Assessment of Nutrition
Status and Risk
Chapter 5
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Nutrition Assessment
• Analysis of the nutrition status of an
individual
 Subjective
 Objective
 Diet
 Psychosocial parameters
 Education
 Motivation
• Used to determine nutrition diagnosis
• Serve as benchmarks to measure
effectiveness of treatment
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Nutrition Assessment
• Nutritional status – reflects
nutrient stores
Excesses vs. deficiency
• Determination of nutritional risk
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Nutrition Assessment
Overview
• Screening – process of gathering
key pieces of information
correlated to nutrition risk
Tools:
• DETERMINE checklist
• Subjective Global Assessment
• Facility-specific instruments
JCAHO
• Screening must be done within 48 hours
of admission
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Nutrition Assessment
Overview
• Subjective data
Obtained during interviews
From patient, family members,
significant others, client’s perceptions
Table 5.1
• Objective data
Information from a verifiable source
such as medical record
Table 5.2
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Nutrition Assessment
Overview
• Collected through patient interview
Dietary
• Diet history
• Previous nutrition education & therapy
• Availability of resources
Psychosocial information
• Economic
• Support systems
• Lifestyle habits
Education, Learning & Motivation
• Ability to communicate
© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth
Dietary Assessment
Methods
• Twenty-Four-Hour Recall
 Recall of all food and drink for a 24 hr.
period
 Figure 5.2
 USDA multiple-pass method
 Advantages/Disadvantages?
• Food Record/Food Diary
 Record of food and beverage intake for 3to 5-day period
 Figure 5.3
 Advantages/Disadvantages?
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24-hour recall form
Food diary
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Dietary Assessment
Methods
• Food Frequency
Retrospective review of food intake
Figure 5.4
Advantages/Disadvantages?
• Observation of food intake/calorie
count
Food weighed before and after intake
Measures “actual” intake
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© 2007 Thomson - Wadsworth
Analysis of Food Intake
• Estimate of energy value and
protein content using
USDA’s MyPyramid
Diabetic Exchanges/CHO counting
Specific nutrient analysis
Computerized dietary analysis
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Nutritional Physical
Exam
• Assess the patient for signs and
symptoms of nutritional deficiency
or malnutrition
Inspection
Palpation
Percussion
Auscultation
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Anthropometric & Body
Composition Measures
• Anthropometric – measure of body
size, weight and proportions
Height/stature
• Age < 2 – length
– Figure 5.5
• Age > 2 – standing height
– Using stadiometer
• Alternatives
– Arm span
– Knee height
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Anthropometric & Body
Composition Measures
• Anthropometric
Weight
• Balance beam & electronic scales
• Wheelchair & bed scales
• Amputation calculations
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Anthropometric
• Interpreting height/weight infants/children
Growth charts - compare with
reference population
• Weight for height
• Percent weight for height
BMI
• Grade I obesity 85-95% of BMI
• Grade II obesity >95% of BMI
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Anthropometric
• Interpreting height/weight - adults
Usual Body Weight
Percent Usual Body Weight and
Percent Weight Change
• See formula
Ideal Body Weight
• Hamwi equation
• BMI
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Anthropometric
• Interpreting height/weight - adults
 Healthy Body Weight
• U.S. Dietary Guidelines weight guidelines
 Body Mass Index (BMI)
• Correlated with overall mortality and nutritional
risk
• See formula
 Frame size
• Wrist circumference
• Elbow breadth
 Waist-to-hip ratio
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© 2007 Thomson - Wadsworth
Anthropometric & Body
Composition Measures
• Body Composition – distribution of
body compartments as part of
total weight
Fat mass vs. fat-free mass
• Fat mass, body water, osseous mineral,
protein
Most concerned with metabolically
active tissue and fluid status
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Body Composition
• Measures of body composition
Skinfold measures
• May use up to 8 sites
• MAC may be used in conjunction
• Measuring tape and calipers needed
• Advatages/Disadvantages?
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© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth
Body Composition
• Measures of body composition
 Biolectrical Impedance Analysis (BIA)
• Based on conduction of electric current through fat and
bone
• Phase angle
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Body Composition
• Measures of body
composition
Hydrodensitometry –
Underwater weighing
• More accurate, less available
Near Infrared Interactance
(NIR)
DEXA
• Body scan
• Most accurate
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Biochemical
Assessment
• Measurement of nutritional
markers and indicators found in
blood, urine, feces, tissue
Protein Assessment
Immunocompetence
Hematological
Vitamin/mineral levels
Others
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Biochemical
Assessment
• Protein Assessment
Somatic protein – skeletal muscle
• Creatinine-height index
• 3-Methylhistidine
• Nitrogen balance
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Biochemical
Assessment
• Protein Assessment
Visceral protein – non-skeletal
proteins – Table 5.8
• Albumin
• Transferrin
• Prealbumin/transthyretin
• Retinol binding protein
• Fibronectin (FN)
• Insulin-like growth hormone (IGF-1)
• C-reactive protein (CRP)
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© 2007 Thomson - Wadsworth
Biochemical
Assessment
• Immunocompetence
Delayed cutaneous hypersensitivity
(DCH)
Total lymphocyte count (TLC)
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Biochemical
Assessment
• Hematological
 Hemoglobin (Hgb)
 Hematocrit (Hct)
 Mean corpuscular volume (MCV)
 Mean corpuscular hemoglobin (MCH)
 Mean corpuscular hemoglobin concentration
(MCHC)
 Ferritin
 Transferrin saturation
 Protpporphyrin
 Serum folate
 Serum B12
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Biochemical
Assessment
• Vitamin/Mineral Assessment
 Table 5.9
 Not routinely done
• Other labs of significance
 Lipid status
 Electrolytes
 BUN
 Creatinine (Cr)
 Serum glucose
 Table 5.10
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© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth
Functional
Assessment
• Skeletal muscle
function or strength
Patient’s perception on
SGA
ADL/ IADLs
Handgrip dynamometry
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Energy and Protein
Requirements
• Determination to establish goals
3 basic components
• BEE + Physical activity + TEF = TEE
• BEE – Basal Energy Expenditure
– Approx. 60%
– Usually substitute REE or RMR – approx. 10%
higher than BEE
• Physical activity – most variable
• TEF - thermic effect of food
– Approx. 10%
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Energy and Protein
Requirements
• Measurement of Energy
Requirements
Most accurate – indirect calorimetry
(metabolic cart)
• Measurement of protein
requirements
Nitrogen balance
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Energy and Protein
Requirements
• Measurement of Energy
Requirements
Prediction equations
• Harris-Benedict
• Mifflin-St. Jeor
• Owen
• WHO
• Table 5.13
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Energy and Protein
Requirements
• Measurement of Energy
Requirements
Based on DRI
• Not recommended for individuals
Include Activity Factors
• Table 5.14
Include Stress Factors
• Table 5.14
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Energy and Protein
Requirements
• Measurement of Protein
Requirements
RDA for protein
• .8 g/kg body weight
Requirements for stress, trauma,
disease
• 1-1.5 g/kg
Protein-kcal ratio
• 1:200 healthy
• 1:150, 1:100 if requirements higher
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Interpretation of
Assessment Data
• Determine nutrition diagnosis
• International Classification of
Disease
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