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

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

3. Detailed MEDICAL HISTORY in NUTRITIONAL ASSESSMENT

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

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

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

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

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

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

10. 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

11. Anthropometric Measurement - Height

12. Anthropometric Measurement - Weight

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

16. Anthropometric Measurement - Triceps Skin Fold Thickness

17. Growth Charts Various growth charts Percentiles Z-scores

18. Evaluate Psychomotor Development Its importance Use of the graphic

19. Activity Exercises

20. 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

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

22. 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.

23. Thank you.