Nutritional Assessment.pptx hiytghoongyygb

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1. Nutritional Assessment (Nutrition and Diet Therapy)

2. Basic concept and definition Nutrition Screening Defined as the process of identifying characteristics known to be associated with nutritional problems. It may consist of a questionnaire, or interview, which identifies eating habits, food allergies and intolerance, dietary restrictions, special diets, recent weight loss, history of illness and hospitalization.

3. Basic concept and definition A person’s Nutriture (nutrition Status) is the condition of body that results from the utilization of essential nutrients made available from his/her daily diet. It depends on the relative nutrient needs of the body and the ability to digest and utilize them . It is measured by anthropometric, biochemical, clinical and dietary methods, (sometimes called the ABC ‘s of nutritional assessment)

4. Basic concept and definition The assessment of the nutritional status of a community or population is the appraisal of the magnitude and geographical distribution pf its nutrition problems, as affected directly or indirectly by available information on determinant ecological factors. Nutrition surveys are conducted for a specific population or a group of community using a serial or longitudinal studies ad by cross sectional or periodic prevalence studies.

5. Basic concept and definition Nutrition Surveillance is carries out by a regular or period evaluation that can be used to indicate present as well as future changes in nutritional status. It involves monitoring activities and events that are expected to have a direct or indirect on nutritional status. Medical Nutrition Therapy (MNT) is a specific nutrition service and procedure used to treat illness, injury or condition. It involves an in-depth nutrition assessment of the patient: nutrition diagnosis, nutrition intervention, which includes diet therapy , counselling or use of specialized nutrition supplements and nutrition monitoring and evaluation.

6. Objectives of Nutritional Assessment The main objective is to collect data on nutritional status of the population to be used as guide in planning. formalization and modifications of action programs intended to improve the nutritional and health of the community/population. Specific objectives: Identify specific nutrition problems determine the extent and geographic distribution of malnutrition problems determine the ecological factors that directly and indirectly affect malnutrition ;and make local government, civic organizations and other fund-controlling administrators to realize the extent of the problems.

7. Methods of Nutritional Assessment ABCD Method Anthropometric Assessments Biochemical Assessments Clinical Assessments Dietary Assessment

8. Anthropometric Assessments Height Weight Mid-upper arm circumference Waist-hip ratio, Waist-hip-circumference Head circumference (new born) Chest circumference (new born)

9. How to weigh the child Use a reliable weighing scale Salter-type Infant beam scale Platform scale

10. < 115mm / < 11.5 cm SAM 115 mm – 124 mm / 11.5 cm – 12.4 cm MAM NORMAL > 125 mm or > 12.5 cm 3c. MID-UPPER ARM CIRCUMFERENCE (MUAC) Measured in children over 6 to 60 months old A simple measure of muscle wasting An independent measure of SAM Strongly predicts risk of dying from SAM

11. Anthropometric Assessments Hamwi Method, a short cut to determine ideal body weight for adult: IBW for males = 106 pounds for 5 feet plus and 6 pounds per inch over 5 feet. IBW for females=100 pounds for 5 feet plus and 5 pounds per inch over 5 feet add 10% for large frame. Subtract 10% for small frame. % of IBW = current weight ideal weight x 100

12. Desirable Body Weight Using NDAP formula which gives closest approximation of desirable BMI as well as the midpoint of FNRI range of reference weight. DBW for men 5 feet tall is 112 lbs. add(subtract) 4 lbs for every above (below) 5 feet DBW for women 5 feet tall is 106 lbs. add (subtract) 4 lbs for every inch above or( below) 5 feet

13. Desirable Body Weight (DBW) Getting your desirable body weight: ex. height -5’1 female Ht = 5 ft 1 in = 61.0 inches = 61.0 inches x 2.54 =154.94 cm DBW= 154.90-100 = 54.94 kg = 54.94-5.49(10% 0f 54.94) DBW= 49.95 kg 50 kg Range: 50+/- 10% (44.51-54.49kg)

14. Body Mass Index *asian BMI ( body mass index) is calculated according to the following formula: BMI= weight in kilograms (kg) height in meters 2 (m 2 ) Example: BMI= 50 kg 2.62 BMI= 19.08 Normal

15. Determine the reasonable energy allowance of the individual by multiplying DBW Activity kcal/kg DBW /day Bed rest but mobile (hospital patients 27.5 Sedentary (mostly sitting) Light (tailor, nurse, student, physician, jeepney driver) Moderate (carpenter, painter, heavy housework) Very active (swimming, lumberman) 30.0 35 40 45 Example of Total Energy allowance ( TEA) of a sedentary person weighing 50 kg TEA = DBW x physical activities TEA = 50 x 30 = 1500 kcal

