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NUTRITION ASSESSMENT Barbara Fine RD, LDN. Malnutrition in Hospitalized Patients Consequences: Consequences: Poor wound healing Poor wound healing Higher.

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Presentation on theme: "NUTRITION ASSESSMENT Barbara Fine RD, LDN. Malnutrition in Hospitalized Patients Consequences: Consequences: Poor wound healing Poor wound healing Higher."— Presentation transcript:

1 NUTRITION ASSESSMENT Barbara Fine RD, LDN

2 Malnutrition in Hospitalized Patients Consequences: Consequences: Poor wound healing Poor wound healing Higher rate of infections Higher rate of infections Greater length of stay (readmission for elderly) Greater length of stay (readmission for elderly) Increased costs Increased costs Increased morbidity and mortality Increased morbidity and mortality Suboptimal surgical outcome Suboptimal surgical outcome

3 Nutrition Assessment Collecting, integrating, and analyzing nutrition-related data Collecting, integrating, and analyzing nutrition-related data Including food-drug interactions, cultural, religious and ethnic food preferences, age related nutrition issues and the need for diet counseling Including food-drug interactions, cultural, religious and ethnic food preferences, age related nutrition issues and the need for diet counseling Dietitian to evaluate patient’s nutritional status and the extent of any malnutrition Dietitian to evaluate patient’s nutritional status and the extent of any malnutrition Data gathered will provide the objective basis for recommendations and evaluation of care Data gathered will provide the objective basis for recommendations and evaluation of care Includes a chart review and patient interview Includes a chart review and patient interview

4 Purpose of Nutrition Assessment Estimates functional status, diet intake and body composition compared to normal populations Estimates functional status, diet intake and body composition compared to normal populations Body composition reflects calorie and protein needs Body composition reflects calorie and protein needs Nutritional status predicts hospital morbidity, mortality, length of stay, cost Nutritional status predicts hospital morbidity, mortality, length of stay, cost Baseline body composition and biochemical markers determine if nutrition support is effective Baseline body composition and biochemical markers determine if nutrition support is effective

5 Nutrition Screening Includes height, weight, unintentional weight loss, change in appetite and serum albumin Includes height, weight, unintentional weight loss, change in appetite and serum albumin Data used to determine patients at nutritional risk and the need for a detailed assessment Data used to determine patients at nutritional risk and the need for a detailed assessment Nutrition care plan developed to reflect calorie, protein and other nutrient needs from the information collected Nutrition care plan developed to reflect calorie, protein and other nutrient needs from the information collected Implement plan Implement plan Monitor and revise as needed Monitor and revise as needed

6 Screening: Nutrition Care Indicators Nutritional history Nutritional history Appetite Appetite Nausea/vomiting (>3 days) Nausea/vomiting (>3 days) Diarrhea Diarrhea Dysphagia Dysphagia Reduced food intake (<50% of normal for 5 days) Reduced food intake (<50% of normal for 5 days) Feeding modality Feeding modality TPN/PPN TPN/PPN TF TF Diet restrictions Diet restrictions Unintentional Weight Loss Unintentional Weight Loss >10 lbs in past 3 months >10 lbs in past 3 months Serum Albumin Serum Albumin Diagnosis Diagnosis Cachexia, end-stage liver or kidney disease, coma, malnutrition, decubitis ulcers, cancer of GI tract, Crohns, Cystic Fibrosis, new onset diabetes, eating disorder Cachexia, end-stage liver or kidney disease, coma, malnutrition, decubitis ulcers, cancer of GI tract, Crohns, Cystic Fibrosis, new onset diabetes, eating disorder Above used to determine nutritional risk and need for referral to RD Above used to determine nutritional risk and need for referral to RD

7 Components of Nutrition Assessment Medical and social history Medical and social history Diet history and intake Diet history and intake Clinical examination Clinical examination Anthropometrics Anthropometrics Biochemical data Biochemical data

8 Medical and Social History Gathered from chart review and patient interview Gathered from chart review and patient interview Medical history: diagnosis, past medical and surgical history, pertinent medications, alcohol and drug use, bowel habits Medical history: diagnosis, past medical and surgical history, pertinent medications, alcohol and drug use, bowel habits Psychosocial data: economic status, occupation, education level, living and cooking arrangements, mental status Psychosocial data: economic status, occupation, education level, living and cooking arrangements, mental status Other: age, sex, level of physical activity, daily living activities Other: age, sex, level of physical activity, daily living activities

