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1 Assessing Nutritional status Dr. Shivananda Nayak Faculty of Medical Sciences The University of The West Indies The nutritional status of an individual.

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Presentation on theme: "1 Assessing Nutritional status Dr. Shivananda Nayak Faculty of Medical Sciences The University of The West Indies The nutritional status of an individual."— Presentation transcript:

1 1 Assessing Nutritional status Dr. Shivananda Nayak Faculty of Medical Sciences The University of The West Indies The nutritional status of an individual is the result of many interrelated factors It is influenced by food intake, quality, quantity and physical health The spectrum of nutritional status spread from obesity to malnutrition

2 2 Why Nutritional assessment required It is required to: Develop health care programs which meet the community needs which are defined by the assessment Develop health care programs which meet the community needs which are defined by the assessment Measure the effectiveness of the nutritional programs and intervention once initiated Measure the effectiveness of the nutritional programs and intervention once initiated Methods of nutritional assessment It is assessed by direct and indirect methods

3 3 The direct method Deal with the individual and measure objective criteria Summarized as ABCD Anthropometric methods Anthropometric methods Biochemical and laboratory methods Biochemical and laboratory methods Clinical methods Clinical methods Dietary evaluation methods Dietary evaluation methods Indirect methods of nutritional assessments Uses community health indices that reflects nutritional influences Uses community health indices that reflects nutritional influences These include Ecological variables including crop production Ecological variables including crop production Economic factors e.g. per capita income, population density and social habits Economic factors e.g. per capita income, population density and social habits Vital health statistics particularly infant under 5 mortality and fertility index Vital health statistics particularly infant under 5 mortality and fertility index

4 4 Clinical assessment method It is an essential feature of all nutritional surveys It is an essential feature of all nutritional surveys Simplest and most practical method of ascertaining the nutritional status of a group of individuals Simplest and most practical method of ascertaining the nutritional status of a group of individuals It utilizes a number of physical signs that are known to be associated with malnutrition & deficiency of vitamins & micronutrients It utilizes a number of physical signs that are known to be associated with malnutrition & deficiency of vitamins & micronutrients

5 5 General clinical examinations, with special attention to organs, like hair, nails, skin, gums, eyes, muscles, tongue, angles of mouth and thyroid gland General clinical examinations, with special attention to organs, like hair, nails, skin, gums, eyes, muscles, tongue, angles of mouth and thyroid gland Detection of relevant signs helps in establishing the nutritional diagnosis Detection of relevant signs helps in establishing the nutritional diagnosis Advantages of Clinical assessment Fast and easy to perform Fast and easy to perform Inexpensive Inexpensive Non-invasive Non-invasiveLimitations May not detect the early stages May not detect the early stages

6 6 Anthropometric measurements Anthropometry is the measurement of body weight and proportions It is an essential part of clinical examination of infants, children and pregnant woman It is also used to evaluate both under and over nutrition The measured values reflect the current nutritional status.

7 7 Other anthropometric measurements: Mid-upper arm circumference Mid-upper arm circumference Head circumference Head circumference Skin fold thickness Skin fold thickness Head/chest ratio Head/chest ratio Hip/waist ratio Hip/waist ratio Anthropometry for children Accurate measurement of height and weight is necessary to evaluate the physical growth of the child Ht/Age: Height of index child compared with the expected weight of a healthy child of the same age Height of index child compared with the expected weight of a healthy child of the same age Measure of long term nutritional status or stunting Measure of long term nutritional status or stuntingWt/Ht: Measure of wasting ie. Appropriate weight for given height

8 8 Mid Upper Arm Circumference: Measured half-way between the acromion process of the scapula and the tip of the elbow (ulnar) with the arm hanging vertically and forearm supinated Measured half-way between the acromion process of the scapula and the tip of the elbow (ulnar) with the arm hanging vertically and forearm supinated Provides an estimate of Arm Muscle Area: reflect skeletal protein reserves lean body mass useful in monitoring vulnerable groups, especially children Provides an estimate of Arm Muscle Area: reflect skeletal protein reserves lean body mass useful in monitoring vulnerable groups, especially children Head Circumference: Useful in children under the age of 3 and is an indicator of non-nutritional abnormalities. Under nutrition must be severe to affect head circumference Useful in children under the age of 3 and is an indicator of non-nutritional abnormalities. Under nutrition must be severe to affect head circumference

