ASSESSMENT
OF
NUTRITIONAL
STATUS
JHEA CHARMAINE T. EMBORGO, RND , FSCO
METHODS OF NUTRITIONAL ASSESSMENT
Anthropometric methods
Biochemical and laboratory methods
Clinical methods
Dietary evaluation methods
BIOCHEMICAL
ASSESSMENT
BIOCHEMICAL AND LABORATORY METHODS
•
Provide the most objective and quantitative data on nutritional status
•
Laboratory tests based on blood and urine can be important indicators of nutritional
status, but they are influenced by non-nutritional factors as well.
•
Laboratory results can be altered by medications, hydration status, and disease states
or metabolic processes, such as stress.
•
As with other areas of nutritional assessment, biochemical data need to be viewed as
part of the whole.
• static biochemical tests: measure either a nutrient in biological fluids or
tissues or the urinary excretion of the nutrient or its metabolite;
especially useful in identifying the second and third stages in the
development of a nutritional deficiency
• functional tests: not only used to detect later stages in the development
of a nutritional deficiency but also to measure nutrient status associated
with optimal health and reduction of the risk of chronic disease
• hemoglobin estimation is the most important test and useful index of the overall state of
nutrition. Aside from anemia, it also tells about protein and trace element nutrition
• stool examination for the presence of ova and/or parasites
• urine dipstick & microscopy for the presence of albumin, sugar and blood
• measurement of individual nutrient in body fluids (serum retinol, iron, urinary iodine,
vitamin D)
• detection of abnormal amount of metabolites in the urine (urinary
creatinine/hydroproline ratio)
• analysis of hair, nails and ksin for micronutrients
CLINICAL
ASSESSMENT
CLINICAL ASSESSMENT
• It is an essential feature of all nutritional surveys.
• It is the simplest & most practical method of ascertaining
the nutritional status of a group of individuals.
• It utilizes a number of physical signs (specific &
nonspecific) that are known to be associated with
malnutrition and deficiency of vitamins & micronutrients.
CLINICAL ASSESSMENT
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,
bones & thyroid gland
Detection of relevant signs helps in establishing the nutritional
diagnosis
DIETARY
ASSESSMENT
DIETARY ASSESSMENT
24 hour food
recall
food
diary/dietary
records
Diet history
Food
frequency
questionnaire
Food
consumption
record
24-HOUR DIETARY RECALL
•
Record of all foods and beverages consumed the previous day or
over the past 24 hours prior to interview
•
Interview conducted face-to-face, structured without probing
questions
•
Estimates of portion size are made using standardized cups and
spoons
•
Record of food amounts converted into nutrient intakes using
food composition tables
FOOD DIARY/DIETARY RECORDS
• Self-reported account of all food and beverages consumed by a
respondent over a specified period of time
• Useful in assessing total dietary intake and/or particular aspects of the
diet
• May be used to estimate current diet of individuals and population
groups, as well as to identify groups at risk of inadequacy
FOOD FREQUENCY QUESTIONNAIRE
• Report usual frequency of consumption of each food
item from a list of food items in reference to a specified
period (past week/month/year)
• Face-to-face interview,
administration
telephone
or
by
self-
• Describes dietary patterns or food habits not nutrient
intake
DIET HISTORY
• An accurate method for assessing nutritional status
• Information should be collected by a trained interviewer.
• Detailed information about an individual’s usual intake,
types, amount, frequency & timing
• Cross-checking to verify data is important
FOOD CONSUMPTION RECORD
• Direct observation of dietary intake and food consumption
behaviour by a trained personnel
• Provides an objective assessment of dietary intake and
accurate information on the social and physical context of
dietary intake
• Most unused method in clinical practice but recommended for
research purposes
• Highly accurate but expensive and requires time & effort
COMPARISON OF METHODS OF DIETARY ASSESSMENT
24-hour Dietary Recall
Food diary/dietary record
Food Frequency Questionnaire
Dietary History
Food Consumption Record
Methods
Subjective measure using
open-ended
questionnaires
administered by a trained
interviewer
Subjective measure using
open-ended, selfadministered questionnaires
Subjective measure using a
predefined self- or intervieweradministered format
Subjective measures using openended and closed-ended
questionnaires administered by a
trained interviewer
Objective observation by trained
staff at the household level
Collected
data
Actual intake information
over the previous 24
hours
Actual intake information
throughout a specific period
Usual intake estimate over a
relatively long period (e.g. 6
months or 1 year)
Usual intake estimates over a
relatively long period
Actual intake information
throughout a specific period
Strengths
Provides detailed intake
data; relatively small
respondent burden
(literacy not required)
Provides detailed intake
data; no interviewer
required; no recall bias
Assesses usual dietary intake
simply; cost-effective and timesaving; suitable for
epidemiological studies
Assesses usual dietary intake
Ease of application among those
with low literacy or those who
prepare most meals at home
Limitations
Possible recall bias;
trained interviewer
required; possible
interview bias; expensive
and time consuming;
multiple days required to
assess usual intake;
possible changes to diet
if repeated measures
Relatively large respondent
burden (literacy and high
motivation required,
possible underreporting);
expensive and time
consuming; multiple days
required to assess usual
intake; possible changes to
diet if repeated measures
Specific to study groups and
research aims; uses a closedended questionnaire; low
accuracy (recall bias); requires
accurate evaluation of developed
questionnaires
High cost and time consuming;
not suitable for epidemiological
studies
Individual dietary consumption not
accurate; not suitable among
those frequently eat outside the
home
SCREENING
TOOLS
MALNUTRITION UNIVERSAL SCREENING TOOL
MUST’ is a five-step screening tool
to identify adults, who are
malnourished, at risk of
malnutrition (undernutrition), or
obese. It also includes
management guidelines which
can be used to develop a care
plan. It is for use in hospitals,
community and other care
settings and can be used by all
care workers.