9 Dietary History and Intake Appetite and intake: taste changes, dentition, dysphagia, feeding independence, vitamin/mineral supplements Appetite and intake: taste changes, dentition, dysphagia, feeding independence, vitamin/mineral supplements Eating patterns: daily and weekend, diet restrictions, ethnicity, eating away from home, fad diets Eating patterns: daily and weekend, diet restrictions, ethnicity, eating away from home, fad diets Estimation of typical calorie and nutrient intake: RDAs, Food Guide Pyramid Estimation of typical calorie and nutrient intake: RDAs, Food Guide Pyramid Obtain diet intake from 24-hour recall, food frequency questionnaire, food diary, observation of food intake Obtain diet intake from 24-hour recall, food frequency questionnaire, food diary, observation of food intake

10 Diet Assessment Evaluate what and how much person is eating, as well as habits, beliefs and social conditions that may put person at risk Evaluate what and how much person is eating, as well as habits, beliefs and social conditions that may put person at risk Usual intake Usual intake 24 hr recall: retrospective, easy 24 hr recall: retrospective, easy Food logs: prospective, requires motivation Food logs: prospective, requires motivation Food frequency questionnaire: general idea of how often foods are consumed Food frequency questionnaire: general idea of how often foods are consumed Compare to estimation of needs Compare to estimation of needs

11 Nutritional Questions for the Review of Systems General General Usual adult weight Usual adult weight Current weight Current weight Maximum, minimum weights Maximum, minimum weights Weight change 1 and 5 years prior Weight change 1 and 5 years prior Recent changes in weight and time period Recent changes in weight and time period Recent changes in appetite or food tolerance Recent changes in appetite or food tolerance Presence of weakness, fatigue, fever, chills, night sweats Presence of weakness, fatigue, fever, chills, night sweats Recent changes in sleep habits, daytime sleepiness Recent changes in sleep habits, daytime sleepiness Edema and/or abnormal swelling Edema and/or abnormal swelling

12 Nutritional Questions for the Review of Systems Alimentary Alimentary Abdominal pain, nausea, vomiting Abdominal pain, nausea, vomiting Changes in bowel pattern (normal or baseline) Changes in bowel pattern (normal or baseline) Diarrhea (consistency, frequency, volume, color, presence of cramps, food particles, fat drops) Diarrhea (consistency, frequency, volume, color, presence of cramps, food particles, fat drops) Difficulty swallowing (solids vs. liquids, intermittent vs. continuous) Difficulty swallowing (solids vs. liquids, intermittent vs. continuous) Early satiety Early satiety Indigestion or heartburn Indigestion or heartburn Food intolerance or preferences Food intolerance or preferences Mouth sores (ulcers, tooth decay) Mouth sores (ulcers, tooth decay) Pain in swallowing Pain in swallowing Sore tongue or gums Sore tongue or gums

13 Nutritional Questions for the Review of Systems Neurologic Neurologic Confusion or memory loss Confusion or memory loss Difficulty with night vision Difficulty with night vision Gait disturbance Gait disturbance Loss of position sense Loss of position sense Numbness and/or weakness Numbness and/or weakness Skin Skin Appearance of a diagnostic rash Appearance of a diagnostic rash Breaking of nails Breaking of nails Dry skin Dry skin Hair loss, recent change in texture Hair loss, recent change in texture

14 Clinical Examination Identifies the physical signs of malnutrition Identifies the physical signs of malnutrition Temporal wasting Temporal wasting Signs do not appear unless severe deficiencies exist Signs do not appear unless severe deficiencies exist Most signs/symptoms indicate two or more deficiencies Most signs/symptoms indicate two or more deficiencies Examples: see list attached Examples: see list attached Hair: easily plucked, thin; protein or biotin deficiency Hair: easily plucked, thin; protein or biotin deficiency Mouth: tongue fissuring (niacin), decreased taste/smell (zinc) Mouth: tongue fissuring (niacin), decreased taste/smell (zinc)

15 Anthropometrics Inexpensive, noninvasive, easy to obtain, valuable with other parameters Inexpensive, noninvasive, easy to obtain, valuable with other parameters Height, weight and weight changes Height, weight and weight changes Segmental lengths, fat folds and various body circumferences and areas Segmental lengths, fat folds and various body circumferences and areas Repeated periodically to note changes Repeated periodically to note changes Individuals serve as own standard Individuals serve as own standard Changes are not obvious for 3-4 weeks Changes are not obvious for 3-4 weeks

