Assessment of nutritional status.pptx

Various methods of nutritional status assessment

1. ASSESSMENT OF NUTRITIONAL STATUS Presented by:- Dr. Suchitra Sharma (JR3) Community Medicine Grant Government Medical College Mumbai

2. DEFINITION OF NUTRITIONAL STATUS Nutritional status is the current body status of a person or population group, related to their state of nourishment (the consumption and utilization of nutrients). Influenced by the adequacy of food intake both in terms of quantity and quality and also by the physical health of the individual.

3. People can have an optimal nutritional status or they can be under-, over-, and /or malnourished. Severe underweight (Under-nourished) Healthy baby (optimal nutritional status) Morbid obesity (Over-nourished)

4. Consequences of the nutritional status of an individual: An optimal nutritional status is a powerful factor for health and well-being. It is a major, modifiable, and powerful element in promoting health, preventing and treating diseases, and improving the quality of life. Malnutrition may increase the risk of (susceptibility to) infection and chronic diseases: Undernutrition may lead to increased infections and decreases in physical and mental development, overnutrition may lead to obesity as well as to metabolic syndrome or type 2 diabetes.

5. PORPOSE OF NUTRIONAL ASSESMENT Identify individual or population groups at risk of becoming malnourished. Identify individuals and populations who are malnourished . To develop a health care program that meets the needs defined by the assessment. To measure the effectiveness of the nutritional programs and interventions once initiated.

6. Methods of Nutritional Assessment Clinical examination Anthropometry Laboratory and biochemical evaluation Functional assessment Assessment of dietary intake Vital and health statics Ecological studies Direct method Indirect Method

7. Anthropometric Methods Anthropometric measurements such as height, weight, skin fold thickness, arm circumference, and proportions, are valuable indicators of nutritional status. These measurements are compared to reference data (standards) of the same age and sex group, in order to evaluate the nutritional status.

8. Measurement for adults Height measurement The subject stands erect and barefooted on a stadiometer with a movable headpiece. The head piece is levelled with a skull vault and the height is recorded.

9. Measuring length in infants and standing height in children

10. Weight measurement Use a regularly calibrated electronic or balanced-beam scale. Spring scales are less reliable. Weight in light clothes, no shoes.

11. Nutritional Indices In Adults The international standard for assessing body size in adults is the body maas index (BMI). BMI is computed using the following formula: BMI = Weight (Kg)/Height (m2) Evidence shows that high BMI (obesity level) is associated with type 2 diabetes and high risk of cardiovascular morbidity and morbidity.

12. Example: Weight = 68 Kg, Height = 165 cm (1.65m) BMI = = 24.98 Kg/ m2  

13. WHO Classification of adults according to BMI Classification BMI Risk of Comorbidities Underweight < 18.50 Low (but risk of other clinical problems increased) Normal range 18.50 to 24.99 Average Over weight: ≥ 25.00 Pre-obese 25.00-29.99 Increased Obese class I 30.00-34.99 Moderate Obese class II 35.00-39.99 Severe Obese class III ≥ 40.00 Very severe

14. Waist circumference Waist circumference is measured at midpoint between the lower border of the rib cage and the iliac crest. The subject stand erect with relaxed abdominal muscles, arm at the side, and feet together. The measurement should be taken at the end of a normal expiration

15. Waist circumference ≥ 102 cm in men Waist circumference ≥ 88 cm in Women Reflect change in risk factor for cardiovascular diseases and another form of chronic diseases.

16. Hip Circumference It is measured at the point of greatest circumference around hips and buttocks to the nearest 0.5 cm. The subject should be standing. Both measurements (waist and hip) should be taken with a flexible, non-stretchable tape in a close contact with the skin, but without indenting the soft tissue.

17. Interpretation of Waist / Hip Ratio (WHR) A high WHR > 1.0 in men and > 0.85 in women indicates abdominal fat accumulation

18. Body mass index for children and teens The criteria used to interpret the meaning of the BMI number for children and teens are different from those used for adults. For children and teens, BMI age and sex-specific percentiles are used for two reasons: The amount of body fat changes with age. The amount of body fat differs between girls and boys.