SUBJECTIVE GLOBAL ASSESSMENT
• simple bedside method used to diagnose malnutrition and
identify those who would benefit from nutrition care
• gold standard for diagnosing malnutrition
• includes taking a history of recent intake, weight change,
gastrointestinal symptoms and a clinical evaluation
MINI NUTRITIONAL ASSESSMENT
• rapidly administered, simple tool for evaluating the nutritional status
of older persons
• consists of 18 items and can be administered by a healthcare
professional in less than 15 minutes
• involves a general assessment of health, a dietary assessment,
anthropometric measurements, and a subjective self-assessment by
the patient
• classifies the patient as well nourished, at risk for malnutrition, or
malnourished. The MNA test was shown to be 92–98% accurate
GERIATRIC NUTRITIONAL RISK INDEX
• Simple and accurate tool for predicting the risk of
morbidity and mortality in hospitalized elderly patients
• Requires measurements of height, albumin, and weight
at admission
• Nutritional risk is graded based on results of calculations
Nutrition
Diagnosis
and Plan of
Care
Nutrition Diagnosis and Plan of Care
– The Nutrition Care Process (NCP) is a
systematic approach to providing high quality
nutrition care.
– Defined as a systematic problem-solving method
used to critically think and make decisions to
address nutrition-related problem and provide
safe and effective quality nutrition care.
Step 1: Nutrition Assessment
– systematic approach to collect, record, and interpret
relevant data from patients, clients, family members,
caregivers and other individual and groups
– an ongoing dynamic process that involves initial
data collection as well as continual reassessment
and analysis of the patient’s status compared to
specified criteria.
Data Sources/ Tools for Assessment
1. Screening or Referral Form
2. Patient/ Client interview
3. Medical or Health Records
4. Consultation with other caregivers, including
family members
5. Community based surveys and focus group
6. Statistical reports, epidemiologic studies
Types of Data Collected
1. Food and Nutrition Related History
2. Anthropometric measurement
3. Biochemical Data, Medical Tests and
Procedures
4. Nutrition focused physical examination
findings
5. Client History
Critical Thinking during this step:
1. Determining appropriate data to collect
2. Determine the need for additional information
3. Selecting assessment tools and procedures that match the
situation
4. Applying assessment tools in valid and reliable ways
5. Distinguishing relevant from irrelevant data
6. Distinguishing important from unimportant data
7. Validating the data
Step 2: Nutrition Diagnosis
1. - a food and nutrition professional’s identification and labelling of
an existing nutrition problem that the food and nutrition professional
is responsible for treating independently
2. - expressed using diagnostic terms and the etiologies, signs and
symptoms that have been identified
Three Parts of Nutrition Diagnosis
(PES)
P= Problem or Nutrition Dx (describes alteration
in patient’s status)
E= Etiology (cause/contributing factor “related
to”)
S= Signs and symptoms (defining characteristics
“as evidenced by”)
Critical Thinking during this step:
1. Finding patterns and relationships among data and possible
causes
2. Making inferences
3. Stating the problem clearly and singularly
4. Suspending judgement
5. Making interdisciplinary connections
6. Ruling in/ruling out specific diagnosis
Step 3: Nutrition Intervention
- is a purposely planned actions designed with the intent
of changing a nutrition-related behavior, risk factor,
environmental condition, or aspect of health status
-consists of planning and implementing
-directed toward resolving nutrition diagnosis or the
nutrition etiology
Four categories of Nutrition Intervention
1. Food and/or Nutrient Delivery
2. Nutrition Education
3. Nutrition Counseling
4. Coordination of Nutrition Care
Critical Thinking during this step:
N1. Setting goals and prioritizing
2. Defining the nutrition Prescription or basic plan
3. Making interdisciplinary connections
4. Initiating behavioral and other nutrition interventions
5. Matching nutrition intervention strategies with patient/ client’s need,
nutrition diagnosis, and values
6. Choosing from among alternatives to determine a course of action
7. Specifying the time and frequency of care
Step 4: Nutrition Monitoring and Evaluation
- identifies the amount of progress made and
whether goals/expected outcomes are being
met.
Four categories of outcomes measured:
1. Food and nutrition related history
2. Anthropometric measurements
3. Biochemical data, medical tests and procedures
4. Nutrition focused physical examination findings
Critical Thinking during this step:
1. Selecting appropriate indicators/measures
2. Using appropriate reference standards for comparison
3. Defining where patient/clients is in terms of expected
outcomes
4. Explaining a variance from expected outcomes
5. Determining factors that help or hinder progress
6. Deciding between discharge and continuance of nutrition
care