16 Disadvantages of Anthropometrics Intra and interobserver error Intra and interobserver error Changes in composition of patient’s tissues Changes in composition of patient’s tissues Inaccurate application of raw data Inaccurate application of raw data Measurements are evaluated by comparing them with predetermined reference limits that allow for classification into risk categories Measurements are evaluated by comparing them with predetermined reference limits that allow for classification into risk categories

17 Anthropometrics Height-measured Height-measured Commonly overestimated in men and underestimated in women Commonly overestimated in men and underestimated in women Estimates for bedridden or wheelchair bound Estimates for bedridden or wheelchair bound Arm span, recumbent length Arm span, recumbent length Knee-height with calipers Knee-height with calipers Weight-measured Weight-measured Effect of fluid status Effect of fluid status Edema and ascites falsely elevate weight Edema and ascites falsely elevate weight Weight history Weight history Weight change over time Weight change over time

18 Anthropometrics Ideal body weight Ideal body weight Males: 106 lbs + 6 lbs per inch over 5 ft Males: 106 lbs + 6 lbs per inch over 5 ft Females: 100 lbs + 5 lbs per inch over 5 ft Females: 100 lbs + 5 lbs per inch over 5 ft Add 10% for large-framed and subtract 10% for small- framed Add 10% for large-framed and subtract 10% for small- framed %IBW = (current wt/IBW) X 100 %IBW = (current wt/IBW) X % mild malnutrition 80-90% mild malnutrition 70-79% moderate malnutrition 70-79% moderate malnutrition 60-69% severe malnutrition 60-69% severe malnutrition <60% non-survival <60% non-survival

19 Anthropometrics %UBW: usual body weight %UBW: usual body weight = (current wt/UBW) X 100 = (current wt/UBW) X % mild malnutrition 85-95% mild malnutrition 75-84% moderate malnutrition 75-84% moderate malnutrition 0-74% severe malnutrition 0-74% severe malnutrition % weight change = usual weight – present weight/usual weight X 100 % weight change = usual weight – present weight/usual weight X 100 Significant weight loss Significant weight loss >5% in 1 month >5% in 1 month >10% in 6 months >10% in 6 months

20 Body Mass Index = BMI Evaluation of body weight independent of height Evaluation of body weight independent of height BMI = weight (kg)/height 2 (m) BMI = weight (kg)/height 2 (m) >40obesity III >40obesity III 30-40obesity II 30-40obesity II 25-30overweight 25-30overweight normal normal PEM I PEM I PEM II PEM II <16PEM III <16PEM III

21 Health Risk and Central Obesity Upper body obesity = increased risk Upper body obesity = increased risk Waist > 35 inches in females Waist > 35 inches in females Waist > 40 inches in males Waist > 40 inches in males Clinically significant for BMI Clinically significant for BMI BMI >35 health risk high and not increased further by waist circumference BMI >35 health risk high and not increased further by waist circumference

22 Frame Size Determined using wrist circumference and elbow breadth Determined using wrist circumference and elbow breadth Determines the optimal weight for height to be adjusted to a more accurate estimate Determines the optimal weight for height to be adjusted to a more accurate estimate Wrist circumference: measures the smallest part of the wrist distal to the styloid process of the ulna and radius Wrist circumference: measures the smallest part of the wrist distal to the styloid process of the ulna and radius Elbow breadth: measures the distance between the two prominent bones on either side of the elbow Elbow breadth: measures the distance between the two prominent bones on either side of the elbow

23 Skinfold Thickness Estimates subcutaneous fat stores to estimate total body fat Estimates subcutaneous fat stores to estimate total body fat Compared with percentile standards from multiple body sites or collected over time Compared with percentile standards from multiple body sites or collected over time Triceps, biceps, subscapular, and suprailiac using calipers are most commonly used Triceps, biceps, subscapular, and suprailiac using calipers are most commonly used Disadvantages: total body fluid overload, caliper calibration, inter-individual variability Disadvantages: total body fluid overload, caliper calibration, inter-individual variability

