1. Slides current until 2008 Nutrition assessment

2. Curriculum Module III-5 Slide 2 of 25 ACTIVITY Slides current until 2008 Identify the factors that influence dietary intake.

3. Nutrition assessment Curriculum Module III-5 Slide 3 of 25 Slides current until 2008 Assessment of health status /1 Socio-economic status and culture Dental health Screening for co-morbidity, e.g. coeliac disease

4. Nutrition assessment Curriculum Module III-5 Slide 4 of 25 Slides current until 2008 Assessment of health status /2 Laboratory tests to determine clinical status –fasting glucose, HbA 1c level –lipid profile (cholesterol — HDL, LDL) –haemoglobin, ferritin, creatinine, U and E’s, thyroid function Screening for complications e.g. cardiovascular, renal disease Current medication and nutrient supplements

5. Nutrition assessment Curriculum Module III-5 Slide 5 of 25 Slides current until 2008 Body weight Height Agreed acceptable weight –using standard height/weight tables Anthropometric measurements

6. Nutrition assessment Curriculum Module III-5 Slide 6 of 25 Slides current until 2008 Weight and height measurements to calculate BMI: BMI = weight in kg/(height in m) 2 Standard BMI normograms: 21-25 desirable 25-30 overweight >30 obese Geographical variations exist Body Mass Index (BMI)

7. Nutrition assessment Curriculum Module III-5 Slide 7 of 25 ACTIVITY Slides current until 2008 Body Mass Index (BMI) Calculate the individual BMI of your fellow participants.

8. Nutrition assessment Curriculum Module III-5 Slide 8 of 25 Slides current until 2008 Waist-to-hip ratio (WHR) Central adiposity – important cardiovascular risk marker High WHR – increased risk WHR used to define body shape A pear-shaped body is preferable to an apple-shaped body

9. Nutrition assessment Curriculum Module III-5 Slide 9 of 25 Slides current until 2008 Measuring WHR The hip circumference is the largest circumference at the posterior extensive of the buttocks The waist circumference is the smallest circumference below the rib cage and above the umbilicus

10. Nutrition assessment Curriculum Module III-5 Slide 10 of 25 Slides current until 2008 Central obesity plus any two of the following four factors: - raised triglycerides - reduced HDL cholesterol - raised blood pressure - raised fasting blood glucose IDF definition of the metabolic syndrome

11. Nutrition assessment Curriculum Module III-5 Slide 11 of 25 Slides current until 2008 Dietary assessment Dietary history –usual food intake recorded through interview Dietary recall –food and drink consumed in previous 24 hours (24-hour recall)

12. Nutrition assessment Curriculum Module III-5 Slide 12 of 25 Slides current until 2008 Dietary history and recall tips Ask for or check: Food pattern on a normal day Size of portions at home Daily/weekly/monthly purchases Eating out and take-away – frequency Food favourites – self and family Food products, e.g. skimmed or whole milk Hunger patterns

13. Nutrition assessment Curriculum Module III-5 Slide 13 of 25 ACTIVITY Slides current until 2008 Identify some disadvantages of the dietary recall method

14. Nutrition assessment Curriculum Module III-5 Slide 14 of 25 Slides current until 2008 Food frequency questionnaire Prospective food records Weighed food records Detailed dietary assessment methods

15. Nutrition assessment Curriculum Module III-5 Slide 15 of 25 Slides current until 2008 Groups with special dietary needs Pregnant women People with a gastro-intestinal condition, such as coeliac disease Older people

16. Nutrition assessment Curriculum Module III-5 Slide 16 of 25 ACTIVITY Slides current until 2008 Interpreting assessment data Analyse the information collected from the assessment process What further considerations are necessary before the management plan is agreed on?

17. Nutrition assessment Curriculum Module III-5 Slide 17 of 25 Slides current until 2008 Summary Detailed assessment Multiple factors for assessment Variety of assessment methods Special groups

18. Nutrition assessment Curriculum Module III-5 Slide 18 of 25 Slides current until 2008 Giving nutrition education to people without first analysing their nutritional and health status is like sailing a ship in a fog without a compass, charts or information about the weather and currents.

19. Nutrition assessment Curriculum Module III-5 Slide 19 of 25 Slides current until 2008 Review question 1. Which of the following is NOT a goal of nutritional assessment? a.To identify malnutrition (under and overweight) b.To identify those at risk of nutritional deficiencies c.To identify eating habits that may be associated with poor diabetes control and increased risk of cardiovascular disease d.To allow people to choose their own treatment plan

20. Nutrition assessment Curriculum Module III-5 Slide 20 of 25 Slides current until 2008 Review question 2. In European populations, which BMI is classified as obese? a.24 b.26 c.28 d.31

21. Nutrition assessment Curriculum Module III-5 Slide 21 of 25 Slides current until 2008 Review question 3. When describing central adiposity, which fruit shape is associated with an increased risk of cardiovascular disease? a.Apple b.Pear c.Orange d.Melon

22. Nutrition assessment Curriculum Module III-5 Slide 22 of 25 Slides current until 2008 Review question 4. Which of the following is NOT included in the IDF definition of the metabolic syndrome? a.Raised fasting blood glucose b.Raised blood pressure c.Reduced LDL cholesterol d.Raised triglycerides

23. Nutrition assessment Curriculum Module III-5 Slide 23 of 25 Slides current until 2008 Review question 5. Which of the following is NOT used to assess diet in normal clinical practice a.Food diaries b.Weighed food records c.Diet histories d.Diet recall

24. Nutrition assessment Curriculum Module III-5 Slide 24 of 25 Slides current until 2008 Answers 1.d 2.d 3.a 4.c 5.b

25. Nutrition assessment Curriculum Module III-5 Slide 25 of 25 Slides current until 2008 References 1.American Diabetes Association. Diabetic Nephropathy. Diabetes Care 2004; 27(suppl 1). 2.American Diabetes Association. Dyslipidemia Management in Adults with Diabetes. Diabetes Care 2004; 27(suppl 1): S68-71. 3.American Diabetes Association. Standards of Medical Care in Diabetes. Diabetes Care 2004; 27(suppl 1): S19. 4.Anil Kapur, et al. Novovare Interactive Nutrition Assistant - A computer aided Interactive Nutrition Management Program, Novo Nordisk. Diabetes Update Proceedings 1997. 5.Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2003 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Can J Diabetes 2003; 27(suppl 2): S19. 6.International Diabetes Federation. www.idf.org 7.Maryniuk MD. The new shape of medical nutrition therapy. Diabetes Spectrum 2000; 13(3): 122-24.