4$5 nutritional assessment.pptx555555555

nutrition

1. DEPARTMENT OF PUBLIC HEALTH AFOMIA T. (BSC, MPH/NUTRITION)

2. Nutritional Assessment 2

3. Outline Definition of nutritional assessment Types of nutritional assessment Purpose of Anthropometric assessment Meaning and purpose of biochemical assessment

4. Definition Nutritional assessment is an interpretation of anthropometric, biochemical (laboratory), clinical and dietary survey data to tell whether a person/ group of people is well nourished or malnourished (Over nourished or under nourished). There are direct and indirect methods of assessing Nutritional status 4

5. DIRECT METHODS The direct involve the direct measurement of body dimensions and proportions, determination of tissue or body fluid concentrations of nutrients, dietary intake, appearance of the clinical symptoms and signs related to a specific nutrient dependent functional impairment abbreviated as the ABCDs A=Anthropometry B= biochemical C= Clinical, D= Dietary 5

6. The indirect methods Indirect methods: include a ssessment of indicators of the food and nutrition situations in the area/region of interest by looking at certain data that are closely related to malnutrition or which are aggravated by malnutrition. These include: Cause specific mortality rates Age specific mortality rates Health service statistics Rate of nutritionally relevant infections 6

7. The indirect methods Meteorological data (rainfall data ) Production pattern and distribution pattern Income levels Market price of foods Predominance of cash crops 7

8. A. ANTHROPOMETRIC ASSESSMENTS Definition :- Anthropometry refers to measurement of variations of physical dimension and gross composition of human body at different levels and degrees of nutrition ( Jelliff , 1966). Anthropo = Human, and Metry = measurement . 8

9. Purposes of Anthropometric measurements Anthropometric measurements are performed with two major purposes in mind: IN CHILDREN : to assess physical growth IN ADULTS : to assess changes in body composition or weight 9

10. ANTHROPOMETRIC MEASUREMENTS OF GROWTH Growth performance of children is an excellent reflection of their underlying nutritional status. Children adapt to the chronic nutritional insult by either reducing their rate of growth or by totally failing to grow . 10

11. HEAD CIRCUMFERENCE (HC) : Measured using flexible measuring tape around 0.6cm wide to the nearest 1mm. It is the circumference of the head along the supra orbital ridge anteriorly and occipital prominence posteriorly. HC is useful in assessing chronic nutritional problems in under two children. But after 2 years as the growth of the brain is sluggish it is not useful. 11

12. LENGTH A wooden measuring board (also called sliding board) is used for measuring length. It is measured in recumbent position in children <2 yrs old to the nearest 1mm. It is always > height by 1-2cm. One assistant is needed in taking the measurement Measurement is read to the nearest mm 12

13. Length… 13

14. HEIGHT Is measured in children > 2 yrs and a adults in standing position to the nearest 0.1 cm. The head should be in the Frankfurt plane during measurement, knees should be straight and the heels buttocks and the shoulders blades, should touch the vertical surface of the stadio -meter ( anthropometer ) or wall. 14

15. Height… 15

16. WEIGHT Weighing sling (spring balance) also called salter scale is used for measurement of weight in children < 2 years. In children the measurement is performed to the nearest 10g. In adults and children >2 years, beam balance is used and the measurement is performed to the nearest 0.1 kg . 16

17. Weight… 17

18. Weight… 18

19. INDICES DERIVED FROM THESE MEASUREMENTS What is an index ? It is a combination of two measurements or a measurement plus age. The following are few of them: - Head circumference-for age Weight -for-age Height-for age Weight for height 19

20. MEANINGS OF THE INDICES DERIVED FROM GROWTH MEASUREMENTS 20

21. both weigh for age and weight for height are indices sensitive to acute changes to nutritional status Height for age of children in a given population indicates their nutritional status in the long run. 21

