Nutritional assessment

assessment of nutritional status

1. Assessment of Nutritional Status Presented by: Abdurehman A. December,2020 Dessie , Ethiopia 1 February 2021 Assessment of Nutrition 1 W OLLO UNIVERSITY COLLEGE OF MEDICINE AND HEALTH SCIENCES SCHOOL OF NURSING AND MIDWIFERY DEPARTMENT OF ADULT HEALTH NURSING

2. P resentation O utline 1 February 2021 Assessment of Nutrition 2 Nutritional Assessment Introduction Purpose Methods of Nutritional Assessment

3. Objectives 1 February 2021 Assessment of Nutrition 3 At the end of this session you will be able to : Assess nutritional status of patients/clients Evaluate the different methods for assessing the nutritional status Recognize the basic anthropometric techniques, applications, & reference standards

4. Introduction 1 February 2021 Assessment of Nutrition 4 Brain storming What is the clinical importance of nutritional assessment?

5. Introduction 1 February 2021 Assessment of Nutrition 5 Nutrition plays a great role in maintaining health and preventing disease Under feeding, over feeding or feeding the wrong food are all harmful nutritional habits The nutritional status of individual is often the result of many inter-related factors.

6. Introduction… 1 February 2021 Assessment of Nutrition 6 It is influenced by food intake, quantity and quality & physical health Certain signs and symptoms that suggest possible nutritional deficiency are easy to note because they are specific. The spectrum of nutritional status spreads from obesity to sever malnutrition.

7. Malnutrition in Hospitalized Patients 1 February 2021 Assessment of Nutrition 7 Consequences: Poor wound healing Higher rate of infections Greater length of stay (readmission) Increased costs Increased morbidity and mortality Suboptimal surgical outcome

8. Purpose of nutritional assessment 1 February 2021 Assessment of Nutrition 8 Identify individuals or population groups at risk of becoming malnourished Identify individuals or population groups who are malnourished To develop health care programs that meet the community needs which are defined by the assessment To measure the effectiveness of the nutritional programs & intervention once initiated

9. Methods of Nutritional Assessment 1 February 2021 Assessment of Nutrition 9 Nutrition is assessed by two types of methods; direct and indirect. The direct methods deal with the individual and measure objective criteria indirect methods use community health indices that reflects nutritional influences.

10. Direct Methods of Nutritional Assessment 1 February 2021 Assessment of Nutrition 10 A= Anthropometrical measurement B = Biochemical, laboratory methods C = Clinical examination of findings D = Dietary evaluation

11. Indirect Methods of Nutritional Assessment 1 February 2021 Assessment of Nutrition 11 These include three categories : Ecological variables including crop production Economic factors e.g. per capita income, population density & social habits Vital health statistics particularly infant & under 5 mortality & fertility index

12. I. Anthropometric method 1 February 2021 Assessment of Nutrition 12 Anthropometry is the measurement of body height, weight & proportions. It is an essential component of clinical examination of infants, children and pregnant women. Used to evaluate both over and under nutrition The measured value reflects the current nutritional status and doesn’t differentiate between acute and chronic changes

13. Con’t … 1 February 2021 Assessment of Nutrition 13 Mid-arm circumference Skin fold thickness Head circumference Head/chest ratio Hip/waist ratio

14. Height 1 February 2021 Assessment of Nutrition 14 The subject stands erect & bare footed on a stadiometer with a movable head piece. The head piece is leveled with skull vault & height is recorded to the nearest 0.5 cm . Decrease Ht may be considered as an Indication of osteoporosis, an important problem related to nutrition, especially in old women. Loss of 5-7.5 cm of height indicates an osteoporosis

15. Height Measurements 1 February 2021 Assessment of Nutrition 15

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17. Weight 1 February 2021 Assessment of Nutrition 17 Use a regularly calibrated electronic or balanced-beam scale. Spring scales are less reliable. Weigh in light clothes, no shoes Read to the nearest 100 gm (0.1kg) weight loss is an extremely important measurement because it reflects inadequate caloric intake. Weight loss indicates an increased loss of protein from the body cell mass Weight should be interpreted in relation to age, sex, and body frame.

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19. Ideal Body Weight (IBW) 1 February 2021 Assessment of Nutrition 19 To calculate the ideal body weight for females Allow 100 lbs for 5 ft of height Add 5 lbs for each additional inch over 5 ft Subtract 10% for small frame Add 10% for large frame

20. Con’t … 1 February 2021 Assessment of Nutrition 20 To calculate the ideal body weight for males Allow 106 lbs for each 5 ft of height Add 6 lbs for each additional inch over 5 ft Subtract 10% for small frame Add 10% for large frame

