1. Assessment of Nutritional Status Dr. Ghada Essam Eldin Amin Assistant prof.of public health Faculty of Medicine- Ain Shams University

2. Assessment of Nutritional Status Objectives of nutritional assessment: To determine the Magnitude & Geographical distribution of malnutrition. To determine the underlying tools of nutritional assessment.

4. Undernutrition contributes to half of all deaths in children under 5 and is widespread in Asia and Africa Percentage of under-five children who are stunted, 2008 - 2013 Source: UNICEF/WHO/World Bank Joint Child Malnutrition Estimates, 2014. -See more at: http://data.unicef.org/nutrition/malnutrition#inline1http://data.unicef.org/nutrition/malnutrition#inline1

5. Assessment of Nutritional Status Direct Tools: Dietary Surveys Clinical Examination Anthropometry Biochemical tests Indirect Tools Morbidity & Mortality Rates Ecological Factors Magnitude of Health services

6. Tools of Nutritional Assessment I - Direct tools, A.Dietary survey B. Clinical examination C. Nutritional Anthropometry D. Biochemical tests. II) Indirect tools: Vital health Statistics and morbidity and mortality rates of malnutritional diseases III) Tools or assessment of ecological factors

7. A) Dietary surveys Need improved national statistics on food & agriculture. Shows the distribution of National food supply among different groups of the population during different seasons and the consumption of food by each individual (per capita). Use representative samples.

8. Dietary surveys Carried on -Community level (food balanced sheet) -Family level -Specific groups -Individuals -Family surveys: The family members are recorded according to – age, sex., and occupation. Food consumption over a week or month, is measured.

9. Disadvantages - Failure of house wives to record or recall, they exaggerate in recalling the food intake of the family. -Individual survey: it is either quantitatively over 24 hours or qualitatively measured. -Specific groups: Feeding of vulnerable groups as Pregnant, lactating Infants & children and elderly.

10. B) Clinical examination Depends on signs observed on Epithelial – tissues as Skin, eyes, hair, buccal mucosa Organs near the surface as thyroid gland : goitre (enlargement of thyroid gland). Disadvantages –Non specific as clinical signs may also be caused by environmental factors as, dryness of skin of extremities Xeroxes in the very hot dry or windy regions

11. Source: Copyright © 2003 Delmar Learning, a Thomson Learning company 11 Clinical Examination Clinical SignsPossible Deficiencies Pallor, blue half circles beneath eyes Iron, copper, zinc, B12, B6, biotin EdemaProtein Bumpy “gooseflesh”Vitamin A Lesions at corner of mouth Riboflavin GlossitisFolic acid

12. 12 Clinical Examination Clinical SignsPossible Deficiencies Numerous “black and blue” spots and tiny, red “pin prick” hemorrhages under the skin Vitamin C Emaciation Carbohydrates, proteins; kcal

13. 13 Clinical Examination Clinical SignsPossible Deficiencies Poorly shaped bones or teeth or delayed appearance of teeth in children Vitamin C Slow clotting time of blood Vitamin K

14. Copyright © 2003 Delmar Learning, a Thomson Learning company 14 Clinical Examination Clinical SignsPossible Deficiencies Unusual nervousness, dermatitis, diarrhea in same patient Niacin TetanyCalcium, potassium, sodium GoiterIodine EczemaFat

15. C) Anthropometry Growth during childhood & adolescence, is greatly affected by nutrition

16. 16 Anthropometric Measurements Height Weight Head circumference (children) Upper arm measurement Skin fold thickness

17. Selective body measurements -weight & height Weight: The key measure Best compared to local standards or reference population Height: sum of 4: leg, pelvis, spines and skull. Length: used in ages less than 2 years. They are plotted on growth chart in relation to age as weight for age, height for age.

18. Growth Charts

19. 19 Anthropometric Measurements Height Weight

20. 20 Anthropometric Measurements Head circumference Triceps skinfold

21. Midarm circumference

22. D) Biochemical Examination Serum or plasma Total proteins or amino acids Vitamin A & carotene- Vit C – B12 Iron, serum Fe & transferrin Red cell count and Hemoglobin RBCs for Riboflavin. Urine: Creatinine, thiamin, riboflavin and urea

23. Immunological tests: Total lymphocytic count - >1200 normal -<800 severe nutritional deficiency Skin tests: delayed cell mediated Immunity Humoral immunity: Decreased or Absent response.

24. II - Indirect Nutritional Assessment Mortality rates : - Infant mortality rate(IMR) -Mortality of children <5 years -Ratio of Death of < 5 years to Total deaths -Perinatal mortality rate -Cause specific Mortality rate Morbidity rates: Infections rates of communicable diseases

25. III - Assessment of Ecological factors : Information about : Number and Quality of Health care centers National feeding habits Socio economic factors Income and food prices. Number of hospitals and health centers