1. Nutritional Analysis & Assessment
We want to have fun.
I am here to help you.
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Has anyone never been to a seminar before?
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Unit 1: Introduction to Nutritional Assessment
Jennifer Neily, MS, RD, CSSD, LD

2. Welcome and Introduction
What are you studying?
How many terms have you been at Kaplan?
When is your ETtG?
What do you want to
do after graduation?
Estimated Time to Graduate?
And then what are your plans?

3. NS 210 Course Syllabus Review
Course Description
This course includes the study of methods and equipment used for nutritional analysis in health, obesity, and malnutrition. Students learn how to utilize the software-based and manual data-gathering systems to assess nutritional status.
Pull up your syllabus – thru doc sharing or Home Page
Break down to sections and cover – look at Course Description

4. Course Syllabus Review Continued
Course Outcomes
Upon successfully completing this course, you will be able to:
List the equipment used to assess markers for obesity and malnutrition.
Critically appraise various methodologies and equipment used for nutritional analysis.
Assess the nutritional status of individuals.

5. Course Syllabus Review cont.
Seminar times:
Thursday: 9-10pm EST
Monday: 9-10pm EST
Your scheduled time is: _____
But you may attend either.
AIM: JenniferNeilyRD
If you are not an AIM member you can download the free software at:
This is flex seminar but have option to do option 2

6. With forever dog Rylee and foster Jeffrey
Yours truly 
With forever dog Rylee and foster Jeffrey

7. Course Syllabus Review Cont.
E-text
Instructors Grading Criteria/Timetable
Late Policy
How to Label your Work
Projects
username-project-unit#.doc.
Allen-Anatomical Terminology-Unit 3.doc.
Seminars
username-seminar-unit#.doc
TAllen-Seminar-Unit 3.doc
Instructor’s Grading Criteria/Timetable:
All course projects submitted on time will be graded within five days of their due date (the Sunday of the following unit). Late work will be graded within five days of the submission date. Seminar Option 1 grades will be updated within 48 hours of the scheduled seminar. Seminar Option 2 grades and Discussion board grades will be updated each week no later than Sunday of the week following the Unit’s completion. 
Late Work Policy:
Extenuating Circumstances: If you have extenuating circumstances that prevent you from completing projects, quizzes, seminars or participating in the class, please contact the instructor to make alternative arrangements. The possibility of alternative arrangements is at the discretion of the instructor. Active communication is the key to overcoming any hurdles you may encounter during the term. It is your responsibility to inform the instructor (ahead of time, whenever possible) of extenuating circumstances that might prevent you from completing work by the assigned deadline. In those situations, we will work together to come up with a mutually acceptable alternative. Prior notification does not automatically result in a waiver of the late penalties. Please note that evaluation of extenuating circumstances is at the discretion of the instructor and documentation may be required for verification of the extenuating circumstance. Examples of extenuating circumstances may include but are not limited to: personal/family member hospitalization, death in the family, weather/environmental evacuation due to fire/hurricane, or active military assignment where internet connectivity is unavailable for a limited time period. Computer-related issues, internet connectivity issues and clinical blocks are not considered extenuating circumstances.
Without Extenuating Circumstances:
Up to one week late 20% deduction in points
After one week late 30% deduction in points
No work will be accepted more than two (2) weeks after the due date.
Note: In order for you to make up a quiz and/or exam, you must contact your instructor by at least one day previous to the day you want to make up the quiz and/or exam. If you do not, the system will not allow entrance into the quiz or exam.
How to Label Your Work:
Projects: Please label your projects: username-project-unit#.doc. For example, a student named Tina Allen would name her file Allen-Anatomical Terminology-Unit 3.doc. T
Seminar Option 2: Please label your seminars: username-seminar-unit#.doc (for example, TAllen-Seminar-Unit 3.doc)
Subject Lines: Please start your subject lines in correspondence with Course & section username: SUBJECT_OF_MESSAGE (for example, HS101-3-TAllen: Question regarding project)

