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ASSESSMENT OF NUTRITIONAL STATUS Mgr. Dana Hrnčířová, Ph.D. Dpt. of Nutrition, 3rd Faculty of Medicine, Charles University.

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Presentation on theme: "ASSESSMENT OF NUTRITIONAL STATUS Mgr. Dana Hrnčířová, Ph.D. Dpt. of Nutrition, 3rd Faculty of Medicine, Charles University."— Presentation transcript:

1 ASSESSMENT OF NUTRITIONAL STATUS Mgr. Dana Hrnčířová, Ph.D. Dpt. of Nutrition, 3rd Faculty of Medicine, Charles University

2 NUTRITIONAL STATUS (NS)  A part of general health status  Adequate = good balance between the body's needs and the intake of nutrients  Malnutrition  imbalance between the body's needs and the intake of nutrients

3 MALNUTRITION (broadly)  undernutrition,  overnutrition  specific deficiencies  develops in stages:  nutrient levels in blood and/or tissues change  intracellular changes in biochemical functions and structure  symptoms and signs appear (morbidity and mortality can result)

4 well-nourished person clinically under-nourished person clinically intoxicated person irreversible changes

5 UNDERNUTRITION  Protein Energy Malnutrition (PEM)  inadequate intake of macronutrients  Marasmus  deficiency of protein and non–protein nutrients  Kwashiorkor  protein deficiency (oedema)  Marasmic kwashiorkor  combined form of PEM

6 Causes of malnutrition  Loss of appetite, anorexia  Digestion and absorption disorders  Catabolic state – surgery, injuries, endocrine disorders  Loss of proteins and liquids by fistulas, injuries …  Pain  Stress  Infection  …

7 Consequences of Undernutrition PRIMARY:  Protracted wound healing  Increased tendency to infections (impaired immune functions)  Hypoproteinosis (oedema)  Decreased gut motility  Myosthenia (muscle failing)  Tendency to thrombosis, embolism  Urinary tract infections

8 SECONDARY:  increased morbidity  prolonged hospitalization time  prolonged recovery time  increased mortality Consequences of Undernutrition

9 ASSESSMENT OF NUTRITIONAL STATUS  1) Clinical assessment  nutritional and medical history, dietary assessment  physical examination  2) Biochemical Laboratory Tests  3) Anthropometric Measurements

10 NUTRITIONAL HISTORY  Inevitably intertwined with the medical history  Nutritional disorders  Basic illnesses  Nutrition related illnesses  Digestion (diarrhoea, constipation)  Weight (stable, variable)  Weight loss / gain  Loss of liquids?  Increased energy demand?

11 DIETARY ASSESSMENT  Past intake  24-hour recall (week and weekend day)  Food-frequency questionaire  Diet history / dietary patterns in last 6 months  Current intake  Estimated food records  Weighed food records  Smoking habits  Alcohol consumption  Cooking techniques (boiling, frying, grilling, roasting, …)

12 24 – Hour Record food/drinkquantity eatenfood/drinkquantity eaten morning meal snack 1 noon meal snack 2 evening meal late evening meal night meal

13 PHYSICAL EXAMINATION  Blood pressure (HT>140/90)  Fragility of gum capillaries (paradontosis, vit. C def.)  Somatoscopy

14 PHYSICAL EXAMINATION - somatoscopy  Skin – petechia, dermatitis, hyperkeratosis, seborea, hyperpigmentation, dry skin, oedema  Head – hair quality, xerophthalmia, lips-angular cheilitis, tongue- glositis, papilla atrophy, gums-bleeding, teeth-caries, spots  Neck – examination of thyroid gland  Chest – rib abnormalities, exudate  Abdomen – acsites, liver size  Limbs – oedemas, reflexes, sensation  Skeleton – deformities, fractures, pain  Skeletal muscle – atrophy

15 BIOCHEMICAL LABORATORY TESTS Serum proteins  Total protein: g/l  Albumin: > 35 g/l (malnutrition < 28 g/l)  Prealbumin  Transferin  Retinol binding protein

16 BIOCHEMICAL LABORATORY TESTS  Complete blood count (haematocrit, haemoglobin, RBC,WBC, lymphocytes, and differential count)  Lymphocyte count: Normal values> 1800/ μl Mildly reduced Moderately reduced Severely reduced < 900

17 BIOCHEMICAL LABORATORY TESTS Plasma lipids (primary prevention)  Triacylglycerides < 1,7 mmol/l  Total cholesterol < 5,0 mmol/l  LDL-cholesterol < 3,0 mmol/l  HDL-cholesterol > 1,0 mmol/l men > 1,2 mmol/l women