9 9 Anthropometry for adults Height measurement The subject stands erect and bare footed on a stadiometer with a movable head piece is leveled with skull vault and height is recorded to the nearest 0.5 cm The subject stands erect and bare footed on a stadiometer with a movable head piece is leveled with skull vault and height is recorded to the nearest 0.5 cm Weight measurement Use of regularly calibrated electronic or balanced-beam scale is suggested to measure the weight. Use of regularly calibrated electronic or balanced-beam scale is suggested to measure the weight. During weight measurement wearing light clothes without shoes is suggested During weight measurement wearing light clothes without shoes is suggested Read to the nearest 100 gm. Read to the nearest 100 gm. Skin folds Triceps, Biceps, Sub-scapular, Supra-iliac used in combination to obtain body fat Triceps, Biceps, Sub-scapular, Supra-iliac used in combination to obtain body fat

10 10 Nutritional Indices in adults The international standard for assessing body size in adults is the body mass index (BMI) The international standard for assessing body size in adults is the body mass index (BMI) BMI is computed using the following formula BMI is computed using the following formula BMI =Weight (kg) kg/m 2 Height (m 2 ) <18.5 = Underweight 18.5-24.9 = Normal Weight 25-29.9 = Overweight 30-34.9= Moderate Obese (Class 1) 35-39.9 = Severely Obese (Class 2)  40= Extreme Obesity

11 11 BMI = Weight (lbs) x 703 Height (in 2 ) Height (in 2 ) <18.5 = Underweight 18.5-24.9 = Normal Weight 25-29.9 = Overweight 30-34.9 = Moderate Obese (Class 1) 35-39.9 = Severely Obese (Class 2)  40 = Extreme Obesity (Class 3) High BMI (obesity level) is associated with type 2 diabetes and high risk of cardiovascular morbidity and mortality Waist/Hip ratio Waist circumference is measured at the level of the umbilicus to the nearest 0.5 cm Waist circumference is measured at the level of the umbilicus to the nearest 0.5 cm The subject stands erect with relaxed abdominal muscles, arms at the side, and feet together The subject stands erect with relaxed abdominal muscles, arms at the side, and feet together The measurement should be taken at the end of a normal expiration The measurement should be taken at the end of a normal expiration

12 12 Waist circumference Waist circumference predicts mortality better than any other anthropometric measurement Waist circumference predicts mortality better than any other anthropometric measurement It has been waist circumference alone can be used to assess obesity and two levels of risks have been identified It has been waist circumference alone can be used to assess obesity and two levels of risks have been identified MalesFemales Level 1 >94 cm>80 cm Level 2>102 cm>88 cm Level 1 is the maximum acceptable waist circumference irrespective of the adult age and there should be no further weight gain Level 1 is the maximum acceptable waist circumference irrespective of the adult age and there should be no further weight gain Level 2 detects the obesity and requires weight management to reduce the risk of type 2 diabetes and cardiovascular complications Level 2 detects the obesity and requires weight management to reduce the risk of type 2 diabetes and cardiovascular complications

13 13 Hip circumference It is measured at the point of greatest circumference around hips and buttocks to the nearest 0.5 cm It is measured at the point of greatest circumference around hips and buttocks to the nearest 0.5 cm The subject should be standing and the measurer should squat beside him The subject should be standing and the measurer should squat beside him Both measurement should be taken with a flexible, non-stretchable tape in close contact with the skin, but without indenting the soft tissue Both measurement should be taken with a flexible, non-stretchable tape in close contact with the skin, but without indenting the soft tissue Interpretation of Waist/Hip Ratio (WHR) High risk WHR = >0.80 for females and >0.95 for males i.e. waist measurement > 80% of hip measurement for women and 95% for men indicates central obesity and is considered high risk for diabetes and cardiovascular disorders High risk WHR = >0.80 for females and >0.95 for males i.e. waist measurement > 80% of hip measurement for women and 95% for men indicates central obesity and is considered high risk for diabetes and cardiovascular disorders

14 14 A WHR below these cut-off levels considered low risk Advantages of Anthropometry Simple, non-invasive. Simple, non-invasive. Equipment is inexpensive, portable. Equipment is inexpensive, portable. Relatively unskilled personnel can perform measurements. Relatively unskilled personnel can perform measurements. Methods are reproducible. Methods are reproducible. Measures long term nutritional history. Measures long term nutritional history. Quickly identifies mild to moderate malnutrition. Quickly identifies mild to moderate malnutrition. Measures many variable of nutritional significance like height weight, skin fold thickness, head circumference waist and hip ratio and BMI Measures many variable of nutritional significance like height weight, skin fold thickness, head circumference waist and hip ratio and BMI