24 Body Circumferences and Areas Estimates skeletal muscle mass (somatic protein stores and body fat stores Estimates skeletal muscle mass (somatic protein stores and body fat stores Midarm or upper arm circumference (MAC): on the upper arm at the midpoint between the tip of the acromial process of the scapula and the olecranon process of the ulna Midarm or upper arm circumference (MAC): on the upper arm at the midpoint between the tip of the acromial process of the scapula and the olecranon process of the ulna Midarm muscle or arm muscle circumference (MAMC): determined from the MAC and triceps skinfold (TSF) Midarm muscle or arm muscle circumference (MAMC): determined from the MAC and triceps skinfold (TSF) MAMC = MAC – (3.14 X TSF) MAMC = MAC – (3.14 X TSF) Total upper arm area: determines upper arm fat stores Total upper arm area: determines upper arm fat stores Upper arm muscle mass provides a good indication of lean body mass, used in the calculation of upper arm fat area Upper arm muscle mass provides a good indication of lean body mass, used in the calculation of upper arm fat area Upper arm fat area: calculation may be a better indicator of changes in fat stores than TSF Upper arm fat area: calculation may be a better indicator of changes in fat stores than TSF

25 Bioelectrical Impedance Analysis (BIA) Measures electrical conductivity through water in difference body compartments Measures electrical conductivity through water in difference body compartments Uses regression equations to determine fat and LBM Uses regression equations to determine fat and LBM Serial measures can track changes in body composition Serial measures can track changes in body composition Obesity treatments Obesity treatments

26 DEXA: dual-energy X-ray absorptiometry Whole body scan with 2 x-rays of different intensity Whole body scan with 2 x-rays of different intensity Computer programs estimate Computer programs estimate Bone mineral density Bone mineral density Lean body mass Lean body mass Fat mass Fat mass “Best estimate” for body composition of clinically available methods “Best estimate” for body composition of clinically available methods

27 Anthropometrics: additional methods Research methods: precise, but cost prohibitive Research methods: precise, but cost prohibitive Total body potassium Total body potassium Underwater weight (hydrodensitometry) Underwater weight (hydrodensitometry) Deuterated water dilution Deuterated water dilution Muscle strength and endurance Muscle strength and endurance

28 Biochemical Data Used to assess body stores Used to assess body stores Altered by lack of nutrients, medications, metabolic changes during illness or stress Altered by lack of nutrients, medications, metabolic changes during illness or stress Interpret results carefully Interpret results carefully Fluid status distorts results Fluid status distorts results “Stressed” states (infection, surgery) effects results “Stressed” states (infection, surgery) effects results Use reference values established by individual lab Use reference values established by individual lab

29 Visceral Proteins Produced by the liver Produced by the liver Affected by protein deficiency, but also renal and hepatic disease, wounds and burns, infections, zinc and energy deficiency, cancer, inflammation, hydration status, and stress Affected by protein deficiency, but also renal and hepatic disease, wounds and burns, infections, zinc and energy deficiency, cancer, inflammation, hydration status, and stress

30 Albumin Half life days Half life days Normal value g/DL Normal value g/DL Most widely used indicator of nutritional status Most widely used indicator of nutritional status Acute phase response: levels decrease in response to stress (infection, injury) Acute phase response: levels decrease in response to stress (infection, injury) Affected by volume Affected by volume Increases with dehydration, decreases with edema and overhydration Increases with dehydration, decreases with edema and overhydration

31 Prealbumin Better measure of nutritional status due to shorter half-life, ~2 days Better measure of nutritional status due to shorter half-life, ~2 days Normal value: mg/DL Normal value: mg/DL Responds within days to nutritional repletion Responds within days to nutritional repletion Levels affected by trauma, acute infections, liver and kidney disease; highly sensitive to minor stress and inflammation Levels affected by trauma, acute infections, liver and kidney disease; highly sensitive to minor stress and inflammation

32 C-reactive protein Positive acute phase respondent Positive acute phase respondent Increases early in acute stress as much as fold Increases early in acute stress as much as fold Decreased correlates with end of acute phase and beginning of anabolic phase where nutritional repletion is possible Decreased correlates with end of acute phase and beginning of anabolic phase where nutritional repletion is possible

33 Creatinine Height Index Estimates LBM Estimates LBM = actual creat excretion (24 hour urine collection) = actual creat excretion (24 hour urine collection) expected creat excretion expected creat excretion Males: IBW X 23 mg/kg Males: IBW X 23 mg/kg Females: IBW X 18 mg/kg Females: IBW X 18 mg/kg >80% normal >80% normal 60-80% moderately depleted 60-80% moderately depleted <60% severely depleted <60% severely depleted Accurate 24-hr urine collection is difficult to obtain in acute- care setting Accurate 24-hr urine collection is difficult to obtain in acute- care setting

