Ans. It was an overwhelming experience as we were able to communicate with the patient
knowing his problems and were able to educate her about healthy eating which helped her to
make healthy changes in diet to improve her health. We learned to take anthropometric
measurements, were able to asses her dietary patterns and analyzed it to make healthy changes.
Our patients showed interest, was comfortable and was willing to make changes. We were able
to make a healthy and positive relationship with our client. Our encouragement, mutual
understanding with client and advice in nonjudgmental way increased self-efficacy of our
client which motivated her to make changes in her lifestyle.

8. Attach completed copies of Lifestyle Management Forms 5.1, 5.2, 5.3, 5.4, 5.5, 5.6, 5.7
and 7.5.
Ans. The lifestyle management forms are attached below:

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 THE END

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