8. Nutrition Assessment
Malnutrition develops when people get too little, too much or an imbalance of energy or nutrients.
4 Nutritional Assessment Methods include:
Anthropometrics
Biochemical
Clinical
Dietary
The relationship between nutrition and health has long been recognized. Scientific evidence confirming this relationship began accumulating as early as the mid-eighteenth century, when James Lind showed that consumption of citrus fruits cured scurvy.
Before the middle of the 20th century, infectious disease was the leading cause of death worldwide, and nutrient deficiency disease and starvation were common. B/c of advances in public health, medicine, and agriculture, chronic diseases such as coronary heart disease, cancer and stroke no surpass infectious diseases as the leading cause of death in developed nations, and hunger and nutrient deficiencies are less common.
Although many factors contribute to the high incidence of chronic disease, diet plays an important role in 4 of the 10 leading causes of death in the US, and excessive alcohol consumption is a prominent factor in 3 of the 15. The increasing prevalence of overweight and obesity is a particularly troubling global trend, even in developing nations where malnutrition, hunger, and starvation are also common. Epidemiologists have coined the term globesity to identify what many regard as a global epidemic of obesity.
Continuing the presence of nutrition-related disease makes it important that health professionals be able to assess nutritional status to identify who might benefit from nutrition intervention and which interventions would be appropriate.

9. 4 of Top 10 Leading Causes of Death Nutrition Related

10. Nutritional Screening and Nutritional Assessment
the process of identifying characteristics know to be associated with nutrition problems.
Nutrition Assessment is the first of four steps in the Nutrition Care Process.
Nutritional Screening “is the process of identifying characteristics known to be associated with nutrition problems. Its purpose is to pinpoint individuals who are malnourished or at nutrition risk. Nutritional screening allows persons who are at nutritional risk to be identified, so that a more thorough evaluation of the individual’s nutritional status can be performed.
Nutrition Assessment is the first of four steps in the Nutrition Care Process. Nutrition assessment is an attempt to evaluate the nutritional status of individuals or populations through measurements of food and nutrient intake and nutrition-related health. Nutritional assessment techniques can be classified according to four types: anthropometric, biochemical or laboratory, clinical and dietary. Use of the mnemonic “ABCD” can help in remembering these four types.
Our expanded ability to alter the nutritional state of a patient and our increased knowledge of the relationship between nutrition and health has made nutritional assessment an important tool in healthcare.
Are any of you aware of the new Nutrition Care Process initiated by the American Dietetic Association?
It is a method of identifying and evaluating data needed to make decisions about nutrition-related problems/diagnosis. While the type of data may vary among nutrition settings, the process and intention are the same. When possible, the assessment data is compared to reliable norms and standards for evaluation. Further, nutrition assessment initiates the data collection process that is continued throughout the nutrition care process and forms the foundation of reassessment and reanalysis of the date in Nutrition Monitoring and Evaluation (Step 4).

11. Nutrition Assessment Methods
Anthropometrics
The objective measurements of body muscle and fat
Biochemical/Laboratory
Tests based on blood and urine- can be important indicators of nutritional status
Influenced by other nutritional factors as well
Anthropometrics are the objective measurements of body muscle and fat.
Relating to measurements of physical characteristics of the body (e.g. height weight, waist and hip, etc.)
They are used to compare individuals, to compare growth in the young, and to assess weight loss or gain in the mature individual. Weight and height are the most frequently used anthropometric measurements, and skinfold measurements of several areas of the body are also taken.
Biochemical/Laboratory tests based on blood and urine can be important indicators of nutritional status, but they are influenced by non-nutritional factors as well. Lab results can be altered by medications, hydration status, and disease states or other metabolic processes, such as stress. As with the other areas of nutrition assessment, biochemical data need to be viewed as a part of the whole.
Blood and urine samples.
Lipid profile (cholesterol); glucose; albumin; etc

