Nutritional Assessment

Over-nutrition (Obesity and over weight) Associated problems Heart disease Cancer Hypertension Diabetes Joint disease Surgical complications Venous thrombosis

Under-nutrition (malnourished) Problems associated Poor wound healing Sepsis Abcess formation Other infections such as pneumonia

Why is the assessment of nutritional risk important? Potential to reduce the severity of the disease Potential for shortened recovery time Ultimately leads to better patient outcomes and reduced health care costs

Elements of Nutritional Screening & Assessment Health History Medical History Diet History

Health History Weight gain or loss, history of N/V/D, or change in appetite Menstrual history Family history - heart disease, etc. Lifestyle habits - smoking, exercise, eating out, fast food, etc.

Medical History Drugs that may affect appetite Drug interactions that may affect nutrient absorption, metabolism, or excretion Supplement use, especially excessive supplementation in the elderly Inform clients of harmful effects of some supplements in megadoses: A & D accumulate in the body B & C may increase risk of kidney stones

Diet History Usual food and fluid intake Eating patterns and habits Type and amount eaten Eating patterns and habits # and timing of meals and snacks setting of meals eaten at home frequency of meals eaten out Snacks

Diet History Food preferences and restrictions Problems with eating religious or cultural food allergies or intolerances Problems with eating Chewing or swallowing Physical limitations-i.e., unable to cut or mash foods Food buying and preparation

Types of Diet History Diet Recall Food Record Recall Food Frequency

Diet Recall Ask client to recall everything eaten on the previous day or on a typical day Advantages Easy to administer Easy for client to participate Disadvantages Only assesses one day’s intake Doesn’t reflect differences-seasons or holidays Relies on memory

Food Record Recall Ask client to record intake over at least 3 days: Advantages Takes only a small amt of time for interviewer More representative of clients diet Helps them review dietary habits Disadvantages Need to be literate Time consuming for client Eat better during collection period

Food Frequency Ask client via a questionnaire how often certain foods have been eaten in past 6-months Advantages Interviewer not required Quick to complete Provides a view of dietary habits over a period of time Disadvantages Can’t assess # and timing of meals May not reflect cultural dietary habits May have difficulty completing forms

Food Guide Pyramid

Healthy Diet The Dietary Guidelines from USDA describe a healthy diet as one that Emphasizes fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products; Includes lean meats, poultry, fish, beans, eggs, and nuts; and Is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars.

Anthropometric Measurements Height and Weight BMI Body Composition Body Proportion

Anthropometric Measures Measure size, weight, and proportions of human body Clinically significant weight changes >5% BW over 1 month >7.5% BW over 3 months >10% BW over 6 months

Height and Weight Weight and height most common measurements Height-flat, vertical measuring surface, no shoes, stand erect Weight-minimal clothing, no shoes, empty bags including colostomies, same time each day, coordinate with diuretic dosing.

Body Mass Index Assessment of optimal weight for height < 18.5 Underweight 18.5 - 24.9 Normal 25.0 – 29.9 Overweight 30 – 39.9 Obesity > 40 Extreme Obesity

Body Composition Proportion of fat versus muscle mass Skinfold calipers to measure skinfold thickness Calipers used most often

Body Proportion – Waist to Hip Ratio Where fat is accumulated on body? Apple shape - abdominal accumulation Android obesity Increased risk for obesity-related diseases and early mortality Pear shape - hip accumulation Gynoid obesity

Laboratory Measurements Serum albumin Decreased protein, poor wound healing, immune system compromised Nitrogen balance Index of Protein nutritional status TLC (total lymphocyte count) Assess immune system, malnutrition causes decrease TLC, also AIDS

Laboratory Measurements Hgb & Hct Associated with anemia Hgb A1C- compliance with Diabetes Fasting blood glucose Screening for diabetics or glucose intolerance, Glucose levels increase when pancreas is not secreting enough insulin or when insulin resistance is present in peripheral tissues Cholesterol & Triglycerides Elevated lipid levels, and heart disease risk High LDL, low HDL

Laboratory Measurements Creatinine-Height Index (CHI) Estimates amount of skeletal muscle mass Skin Testing Immunity function

Dietary Deficiencies for Specific Client Populations Healthy adults & children Low fiber, fruits & vegies Vegetarians Need supplemental Vit B12-only found in animal products Athletes, active children & adults Need complex carbohydrates (muscle energy) Need iron-rich foods to correct anemia

Dietary Deficiencies for Specific Client Populations Pregnant and breast feeding women Last 2 trimesters-caloric needs increase by 300cal/day Breast feeding requires 500 additional cal/day Elderly men & women Drying of mouth, decreased sense of taste & smell, decreased thirst, may diminish appetite Obese clients 63% of US population is overweight 25% of children are obese

Nutrition and Illness Eating disorders HTN, diabetes, heart disease 8 mil people have either anorexia or bulimia HTN, diabetes, heart disease 43 mil people, more common in African Americans Cancer Increased caloric requirements Decreased appetite