15 15 Disadvantages of Anthropometry Relatively insensitive to short term nutritional status Relatively insensitive to short term nutritional status Cannot identify specific nutrient deficiencies Cannot identify specific nutrient deficiencies Measurements: e.g.. Skin-folds difficult to carry out in obese people Measurements: e.g.. Skin-folds difficult to carry out in obese people Ethnic differences in fat deposition Ethnic differences in fat deposition Dietary assessment Nutritional intake of humans is assessed by five different methods Nutritional intake of humans is assessed by five different methods 24 hour dietary recall 24 hour dietary recall Food frequency questionnaire Food frequency questionnaire Dietary history from the beginning Dietary history from the beginning Food dairy technique Food dairy technique Observed food consumption Observed food consumption

16 16 24 hour dietary recall A trained interviewer asks the subject to recall all food and drink taken in the previous 24 hours A trained interviewer asks the subject to recall all food and drink taken in the previous 24 hours It is quick, easy, and depends on short term memory, but may not be truly representative of the person’s usual intake It is quick, easy, and depends on short term memory, but may not be truly representative of the person’s usual intake Food frequency questionnaire The subject is given a list of around 100 food items to indicate his or her intake (frequency and quantity) per day, per week and per month The subject is given a list of around 100 food items to indicate his or her intake (frequency and quantity) per day, per week and per month It is inexpensive, more representative and easy to use It is inexpensive, more representative and easy to use

17 17 Dietary history It is an accurate method for assessing the nutritional status It is an accurate method for assessing the nutritional status The information should be collected by a trained interviewer The information should be collected by a trained interviewer Details about the usual intake, types, amount, frequency and timing needs to be obtained Details about the usual intake, types, amount, frequency and timing needs to be obtained Cross-checking to verify data is very important Cross-checking to verify data is very important Food dairy Food intake should be recorded by the subject at the time of consumption Food intake should be recorded by the subject at the time of consumption The length of the collection period range between 1- 7 days The length of the collection period range between 1- 7 days It is reliable but difficult to maintain It is reliable but difficult to maintain

18 18 Observed food consumption The most unused method in clinical practice (must for research) The most unused method in clinical practice (must for research) The meal eaten by the individual is weighed and contents are to be calculated exactly The meal eaten by the individual is weighed and contents are to be calculated exactly High degree of accuracy but expensive and needs more time and efforts High degree of accuracy but expensive and needs more time and efforts Interpretation of dietary data 1.Qualitative method Using the food pyramid and the basic food groups method Using the food pyramid and the basic food groups method Different nutrients are classified into 5 groups (fats and oils, bread and cereals, milk products, meat-fish- poultry, vegetables and fruits Different nutrients are classified into 5 groups (fats and oils, bread and cereals, milk products, meat-fish- poultry, vegetables and fruits

19 19 Determine the number of serving from each group and compare it with minimum requirement 2.Quantitative method The amount of energy and specific nutrients in each food consumed can be calculated using food composition tables and then compare it with the recommended daily intake The amount of energy and specific nutrients in each food consumed can be calculated using food composition tables and then compare it with the recommended daily intake Evaluation by this method is expensive and time consuming, unless computing facilities are available Evaluation by this method is expensive and time consuming, unless computing facilities are available Laboratory measurements  Blood: accessible, relatively non-invasive reflect recent dietary intakes but influenced by: diet; drugs; infection; stress

20 20  Haemoglobin is the most important test and useful index of the overall state of nutrition. Beside anaemia it also gives idea about protein and trace element nutrition  Stool examination: to detect the presence of ova and intestinal parasites  Urine examination for albumin, sugar and blood  RBC vs WBC: gives idea about long/short term nutrient status  Analysais of hair nails and skin for micronutrients (Cu, Se, Zn, Hg,etc)  Detection of abnormal amount of metabolites in the urine (creatinine/hydroxyproline ratio)  Functional tests done to study about the metabolic pathways

21 21 Advantages of Biochemical Measurements It is useful in detecting early changes in body metabolism and nutrition before the appearance of overt clinical signs It is useful in detecting early changes in body metabolism and nutrition before the appearance of overt clinical signs It is precise, accurate and reproducible It is precise, accurate and reproducible Useful to validate data obtained from dietary methods (e.g. comparing salt intake with 24- hour urinary excretion Useful to validate data obtained from dietary methods (e.g. comparing salt intake with 24- hour urinary excretion Disadvantages of Biochemical Measurements Expensive Expensive Time consuming Time consuming Needs trained personal and facilities Needs trained personal and facilities Reference: Essentials of Biochemistry by Dr S Nayak


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