34 Hematological Indices Determine nutritional anemias Determine nutritional anemias Transferrin: Fe transport protein Transferrin: Fe transport protein TIBC: total Fe binding capacity TIBC: total Fe binding capacity Indicates number of free binding cites on transferrin Indicates number of free binding cites on transferrin Fe deficiency: increased transferrin levels, decreased saturation Fe deficiency: increased transferrin levels, decreased saturation Ferritin: Fe storage protein, increases during inflammation Ferritin: Fe storage protein, increases during inflammation Depressed hemoglobin is an indicator of Fe deficiency anemia Depressed hemoglobin is an indicator of Fe deficiency anemia

35 Nitrogen balance Goal for repletion is a positive nitrogen balance Goal for repletion is a positive nitrogen balance 24-hr record of protein intake and urine collection is required 24-hr record of protein intake and urine collection is required Done within 48 hr after initiation of nutrition therapy Done within 48 hr after initiation of nutrition therapy Results not valid in conditions with high protein losses (burns or high-output fistulas) Results not valid in conditions with high protein losses (burns or high-output fistulas) N balance = protein intake/6.25 – (urinary urea N + 3 or 4) N balance = protein intake/6.25 – (urinary urea N + 3 or 4)

36 Estimation of Nutrient Needs Predictive equation for energy (calorie) needs Predictive equation for energy (calorie) needs Harris Benedict uses age, height, and weight to estimate basal energy expenditure (BEE), the minimum amount of energy needed by the body at rest in fasting state Harris Benedict uses age, height, and weight to estimate basal energy expenditure (BEE), the minimum amount of energy needed by the body at rest in fasting state In men: In men: BEE (kcal/day) = (13.8 X W) + (5.0 X H) – (6.8 X A) In women: In women: BEE (kcal/day) = (9.6 X W) + (1.8 X H) – (4.7 X A) Where W = weight in kilograms, H = height in centimeters and A = age in years Where W = weight in kilograms, H = height in centimeters and A = age in years BEE is multiplied by an activity factor and injury factor to predict total daily energy expenditure BEE is multiplied by an activity factor and injury factor to predict total daily energy expenditure

37 Activity Categories Confined to bed = Confined to bed = Out of bed = 1.3 Out of bed = 1.3 Very light = 1.3 Very light = 1.3 Light = 1.5 (women), 1.6 (men) Light = 1.5 (women), 1.6 (men) Moderate = 1.6 (women), 1.7 (men) Moderate = 1.6 (women), 1.7 (men) Heavy = 1.9 (women), 2.1 (men) Heavy = 1.9 (women), 2.1 (men)

38 Injury Categories Surgery Surgery Minor = Minor = Major = Major = Infection Infection Mild = Mild = Moderate = Moderate = Severe = Severe = Trauma Trauma Skeletal = Skeletal = Blunt = Blunt = Head trauma treated with steroids = 1.6 Head trauma treated with steroids = 1.6 Burns Burns Up to 20% body surface area (BSA) = Up to 20% body surface area (BSA) = % BSA = % BSA = Over 40% BSA = Over 40% BSA =

39 Energy Needs Quick rule of thumb Quick rule of thumb Also calculated based on weight in kilograms and adjusted for activity level Also calculated based on weight in kilograms and adjusted for activity level kcal/kg for acute illness, minimally active, overweight, > kcal/kg for acute illness, minimally active, overweight, >80 Adjusted body weight Adjusted body weight kcal/kg for young, active kcal/kg for young, active

40 Indirect calorimetry/Metabolic Cart Measures CO 2 produced and O 2 consumed in critically ill patients on ventilators Measures CO 2 produced and O 2 consumed in critically ill patients on ventilators Calculates resting metabolic rate based on gas exchange Calculates resting metabolic rate based on gas exchange Respiratory quotient calculated Respiratory quotient calculated Corresponds to oxidation of nutrients Corresponds to oxidation of nutrients CHO: 1:1 ratio of CO 2 produced/O 2 consumed CHO: 1:1 ratio of CO 2 produced/O 2 consumed Lipid: 0.7:1 ratio Lipid: 0.7:1 ratio Protein: 0.82:1 ratio Protein: 0.82:1 ratio Mixed diet: 0.85:1 ratio Mixed diet: 0.85:1 ratio Overfeeding/lipogenesis: >1.0 Overfeeding/lipogenesis: >1.0