18 ANTHROPOMETRIC MEASUREMENTS  Indexes (to assess body weight)  Body circumferences  SkinFolds

19 Rohrer’s index (RI)  RI = body weight (gr) / height (cm) 3 x 100  standards: men 1,2 – 1,4 women 1,25 – 1,5

20 Body Mass Index (BMI)  BMI is often used as a predictor of future disease risk.  BMI = BODY WEIGHT (kg) / HEIGHT (m) 2  BMI as the sole criterion indicating overweight and obesity is only informative up to a certain point! WHO Classification BMI Underweight < 18,5 Desirable 18,5 - 24,9 Overweight 25,0 - 29,9 Grade 1 Obesity 30,0 - 34,9 Grade 2 Obesity 35,0 - 39,9 Grade 3 Obesity >40

21 BODY FAT DISTRIBUTION  Not whole body fat but its distribution determines risk of mortality and morbidity  ABDOMINAL FAT  Hyperinsulinemia, dyslipidaemia, hypertension, glucose intolerance  Increases risk of DM II., cardiovascular diseases  Waist circumference (WC)  Waist/hip ratio /WHR)

22 Waist Circumference  Perhaps better indicator of cardiovascular and metabolic risks of obesity compared with WHR Classificationincreased riskHigh risk Men> 94 cm> 102 cm Women> 80 cm> 88 cm

23 Classification of overweight and obesity according to BMI and WC In connection with the risk of some diseases Classification of body weight BMI (kg/m 2 ) Classification of obesity RISK OF DISEASES (relative to normal body weight and waist circumference) WAIST CIRCUMFERENCE men ≤ 102 cm women ≤ 88 cm men > 102 cm women > 88 cm underweight < 18,5 –– norm 18,5 - 24,9 –– overweight 25,0 - 29,9 increasedhigh obesity 30,0 - 34,9Ihighvery high 35,0 - 39,9IIvery high extreme obesity ≥ 40IIIextremely high

24 Waist to Hip Ratio (WHR)  Indicator of cardiovascular disease risk  Fat distributed mostly in the abdominal area is associated with higher morbidity and mortality due to cardiovascular disease.  Waist – with abdomen relaxed, horizontal measure taken at the level of the narrowest part of waist below bottom of rib cage and above umbilicus  Hips – while standing erect, horizontal measure taken at a level of maximum circumference of hips  WHR = waist circumference / hip circumference ClassificationModerately high riskHigh risk Men0,9 - 1,0> 1,0 Women0,8 - 0,85> 0,85

25 Mid–arm muscle area  Used to estimate lean body muscle mass  Derived from the TSF and the mid-arm circumference  Mid-arm circumference - midway between the olecranon process and the acromium, right arm in a relaxed position  Triceps skin fold - midway between the olecranon process and the acromium, on the posterior of the arm over the long head of the triceps brachii.  Mid–Arm Circumference (cm) – 0,314 x Triceps Skinfold (mm) Muscle MassAdequateMarginalDepletedWasted Men25,3 - 22,822,8 - 20,820,8 - 17,7< 17,7 Women23,2 - 20,920,9 - 18,618,6 - 16,2< 16,2

26 Measurement of skinfolds  Cheek – horizontal fold on a join tragus – nostrils, right bellow the temple  Jowl – vertical fold between chin and laryngeal prominence  Chest – anterior axillary fold (oblique). Diagonal fold taken ½ the distance between the anterior axillary line and the nipple (1/3 distance women).  Axilla – at the intersection of a horizontal line level with the 10th rib and the anterior axillary line.  Triceps – vertical fold on posterior midline of upper arm, midway between the acromion (bony tip of shoulder) and olecranon processes (elbow joint).  Biceps – the pinch position is at the same level as for triceps, though on the anterior (front) surface of arm.  Subscapula - 2 cm below the lower angle of the scapula (bottom point of shoulder blade) on a line running laterally and downwards (at about 45 degrees).  Abdominal – vertical fold, is made 5 cm adjacent to the umbilicus (belly-button) taken on a line running laterally to the spina iliaca anterior  Suprailiac – taken in the anterior axillary line immediately superior to the iliac crest  Thigh – vertical fold above patella  Calf – 5 cm below popliteal fossa

27 Practical training Body circumferences 1. Mid-Arm Circumference Mid-Arm Muscle Area 2. Waist Circumference 3. Hip Circumference WHR Skinfolds skinfolds % of body fat 2. 4 skinfolds % of body fat Bioelectric impedance (BIA)

28 Thank you for your attention.


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