21. Guideline to estimate frame size 1 February 2021 Assessment of Nutrition 21 Measure height in cm Measure wrist circumference in cm Calculate the ratio of height to wrist circumference to estimate frame size (170/17=10) 1 pound ( lb ) = 0.453 kg. (1kg=2.2 pounds ( lb ) 1 feet ( ft ) = 12 inches = 30.48 Cm (1 inch = 2.54cm) 80Kg=176lbs 1ft=12inch=30.48cm 170cm=5ft +7 inch = ? =170cm 1ft=30.48cm 5ft=152.4cm 170-152.4= 17.6 cm( 7inch)

22. Standard Range 1 February 2021 Assessment of Nutrition 22 Frame Female Male Small >11 >10.4 Medium 10.1-11 9.6-10.4 Large <10.1 <9.6

23. Interpretation 1 February 2021 Assessment of Nutrition 23 Body wt 10% above to 10% below the ideal weight for the individual is normal Body weight less than 10-20% of the ideal weight is under nutrition Body weight greater than 10% of the ideal weight is overweight . Body weight greater than 20% of the ideal body weight is obesity .

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25. Body mass index /BMI/ 1 February 2021 Assessment of Nutrition 25 The international standard for assessing body size in adults is the body mass index (BMI). BMI= The obtained value is then compared with established standards The BMI is highly correlated with body fat Evidence shows that high BMI (obesity level) is associated with type 2 diabetes & high risk of cardiovascular morbidity & mortality  

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27. Waist/Hip Ratio 1 February 2021 Assessment of Nutrition 27 Waist circumference is measured at the level of the umbilicus to the nearest 0.5 cm. The subject stands erect with relaxed abdominal muscles, arms at the side, and feet together. Waist circumference predicts mortality better than any other anthropometric measurement. It has been proposed that waist measurement alone can be used to assess obesity.

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30. Hip Circumference 1 February 2021 Assessment of Nutrition 30 Is measured at the point of greatest circumference around hips & buttocks to the nearest 0.5 cm. The subject should be standing and the measurer should squat beside him. Both measurement should taken with a flexible, non-stretchable tape in close contact with the skin, but without indenting the soft tissue. High risk WHR= >0.80 for females & >0.95 for males (indicates central (upper body) obesity and is considered high risk for diabetes & CVS disorders).

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32. Mid upper arm circumferences 1 February 2021 Assessment of Nutrition 32 MUAC = mid upper arm circumferences This helps to determine skeletal muscle mass. Used for those whose weight does not necessarily indicate their nutritional status. Used for pregnant women or PLHIV with edema Used for patients who cannot stand to have their weight and height measured

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36. Measurement of skinfold thickness 1 February 2021 Assessment of Nutrition 36 A skinfold caliper is used to assess the skinfold thickness, so that a prediction of the total amount of body fat can be made. This method is based on the hypothesis that the body fat is equally distributed over the body and that the thickness of the skinfold is a measure for subcutaneous fat .

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38. Skinfold thickness 1 February 2021 Assessment of Nutrition 38 To estimate the total amount of body fat, four skinfolds are measured: Biceps skinfold (front side middle upper arm ) Triceps skinfold (back side middle upper arm ) Subscapular skinfold (under the lowest point of the shoulder blade) Suprailiac skinfold (above the upper bone of the hip)

39. Triceps skinfold 1 February 2021 Assessment of Nutrition 39 The triceps skinfold is necessary for calculating the upper arm muscle circumference . Its thickness gives information about the fat reserves of the body, whereas the calculated muscle mass gives information about the protein reserves. Frisancho (1981) published tables showing percentiles for the thickness of the triceps skinfold. Below P15, the patient is malnourished. It's  better to repeat the measurements for a good indication of changes in nutritional status and body fat mass. 

40. Triceps skinfold thickness… 1 February 2021 Assessment of Nutrition 40

41. Biceps skinfold thickness measurement 1 February 2021 Assessment of Nutrition 41

42. Subcapular skinfold thickness… 1 February 2021 Assessment of Nutrition 42

43. Suprailiac skinfold thickness …. 1 February 2021 Assessment of Nutrition 43

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45. Advantage of anthropometric measurements 1 February 2021 Assessment of Nutrition 45 Objective with high specificity & sensitivity Measures many variables of nutritional significance ( Ht , Wt , MAC, HC, skin fold thickness, waist & hip ratio & BMI). Readings are numerical & gradable on standard growth charts Readings are reproducible. Non-expensive & need minimal resources

46. D isadvantage 1 February 2021 Assessment of Nutrition 46 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 considered as abnormal values.

47. Biochemical Assessment 1 February 2021 Assessment of Nutrition 47 Biochemical assessment reflects the tissue level of a given nutrient Any abnormality of metabolism in the utilization of nutrient These determinations are made from serum ( protein, albumin, globulin, hemoglobin, vitamin A, C and iodine) urine (creatinine, thiamine, riboflavin, niacin, and iodine) studies This test is important when there are no clinical symptoms of deficiency.