16. Determine the Carbohydrate (CHO), Protein (Pro) and Fat A. Percentage Distribution: Carbohydrates = 55 - 70 % of TEA Protein = 10 - 15 % of TEA Fats = 20 - 30 % of TEA Example for a normal diet, allot 65% of the total energy allowance for carbohydrates, 15% of protein and 20% for fat. The corresponding energy distribution of the three nutrients are: Example CHO = 1500 X 0.65 = 975 kcal PRO = 1500 X 0.15% = 225 kcal FATS = 1500 X 0.20% = 300 kcal

17. TEA:1800 CHO:1800 *60%=1080kcal CHON:1800*15%=270 kcal FATS:1800*25%= 450kcal Diet Rx: 1800kcal,CHO1080KCAL,CHON 270KCAL,450 FATS

18. Determine the Carbohydrate (CHO), Protein (Pro) and Fat B. Calculate the number of grams of CHO, PRO, FAT by dividing the calories for each nutrient by the corresponding physiological fuel value: 4 kcal for CHO 4 kcal for PRO 9 kcal for FATS Example CHO = 975 ÷ 4 = 245g PRO = 225 ÷ 4 = 56.2 g FATS = 300 ÷ 9 = 35 g Diet Rx: 1500 kcal; CHO 245g, PRO 55 g, Fat 35g *for simplicity and practicality of the diet prescription (Rx) round off calories to the nearest 50, carbo, pro and fats to nearest 5 grams.

19. FOOD EXCHANGE LIST (FEL) a tool used for a quick estimation of carbo, protein and fat values, not only for diabetic but for normal and other therapeutic diet as well. Sample Calculation

20. One day sample MENU

21. PDRI (Philippine dietary reference intake) - is the collective term comprising reference value for energy and nutrient levels of intakes. The components of PDRI are: Estimated Average Requirement (EAR) Recommended Energy/Nutrient Intake (REI/RNI) Adequate Intake (AI)

22. WHR (waist to hip ratio) is calculated according to the formula:

23. you tube link for video presentation for DBW computation and BMI https://youtu.be/GlzrxLDHVX0

24. Biochemical Assessment Many of the routine blood and urine laboratory test found in patient’s chart are useful in providing an objective assessment of nutritional status. Care should be taken interpreting test results for a number of reasons: There is no single available yest for evaluation short-term response for medical nutrition therapy. Laboratory test should be used as a conjunction with anthropomtric data, clinical data and dietary intake assessment. Some test are not applicable to person e.g serum albumin cannot be used to evaluate protein status in patients with liver failure, because this test assumes normal liver function. Lab test are to be conducted several times over a certain period to given more accurate information compared to a single test

25. Biochemical Assessment Advantage They can detect early sub-clinical status of nutrient deficiency They identify specific nutrient deficiency They are objective results, independent of the emotional and subjective factors that they usually affect the investigator or reliability of the patient’s recollection Disadvantage They are expensive and time consuming Standard could vary with wide range They may be problems in interpreting results. The significance and accuracy of results of biochemical tests are related to standards of collection , method of transport/storage, and the actual technique used.

26. Selected Biochemical Test for Nutrition Assessment

27. Clinical Assessment Clinical Assessment is the Physical examination (P.E) of an individual for signs and symptoms suggestive of nutritional health and/or clinical pathology. Signs usually come late in the pathogenesis of a disease, unlike biochemical test that can detect early malnutrition state. also includes medical history of the patient, like past surgeries and previous diagnosis by other physicians, number of child births (for adult mother), and disorder of of the family members (parents,siblings, e.g history of hypertension, cardiovascular disease and diabetes mellitus.

28. Selected Clinical Test (partial list)

29. Dietary Assessment T here are several methods for collecting information regarding actual and habitual dietary intake. Mostly commonly used data collected are food recalls and food frequency questionnaire (retrospective) and food records (prospective). Each method has its pros and cons, thus it is important to choose method best suited ti the type of information needed. 25 hour food recall; Food frequency questionnaire and Food records

30. Dietary Assessment For Dietary Assessment of Individual for nutrients with recommended dietary allowances compare results from food records with the appropriate life stage and gender group to assess the likelihood of dietary inadequacy for the individual. for nutrients with adequate (AI) usual intake determined to be at or above the AI can be assessed as adequate. Intakes below the AI cannot be assessed. for nutrients with tolerable upper intake level (UL, usual intake above this level places an individual at risk of adverse effect.

31. Sample Form for nutritional Screening

32. Dietary Assessment For Dietary Assessment of Population Groups adjust intake distribution for within individual variation use EAR to estimate the prevalence of inadequate intakes. for nutrients with an AI, mean intakes at or above this level implies low prevalence of inadequate intakes. Mean intakes below the AI cannot be assessed. for nutrients with UL, use UL as a cut-off point to estimate the percentage of the group at risk of adverse effect

33. References: A.Ruiz et al. Basic Nutrition For Filipinos 6th edition, copyright 2010,Merriam and Webster Bookstore Food Exchange List for Mel Planning, Department of Science and Technology A.Ruiz et al, Medical Nutrition Therapy for Filipinos 6th edition, copyright 2011,Merriam and Webster Bookstore

34. Thank you!