1. Nutritional Assessment

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1. Nutritional Assessment
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Biochemistry results can be affected by:
o Acute phase response – Injury, inflammation, infection
 Liver protein synthesis shifts from visceral to acute phase proteins
 Visceral protein levels then reflect severity of illness (nutritional risk not
nutritional status)
o Low serum albumin (low calcium)
o Renal failure (higher prealbumin)
o Depleted muscle mass (lower creatinine)
o Dehydration (decreased renal function)
o Insulin resistance e.g. in stress (high glucose)
o GI bleed (higher urea)
o Blood transfusion (higher serum K and Hb)
o Surgery (lower Hb and albumin)
Nutritional indicators – indications of nutritional inadequacy:
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Commonly used nutritional indicators include albumin and prealbumin
Neither of these is specific to intake
The ideal marker would be sensitive and specific to nutritional intake
Albumin:
 Synthesised in the liver
 May be useful indicator of nutritional status in healthy population but
adapts to chronic malnutrition by reducing turnover so may still be normal
 Not a good indicator of protein status during critical illness due to acute
phase response
 Long half life (14-20 days) and large body pool – slow to respond to
improvements in clinical status
 Factors affection serum albumin levels:
 Increased in dehydration, blood transfusions, exogenous albumin
 Decreased in acute phase response, overhydration, hepatic failure,
metabolic stress, post-op, bed rest, pregnancy, nephrotic syndrome
o Prealbumin (also known as transthyretin or thyroxine binding protein)
 Synthesised in the liver
 Relatively short half life (3-5 days)
 Negative acute phase reactant (decreases in acute phase response)
o Indicators of nutritional risk:
 C Reactive Protein (CRP)
 Acute phase protein
 Good indicator of inflammation/stress and nutritional risk
 White Blood Cell Count (WCC)
 Indicator of infection and nutritional risk
 Influenced by antibiotics, immunosuppression
o Biochemistry and other blood tests:
 Interference – drugs, sampling
 Nutrient-nutrient interactions, drug-nutrient interactions
 Be aware of hydration status
 Must interpret lab results with other nutritional parameters
Physical signs
o SKIN: dermatitis, follicular hyperkeratosis, abnormal dryness, build-up of sebum
especially around nose or ears, bruising
o MOUTH: cracked lips (cheilosis), cracks at corners of mouth or eyes (angular
stomatitis), bleeding or spongy gums, altered tongue colour or texture, inflamed
tongue (glossitis) or gums
o HAIR: general condition, easily pluckable, dry, brittle, sparse, pigment loss
o NAILS: flat or spoonshaped (koilonychia), dull, ridged, mottled, pale, poorly
blanching
o NEUROLOGICAL: thiamine depletion – paresthesia, loss of reflexes, wrist drop, foot
drop, dementia, confusion. Vitamin B12 – changed gait
Protein restriction results in hair root bulb shrinkage – reversible in repletion
Nutritional status vs nutritional risk
Nutritional screening (MST, MUST, MNA-SF) vs nutritional assessment (MNA, SGA)
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