22. Indicator An indicator is an index + a cut-off point . E.g. W F A < 60% = is indicator of severe malnutrition MBI < 16 kg/m2 = indicator of severe chronic energy deficiency W F H < 7o% = is indicator of severe wasting 22

23. Relationship of conventional cut-off points for diagnosing moderate malnutrition 23

24. EXPRESSING ANTHROPOMETRIC MEASUREMENTS 24

25. EXPRESSING ANTHROPOMETRIC MEASUREMENTS #2 25

26. 26

27. We use SD in Ethiopia 27

28. ASSESSMENT BODY COMPOSITION Linear growth ceases at around the age of 25-30 years. Therefore, the main purpose of nutritional assessment of adults using Anthropometry is determination of the changes of body weight and body composition. 28

29. ASSESSMENT BODY COMPOSITION Using Anthropometry Whole body level assessment is used In assessing body composition we consider the body to made up of two compartments: The fat mass and the fat free mass. Total body mass= Fat mass + fat free Mass. Therefore different measurements are used to assess these two compartments: 29

30. Measurements used for assessing fat free mass: Mid upper arm circumference*** Mid upper arm Muscle area Mid thigh circumference Mid thigh muscle area Mid calf circumference Mid calf muscle area 30

31. Mid upper arm circumference (MUAC ) Is used for screening purposes especially in emergency situations where there shortage of human resource, time and other resources as it is less sensitive as compared to the other indices. It is measured half way between the olecranon process and acromion process using non stretchable tap In children the cut-off points are: Normal > 12.5 cm Mild to moderate malnutrition 11.5-12.5cm Severe malnutrition < 11.5cm 31

32. MUAC… It is a sensitive indicator of risk of mortality. Useful for screening of children for community based nutrition interventions. Useful for the assessment of nutritional status of pregnant women. 32

33. MUAC.. 33

34. Measurements used to assess fat mass : Body mass index Waist to Hip circumference ratio Skin fold thickness 34

35. Indices derived from the measurements Different indices could be derived by measuring the weight and height of an adult Body mass index ( Quetelet’s index) = Wt /(Height in meters) 2 Weight/height ratio (Benn’s index) P Ponderal index = Wt / ( ht ) 3 35

36. Body mass Index(BMI) Body mass index the best method for assessing adult nutritional status as the index is not affected by the height of the person Therefore, it is most frequently used for assessing adult nutritional status 36

37. Cut-off points for BMI > 40 kg/m2 = very obese 30-40 kg/m2 = obese 26-30 kg/m2 = overweight 18.5-25kg/m2 = Normal 17-17.9 kg/m2 = mild chronic energy deficiency 16-16.9kg/m2 = Moderate chronic energy deficiency < 16 kg/m2 = severe chronic energy deficiency 37

38. This classification is based on the mortalities and morbidities associated with either extremities 38

39. Arm span, Demi -span and Knee height #1 When it is not possible to measure height as in the case of : Elderly people Kyphosis / Scoliosis People unable to assume erect position Height can be estimated from arm span or demi-span 39

40. Arm span and Demi-span and Knee height #2 Arm span is the distance between the two tallest fingers when a person stretches his/her arm on straight line Demi-span is the distance between the roots of the two tallest fingers when a person stretches his/her arm on straight line Knee height is the distance measured from the heel to the top of the knee 40

41. Estimating height from knee height Height(men)= 64.19-(0.4Xage) + (2.02 X knee height) Height(women)=84.88-(0.24Xage) +(1.83 x knee height) 41

42. SKIN FOLD THICKNESSES #1 Skin fold thickness is done at the following anatomical sights: Biceps skin fold Triceps skin fold Subscapular skin fold Suprailliac skin fold Mid axillary skin fold Thigh skin fold Calf skin fold 42

43. SKIN FOLD THICKNESSES # 3 Skin fold should be read to the nearest 0.5 mm after 2-3 seconds of caliper application Measurements are made in triplicate until readings agree within ± 1.0 mm All the measurements should be made on the left side 43