12. Nutrition Assessment Methods
Clinical Data
Information about the individuals medical history – acute and chronic illness, etc.
Physical exam. Eyes, skin, hair, muscle wasting, edema, etc.
Dietary Methods
24 Hour recall
Food frequency questionnaire
Clinical data provides information about the individual's medical history, including acute and chronic illness and diagnostic procedures, therapies, or treatments that may increase nutrient needs or induce malabsorption. Current medications need to be documented, and both prescription drugs and over-the-counter drugs, such as laxatives or analgesics, must be included in the analysis. Vitamins, minerals, and herbal preparations also need to be reviewed. Physical signs of malnutrition can be documented during the nutrition interview and are an important part of the assessment process.
Dietary Methods –
Historical. Diet history (FFQ, 24-hr recall), family, socioeconomic etc.
There are many ways to document dietary intake. The accuracy of the data is frequently challenged, however, since both questioning and observing can impact the actual intake. During a nutrition interview the practitioner may ask what the individual ate during the previous twenty-four hours, beginning with the last item eaten prior to the interview. During the nutrition interview, data collection will include questions about the individual's lifestyle—including the number of meals eaten daily, where they are eaten, and who prepared the meals. Information about allergies, food intolerances, and food avoidances, as well as caffeine and alcohol use, should be collected. Exercise frequency and occupation help to identify the need for increased calories. Asking about the economics of the individual or family, and about the use and type of kitchen equipment, can assist in the development of a plan of care. Dental and oral health also impact the nutritional assessment, as well as information about gastrointestinal health, such as problems with constipation, gas or diarrhea, vomiting, or frequent heartburn.

13. Joe B. Why it’s important to look at the total picture. A B C D
Joe B. at first glance …

14. Healthy People 2010 (2020)
A national public health initiative under the jurisdiction of the US Dept of Health and Human Services that identifies the most significant preventable threats to health and focuses efforts toward eliminating them.
Healthy People 2000 was established in 1990
Healthy People 2010 was established in 2000
2020 due out soon

15. Healthy People 2010
Increase proportion of adults who are at a healthy weight
Reduce the proportion of adults who are obese
Reduce the proportion of children and adolescents who are overweight or obese
Reduce growth retardation among low-income children under age 5
Increase the proportion of persons aged 2 years and older who consume at least 2 daily servings of fruit
Objectives related to nutrition and health have a prominent place in the Healthy People 2010 objectives. Skill in applying nutritional assessment techniques will play a major part in the health professional’s efforts to help achieve these objectives.
Top 5 Healthy People 2010 objective of 18
Page 6 in text box 1.2

16. Healthy People 2020

17. Protein Energy Malnutrition (PEM)
An excessive loss of lean body mass resulting from inadequate consumption of energy and/or protein or resulting from the increased energy and nutrient requirements of certain diseases
It is estimated that as many as ¼ of all patients in long term care facilities and half of all patients in acute-care hospitals suffer from PEM. Patients with PEM tend to have longer hospital stays and higher incidence of complications and mortality. Relatively simple techniques often can identify patients at nutritional risk.
Prevalence of PEM in LTC facilities ranges from 19-27%
Prevalence of PEM in acute care hospitals ranges from 33-58%
Identifying patients at nutritional risk is a major activity necessary for providing cost-effective medical treatment and helping contain health care costs. Good medical practice and economic considerations make it imperative that hospital patients e nutritionally assessed and that steps be taken, if necessary to improve their nutritional status. Evaluation of a patient’s weight, height, midarm muscle area, and triceps skinfold thickness and values from various laboratory tests can be valuable aids in assessing protein and energy nutrition. Some researchers believe that rapid, non-purposeful weight loss is the single bets predictor o malnutrition currently available.

18. Nutritional Assessment and Diabetes
Goals for persons with diabetes are based on:
Dietary history
Nutrient intake
Clinical data
Nutritional assessment is now a major component of the American Diabetes Association’s nutrition recommendations and principles for people with diabetes.
Goals for persons with diabetes are based on dietary history, nutrient intake and clinical data. A thorough knowledge of the patient gained through nutritional assessment will assist you as the dietitian – the primary provider of nutrition therapy – in guiding the patient to a successful treatment outcome. The role of nutrition assessment in managing diabetes is discussed further in chapter 8.

