NUTRITIONAL ASSESSMENT :Clinical And Laboratory Aspects WORKSHOP 1 Merce Macalintal, MD 29 November 2009

NUTRITIONAL ASSESSMENT Detailed Medical History Important findings to explore in complete physical examination Dietary History Laboratory Data

Detailed MEDICAL HISTORY in NUTRITIONAL ASSESSMENT

Physical Appearance Examination and Evaluation of –General appearance –Specific systems Signs of dehydration Signs of Nutritional deficiencies

Physical Appearance Inadequate caloric intake may present as –Apathy –Depression –Weakness –Malaise –Increased susceptibility to illness

Nutritional Deficiencies may present as changes in Skin Eyes Oral cavity Skeletal Neuromuscular

Dietary History - Assess: Nutrition Intake Food consumption patterns Food preferences Feeding environments Variety of methods for obtaining dietary histories.

Evaluation of Dietary Data Comparing intake to values of common portions of foods

Laboratory Data - Provide objective confirmation of nutritional deficiencies May allow detection of subclinical abnormalities

Laboratory Data - Also for better monitoring nutritional therapy Detects underlying causes of malnutrition Measures level of depletion of tissue stores Determines quantitative alterations of biochemical levels of nutrients not detectable by clinical or anthropometric measurements

Anthropometric Measurement - Height

Anthropometric Measurement - Weight

Head Circumference Usefulness : up to 36 months Occifrontal circumference (OFC) – up to the nearest 1mm –Use non-flexible tape measure

Anthropometric Measurement - Triceps Skin Fold Thickness

Growth Charts Various growth charts Percentiles Z-scores

Evaluate Psychomotor Development Its importance Use of the graphic

Activity Exercises

Example 1:Plot GROWTH charts for Percentiles and Z- scores Child data: 21 months Weight 7.9kg Ht =75 cm Head circ: 45.5cm Interpret patient Z-Scores using Table #3 on workbook page 11

Example 2: Plot GROWTH charts for Percentiles Child data: 36 months Weight =20.3 kg Ht =100 cm BMI : 20.5

Nutritional assessment - an integral component of pediatric health care. identifies nutritionally depleted or at-risk infants and children provides essential information for developing achievable nutritional care plans, and serves as a mechanism for evaluating the effectiveness of nutritional care.

Thank you.