44. WAIST TO HIP CIRCUMFERENCE RATIO It is the circumference of the waist measured mid-way between the lowest rib cage and anterior superior iliac spine divided by the circumference of the hip measured at the level of the greater trochantor off the fumer( both are measured to the nearest 0.5 cm) If the ratio is > 1 in male, and > 0.87 in female there is high risk of coronary heart disease. 44

45. B. BIOCHEMICAL ( LABORATORY) METHODS This involves measurement of either total amount of the nutrient in the body, or its concentration in a particular storage site (organ) in the body or in the body fluids. This group includes those that are indicative of defect in intermediary metabolism in other words they occur when there is a biochemical lesion (Depletion). The depletion could be detected by biochemical tests and/or by tests that measure physiological or behavioral functions dependent on specific nutrient. 45

46. Static biochemical tests:- This involves measurement a nutrient or its metabolites in pre-Selected biological material (blood, body fluids, urine, hair, fingernails etc.) Biochemical Tests (laboratory) 1.      Serum ferritin level 2.      Serum HDL 3.      Erythrocyte Folate 4.      Tissue stores of Vit . A, Vit D, 46

47. C.      CLINICAL METHODS #1 This are detection of deviations from the normal state of nutrition just by observing and interpreting clinical signs and symptoms of deficiency or under intake, for instance, see the following 47

48. CLINICAL METHODS #2 48

49. ii. DIETARY METHODS These methods include assessment of past or current intakes of nutrients from food by individuals or a group in order to know their nutritional status. At national level:- Food balance Sheet Also called National food disappearance data or food going in to consumption Market data bases( for fortified foods by FDA) At a household level Weighed record method Observed weighed method Food Diary method Household food record method   49

50. Methods used to assess current intake (at a group or individual level) I. Weighed record method : In this method the subject will be asked to weigh whatever he/she consumes including drinks both before cooking and after cooking and the portion sizes he consumed and the left over. 50

51. ii. Observed weighed method In this method the investigator him/herself records the amount and type of food consumed by the study subjects over specified period of time. This method is usually applied for disabled people, infants and small children, mentally ill people or institutionalized elderly people or patients admitted to a hospital. 51

52. III. Food Diary method In this method the subject/s are asked to record what ever they eat including beverages for specified period of time with estimation of the portion sizes consumed. 52

53. II. Methods Used to assess past intake 24 hours dietary recall In this method, the subjects are requested to remember whatever they consumed within the last 24 hours. This involves all beverages, snacks deserts etc. That have been ingested from x time yesterday to x time today. The portion sizes consumed during this time should also be determined by the respondents by assessing them to use either photographs or the common food being consumed at different sizes or by using a line graph etc. Currently- Multiple pass 24 hours is used to improve the quality 53

54. Dietary history This method is used to assess the nutrient intake of an individual or a group from food over a longer period of time, usually to see the association between diet and disease. 54

55. Food frequency questionnaire This method is based on the preparation of a food frequency questionnaire, which is based on the local staple diet to determine the frequency of consumption of a particular nutrient. This could be achieved through self or interviewer administration of the questionnaire. Sometimes the quantities consumed could be included, in such circumstances, the FFQ is called semi quantitative FFQ. The following table indicates the frame of a food frequency questionnaire. 55

56. Example of semi quantitative FFQ for Vitamin A friendly foods 56

57. Stages of development of nutritional deficiency STAGE DEPLETION STATUS METHOD OF ASSESSMENT One: Dietary inadequacy Dietary Two: Decreased level in the tissue reserves Biochemical Three: Decreased level in the body fluids Biochemical Four: Decreased functional level in the tissues Biochemical Five: Decreased activity of nutrient dependent enzymes  Biochemical/Biophysical Six: Functional changes Clinical/biophysical/ Anthropometric Seven: Clinical symptoms Clinical Eight Anatomical signs Clinical 57

58. Thank you ! 58