19. Nutritional Assessment: Heart Disease and Cancer
Diabetes
Cholesterol
Male sex
Abdominal obesity
Cigarette smoking
Advancing age
Overweight and obesity
Nutritional assessment also plays a significant role in identifying diet-related risk factors for heart disease and cancer in monitoring efforts to reduce risk.
In the boxes above we are looking at categories of coronary heart disease risk factors. There are 3 different types of risk factors: causative, conditional and predisposing.
Which of the risk factors listed below heart disease are causative? Which are Conditional? And which are Predisposing?
Causative: Cigarette smoking, diabetes, advancing age,
Conditional: Triglycerides, serum lipoprotein,
Predisposing: overweight and obesity, male sex, abdominal obesity
The American Cancer society guidelines on nutrition and physical activity for cancer prevention can be found on page 10 of your text box 1.4

20. Review of Unit 1: Introduction to Nutritional Assessment
Nutritional assessment is central to monitoring and improving nutritional status
Nutritional assessment is an attempt to evaluate the nutritional status of individuals
Nutritional assessment is central to current government efforts to monitor and improve the nutritional status of its citizens. It is also essential for nutritional epidemiologist and other nutrition researchers investigating links between diet and health.
Nutrition assessment is an attempt to evaluate the nutritional status of individuals or populations through measurements of food and nutrient intake and nutrition-related health. Nutritional assessment techniques can be classified according to four types: anthropometric, biochemical or laboratory, clinical and dietary. Use of the mnemonic “ABCD” can help in remembering these four types.

21. Dietary Standards Common standards for evaluating nutrient intake
Dietary Reference Intakes (DRIs)
Dietary Guidelines for Americans
Regulations governing the nutritional labeling of food
The MyPyramid Food Guidance System
A variety of standards for evaluating the food and nutrient intake of groups and individuals include the Dietary reference intakes, the dietary guidelines for Americans, regulations governing the nutritional labeling of food, the MyPyramid food guidance system and various graphics developed to pictorially communicate recommendations for food intake and principles of good nutrition. Although most of these standers originally were designed to serve as standards for nutritional status, they are also useful as standards for evaluating the amounts and proportions of macronutrients, micronutrients and various food components consumed by individuals and groups
Recognition of diet’s role in health and disease has led to numerous efforts in the past several decades to formulate dietary guidelines and goals to promote health and prevent disease. A clear consensus has developed among most dietary guidelines and goals; dietary patterns are important factors in several of the leading causes of death, and dietary modifications can, in a number of instances, reduce one’s risk of premature disease and death. Nutrition assessment is pivotal to improving dietary intake, thus reducing disease risk and improving health.

22. History of Dietary Standards
Advances in metabolism, vitamin and mineral research during the early twentieth century led to the establishment of human nutrient requirements.
One of the first Standards were the Recommended Dietary Allowance (RDAs)
RDA does have limitations
With a few exceptions, dietary standards up until the twentieth century were observational and lacked a firm scientific base. Advances in metabolism, vitamin and mineral research during the early twentieth century led to the establishment of scientifically based estimates of human nutrient requirements by the League of Nations and several European countries, Canada and the United States
One of the earliest and most familiar of the dietary standards is the Recommended Dietary Allowance (RDA, developed by the Food and Nutrition Board of the National Research Council. The RDA’s provided specific nutrient recommendations for healthy persons in each life stage and gender group. They were originally developed in 1941 and revised about every 5 years.
RDA’s were seen to have their limitations as time went on and as nutrition science advanced and as the primary nutrition concern of North America changed from nutrient deficiency to food and nutrient overconsumption, with an attendant increase in chronic disease risk. In addition the RDA’s had no recommendations for carbohydrate, fiber, fat, cholesterol and food components not traditionally regarded as nutrients. They failed to address the role of nutrition in reducing chronic disease risk and gave no guidance on use of nutritional supplements. In response to RDA’s limitations scientists from the Food and Nutrition Board, the Canadian Institute of Nutrition, and Health Canada developed a new set of nutritient reference values, known as the Dietary Reference Intakes (DRI’s).

23. Due This Week Introduce Yourself Weekly Discussion Board Unit 1 Quiz
Review Box 1.2 on page 6 of the text. Healthy People 2010 Objectives for the Nutritoin and Overweight Focus Area.
Then answer the questions below:
Which objective do you think is the most important?
Which objective do you think will be the easiest to achieve?
Which objective will be most difficult to achieve?
Why do you hold these positions?

24. See you on the DB!