41 Protein Needs Determined based on clinical condition and body weight in kilograms Determined based on clinical condition and body weight in kilograms Normal - RDA: 0.8 g/kg for adult Normal - RDA: 0.8 g/kg for adult Fever, fracture, infection, wound healing: Fever, fracture, infection, wound healing: Protein repletion: Protein repletion: Burns: Burns: Typically use range of g/kg Typically use range of g/kg Decreased protein needs in acute renal failure Decreased protein needs in acute renal failure Comparison of intake to needs will indicate intervention required Comparison of intake to needs will indicate intervention required

42 Subjective Global Assessment Alternative method to assess nutritional status of hospitalized patients Alternative method to assess nutritional status of hospitalized patients Combines information from the patient’s history with parts of a clinical exam Combines information from the patient’s history with parts of a clinical exam

43 Subjective Global Assessment History History Unintentional weight loss over the past 6 months Unintentional weight loss over the past 6 months Pattern and amount of weight loss is considered Pattern and amount of weight loss is considered Weight change in past 2 weeks Weight change in past 2 weeks Weight of 10% is significant Weight of 10% is significant Dietary intake change (relative to normal) Dietary intake change (relative to normal) GI symptoms >2 weeks (nausea, vomiting, diarrhea, anorexia) GI symptoms >2 weeks (nausea, vomiting, diarrhea, anorexia) Functional capacity (energy level: daily activities, bedridden) Functional capacity (energy level: daily activities, bedridden) Metabolic demands of primary condition noted Metabolic demands of primary condition noted

44 Subjective Global Assessment Physical Exam Physical Exam Each feature is noted as normal, mild, moderate, or severe based on clinician’s subjective impression Each feature is noted as normal, mild, moderate, or severe based on clinician’s subjective impression Loss of subcutaneous fat measures in the triceps and the mid-axillary line at the lower ribs Loss of subcutaneous fat measures in the triceps and the mid-axillary line at the lower ribs Muscle wasting in the quadriceps and deltoid area Muscle wasting in the quadriceps and deltoid area Presence of edema in ankle or sacral region Presence of edema in ankle or sacral region Presence of ascites Presence of ascites

45 SGA Rating Determined by subjective weighting Determined by subjective weighting May choose to place more emphasis on weight loss, poor dietary intake, subcutaneous tissue loss, muscle wasting May choose to place more emphasis on weight loss, poor dietary intake, subcutaneous tissue loss, muscle wasting Must be trained in this technique to achieve consistency Must be trained in this technique to achieve consistency Scoring may predict development of infection more accurately than other objective measures of nutritional status (albumin) Scoring may predict development of infection more accurately than other objective measures of nutritional status (albumin) A = well nourished (60% reduction in post-op complications) A = well nourished (60% reduction in post-op complications) B = moderately malnourished ( at least 5% wt loss with decreased intake and subcutaneous loss) B = moderately malnourished ( at least 5% wt loss with decreased intake and subcutaneous loss) C = severely malnourished (4X more post op complications, 10% wt loss and physical signs of malnutrition) C = severely malnourished (4X more post op complications, 10% wt loss and physical signs of malnutrition) Ascites and edema decrease significance of body weight Ascites and edema decrease significance of body weight

46 Subjective Global Assessment Advantages Advantages Predicts post-surgical complications Predicts post-surgical complications Does not require lab testing Does not require lab testing Can be taught to a broad range of health professionals Can be taught to a broad range of health professionals Compares favorably with objective measurements Compares favorably with objective measurements Validated in liver transplant, dialysis, and HIV patients Validated in liver transplant, dialysis, and HIV patients Disadvantages Disadvantages Subjective and dependent on the experience of the observer Subjective and dependent on the experience of the observer Not sensitive enough to use in following nutrition progress Not sensitive enough to use in following nutrition progress

47 Nutrition Screening Initiative From 1991, is a checklist for the elderly to use in early identification of common nutrition problems From 1991, is a checklist for the elderly to use in early identification of common nutrition problems 9 warning signs of poor nutritional status 9 warning signs of poor nutritional status Disease, poor eating pattern, tooth loss/mouth pain, economic hardship, reduced social contact, multiple medications, involuntary weight loss/gain, a need for assistance in self care, and older than 80 Disease, poor eating pattern, tooth loss/mouth pain, economic hardship, reduced social contact, multiple medications, involuntary weight loss/gain, a need for assistance in self care, and older than 80 When concerns are identified, interventions are suggested When concerns are identified, interventions are suggested Goal is to provide appropriate intervention before health and quality of life are seriously impaired Goal is to provide appropriate intervention before health and quality of life are seriously impaired


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