48. Biochemical Assessment 1 February 2021 Assessment of Nutrition 48 Provides information about Protein-energy nutrition Vitamin & mineral status Fluid & electrolyte balance Organ functioning Analysis of serum/blood & urine samples Measurement of individual nutrient in body fluids (e.g. serum retinol, serum iron, urinary iodine, vitamin D)

49. Advantages of Biochemical Method 1 February 2021 Assessment of Nutrition 49 It is useful in detecting early changes in body metabolism & nutrition before the appearance of overt clinical signs. It is precise, accurate and reproducible. Useful to validate data obtained from dietary methods

50. Disadvantage of Biochemical Method 1 February 2021 Assessment of Nutrition 50 Time consuming Expensive They cannot be applied on large scale Needs trained personnel & facilities

51. Clinical assessment 1 February 2021 Assessment of Nutrition 51 It is the simplest & most practical method It utilizes a number of physical signs, (specific & non specific), that are known to be associated with malnutrition and deficiency of vitamins & micronutrients. The state of nutrition is often reflected in the person’s appearance. Although the most obvious clinical physical sign of good nutrition is a normal body weight with respect to age, sex and height Other tissues can serve as indicators of general nutritional status and adequate intake of specific nutrients.

52. Clinical assessment 1 February 2021 Assessment of Nutrition 52 General clinical examination, with special attention to organs like hair , angles of the mouth , gums , nails , skin , eyes , tongue , muscles , bones , & thyroid gland . Detection of relevant signs helps in establishing the nutritional diagnosis . Advantages Fast & Easy to perform Inexpensive Non-invasive Disadvantage Did not detect early cases

53. Clinical signs of nutritional deficiency 1 February 2021 Assessment of Nutrition 53

54. Clinical signs of nutritional deficiency 1 February 2021 Assessment of Nutrition 54

55. Dietary assessment 1 February 2021 Assessment of Nutrition 55 Nutritional intake of humans is assessed by five different methods. 24 hours dietary recall Food frequency questionnaire Dietary history since early life Food dairy technique Observed food consumption Estimation of typical calorie and nutrient intake : Recommended Daily Allowances(RDAs) Evaluate what and how much person is eating, as well as habits, beliefs and social conditions that may put person at risk

56. Con’t … 1 February 2021 Assessment of Nutrition 56 24 hours dietary recall A trained interviewer asks the subject to recall all food & drink taken in the previous 24 hours. Not be truly representative of the person’s usual intake. Food frequency questionnaire In this method the subject is given a list of around 100 food items to indicate his or her intake (frequency & quantity) per day, per week & per month . More representative & easy to use .

57. Con’t … 1 February 2021 Assessment of Nutrition 57 Dietary history It is an accurate method for assessing the nutritional status. Details about usual intake, types, amount, frequency & timing needs to be obtained. Food dairy Food intake (types & amounts) should be recorded by the subject at the time of consumption(between 1-7 days ) . Reliable but difficult to maintain.

58. Con’t … 1 February 2021 Assessment of Nutrition 58 Observed Food Consumption The most unused method in clinical practice, but it is recommended for research purposes. The meal eaten by the individual is weighed and contents are exactly calculated. The method is characterized by having a high degree of accuracy but expensive & needs time & efforts.

59. Interpretation of Dietary Data 1 February 2021 Assessment of Nutrition 59 1.Qualitative Method Using the food pyramid & the basic food groups method. Determine the number of serving from each group & compare it with minimum requirement . 2. Quantitative Method The amount of energy & specific nutrients in each food consumed can be calculated using food composition tables & then compare it with the recommended daily intake.

60. Food Frequency Questionnaire 1 February 2021 Assessment of Nutrition 60

61. Hydration assessment 1 February 2021 Assessment of Nutrition 61 Hydration is another important indicator of the client’s general health status but may be overlooked or confused with the signs and symptoms of nutritional changes. The signs of hydration changes may also be confused with certain disease states if only one or two indicators are evaluated. For this reason, the nurse needs to look for clusters of signs & symptoms that may indicate changes in hydration

62. Con’t … 1 February 2021 Assessment of Nutrition 62 Adequate hydration can be affected by various situations. Exposure to excessively high environmental temperatures Inability to access adequate fluids, especially water (e.g., clients who are unconscious, confused, or physically or mentally disabled ) Excessive intake of alcohol or other diuretic fluids (coffee, sugar-rich and/or caffeine-rich soft drinks ) People with impaired thirst mechanisms People taking diuretic medications, DM and high fever.

63. References 1 February 2021 Assessment of Nutrition 63 Health assessment in nursing 4 th edition Jarvis physical examination and health assessment 8 th edition Advanced health assessment and diagnostic reasoning 4 th edition https://nutritionalassessment.mumc.nl/en/skinfold-measurements https://www.sciencedirect.com/topics/nursing-and-health-professions/skinfold-thickness

64. THANK YOU !!! 1 February 2021 Assessment of Nutrition 64