Nutritional Assessment Chapter 11 Defining Nutritional Status Optimal

Nutritional Assessment Chapter 11

Defining Nutritional Status • • Optimal nutritional status Undernutrition Overnutrition Nutritional requirements at different ages – Infants and children – Adolescence – Pregnancy and lactation – Adulthood – The aging adult Slide 11 -2

Purposes and Components of Nutritional Assessment • Purposes of nutritional assessment • Nutrition screening – Admission nutrition screening tool – 24 -Hour diet recall – Food frequency questionnaire – Food diaries – Direct observation • Food guide pyramid Slide 11 -3

Subjective Data— Health History Questions • • • Eating patterns Usual weight Changes in appetite, taste, smell, chewing, swallowing Recent surgery, trauma, burns, infection Chronic illnesses Vomiting, diarrhea, constipation Food allergies or intolerances Medications and/or nutritional supplements Self-care behaviors Alcohol or illegal drug use Exercise and activity patterns Family history Slide 11 -4

Objective Data—Physical Exam • Equipment needed – Skinfold calipers—Lange or Harpenden – Measurement tape – Anthropometer – Pen or pencil – Nutrition assessment data form Slide 11 -5

Objective Data—Physical Exam (cont. ) • Anthropometric measures – Derived weight measures • Body weight as percent of ideal body weight • Percent usual body weight • Recent weight change Slide 11 -6

Objective Data—Physical Exam (cont. ) l Body mass index = Weight (kg) Height (m)2 or Weight (lbs) Height (in)2 x 705 l Waist-to-hip ratio = Waist circumference Hip circumference Slide 11 -7

Objective Data—Physical Exam (cont. ) • Skinfold thickness – Technique of measurement – Repeat three measurements and then take average • Mid-upper arm circumference (MAC) Slide 11 -8

Objective Data—Physical Exam (cont. ) • Derived anthropometric measures – Mid-upper arm muscle circumference (MAMC) MAMC = MAC – (p × TSF) – Mid-arm muscle area (MAMA) MAMA = (MAC – MAMA)2 4 p – Arm span or total arm length – Frame size by elbow breadth Slide 11 -9

Laboratory Studies in Nutritional Assessment • • • Hemoglobin Hematocrit Cholesterol Triglycerides Total lymphocyte count Skin testing Slide 11 -10 • Serum proteins – Serum albumin – Serum transferrin – Prealbumin • Nitrogen balance • Creatinine-height index

Abnormal Findings Classification of Malnutrition • • Obesity Marasmus (protein-calorie malnutrition) Kwashiorkor (protein malnutrition) Marasmus/kwashiorkor mix Slide 11 -11

Abnormal Findings Abnormalities Caused by Nutritional Deficiencies • • Pellagra Scorbutic gums Follicular hyperkeratosis Bitot’s spots Kwashiorkor Rickets Magenta tongue HIV-associated malnutrition Slide 11 -12