1. Welcome to Seminar on Nutrition Assessment and Management in Family Medicine Part - 1 Meera Kaur, PhD, RD Assistant Professor, Family Medicine kaur@cc.umanitoba.ca

2. Objectives To understand the importance of routinely incorporating nutrition into clinical practice for all ages. To identify methods to assess the nutritional status of healthy clients and those with acute or chronic illness. To identify the prevalence, risk factors and usual physical findings associated with malnutrition and obesity. To assess which patient would benefit from additional nutrition counseling. To be timely- little amount of clinical time and a lot of ground to cover. 2

3. For all your nutrition needs… enable you to feel comfortable with basic nutrition questions asked by your patients. think about nutrition as a preventative health strategy, and to take action. know where and when to consult an RD. My Goals for you are to: 4

4. What is Nutrition Assessment? Nutrition Assessment is an in-depth evaluation of both objective and subjective data related to an individual’s food and nutrient intake, lifestyle and medical history 5

5. Why nutrition assessment is important? Nutrition-related diseases are leading causes of morbidity and mortality around the globe Increasing need for better preventative health strategies. –Want to find help for these people before it is too late. Most people’s eating habits can be improved. –Health Canada Canadian Community Health Survey : Nutrition (2006) –Malnutrition is common. 40-65% of hospitalized population are malnourished (Singh, Nutrition, 2006). 6

6. Canadian Community Health Survey (2006) Canadians consume: –31% of calories from fat. Main contributor is pizza, sandwiches, subs, burgers, hot dogs –70% of children, and 50% of adults do not eat enough fruits and vegetables. –33% of children and 67% adults do not get enough milk products. –59% of adults were overweight or obese. 10

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8. AH Mokdad, Unpublished data PT Katzmarzyk, Can Med Assoc J 166:1039-1040, 2002 No Data <10% 10%-14% 15-19%  20% Obesity Trends Among Canadian and U.S. Adults, 1985 7

9. Obesity Trends Among Canadian and U.S. Adults, 2000 AH Mokdad, Unpublished data PT Katzmarzyk, Can Med Assoc J 166:1039-1040, 2002 No Data <10% 10%-14% 15-19%  20% 8

10. Components of nutritional assessment What Nutrition Assessment includes: –Nutritional genomics –Anthropometrical measurement –Social/ life style assessment –Biochemical measurement –Clinical (Medical hx., Supplements, Diet/Social hx, Review of systems, Physical examination) –Subjective Global assessment 11

11. Nutritional Genomics –Nutritional genomics is a science studying the relationship between human genome, nutrition and health. It can be divided into two disciplines: –Nutrogenomics: studies the effect of nutrients on health through altering genome, proteome, metabolome and the resulting changes in physiology. –Nutrogenetics: studies the effect of genetic variations on the interaction between diet and health with implications to susceptible subgroups. 11

12. Anthropometrical Measurement Weight (Dry vs. Wet) Height Waist circumference vs. Body Mass Index –BMI is not a direct measure of body fatness, varies with body composition. –Can adjust for age. Waist Circumference allows us to assess body fatness >102 cm male and >88 cm women = increased health risk. Apple vs Pear Skinfold measurement 12

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15. 15 Measurements of lean body mass, body fat and bone mass

16. Social and Life Style Assessment Lifestyle assessment –Employment, exercise, who they live with/ who does grocery shopping and cooking. –Walking –Taking medications –Managing money –ETOH Special diets in past Dietary Hx –24-Hr Recall –Food frequency –Usual intake –Food record 16