19. Body mass index for children and teens BMI for Age Percentile Less then 5 th percentile Underweight 5 th percentile to less than the 85 th percentile Healthy weight 85 th percentile to less that the 95 th percentile Overweight 95 th percentile Has obesity

20. Other anthropometric Measurements Mid-arm circumference Skin fold thickness Head circumference Head/chest ratio Hip/waist ratio

21. Advantages of Anthropometry Objective with high specificity and sensitivity. Measures many variables of nutritional significance (Ht., Wt., MAC, HC, skin flod thickness, waist & hip ratio BMI). Reading are numerical and gradable on standard growth chart. Readings are reproducible. Non-expensive & need minimal training. Limitation of Anthropometry Inter observers errors in measurement. Limited nutritional diagnosis problems with reference standards, i.e. local versus international standards. Arbitrary statistical cut-off levels for what is considered abnormal values.

22. 2. Clinical Examination Good Nutritional history should be obtained. General clinical examination, with special attention to organs like hair, angles of the mouth, gums, nails, skin, eyes, tongue, muscles, bone, and thyroid gland. Detection of relevant signs helps in establishing the nutritional diagnosis.

23. Examples of illnesses caused by improper nutrient consumption

24. Vitamin A deficiency Xeropthalmia Bitot’s spot

25. Vitamin A Deficiency

26. Vitamin B1 (Thiamine) Deficiency- Beri Beri

27. Vitamin B2 deficiency ( Ariflavinosis )

28. Pellagra Vitamin B3 (Niacin) Deficiency Clinical- 4D’s: Dermatitis, Diarrhoea, Dementia, Death

29. Scurvy: Vitamin C deficiency

30. Vitamin D deficiency: Rickets

31. Goitre ( Iodine deficiency disorder)

32. Protein Energy malnutrition Marasmus Kwashiorkor

33. Protein Energy Malnutrition (PEM)

34. Clinical Assessment Advantages Fast & Easy to perform Inexpensive Non- invasion Limitation: Did not detect early cases

35. 3. Laboratory and biochemical assessment Laboratory tests:- Haemoglobin level Stool and urine Biochemical test:- Vitamin and Minerals level in blood and urine. Detection of abnormal amount of metabolites in the urine (urinary creatinine/ Hydroxyproline ratio) Analysis of hair, nails, and skin for micronutrient and diseases.

36. Biochemical Methods Advantages of Biochemical Methods Useful in detecting early changes in body metabolism and nutrition before the appearance of overt clinical signs. It is precise, accurate and reproducible. Useful to validate data obtained from dietary methods e.g. comparing salt intake with 24 hrs urinary excretion.

37. Biochemical Methods Limitations of Biochemical Methods Time consuming Expensive Cannot be applied on large community scale Need trained personnel and facilities.a

38. 4. Functional Indicator System Nutrition 1. Structural integrity Erythrocyte fragility Vit. E, Se Capillary fragility Vit. C 2. Host defence Leucocyte phagocytic capacity P/E, Fe Leucocyte bactericidal capacity P/E, Fe, Se 3. Haemostasis Prothrombin time Vit. K 4. Reproduction Sperm count Energy, Zn 5. Nerve conduction Nerve conduction P/E, Vit B1, B12 Dark adaptation Vit A, Zn

39. 5. Assessment of dietary intake Weighment of raw foods Weighment of cooked foods Oral questionnaire method (24 hours recall method) A dietary survey may also include a collection of data relating to dietary patterns, specific foods consumed, and estimated nutrient intakes.

40. 6. Vital Statistics Mortality and Morbidity Data- will identify groups at high risk and indicate the extent of risk to the community. Mortality under 1 to 4 years particularly related to malnutrition. Other rates:- Infant mortality rate Low birth weight babies Life expectancy ( Influenced by nutritional status)

41. 7. Assessment Of Ecological Factors Food balanced sheet: A comprehensive compilation of a pattern of food supply, production, and consumption in terms of per capita supply availability. Socio-Economic factors : Family size, occupation, income, cultural patterns, education. Health and Educational services: PHC services, feeding, and immunization program. Conditioning Influences: Parasitic, bacterial, and viral infection.