Nutritional Assessment
Chapter 11
Defining Nutritional Status
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Optimal nutritional status
Undernutrition
Overnutrition
Nutritional requirements at different ages
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Slide 11-2
Infants and children
Adolescence
Pregnancy and lactation
Adulthood
The aging adult
Purposes and Components
of Nutritional Assessment
• Purposes of nutritional assessment
• Nutrition screening
– Admission nutrition screening tool
– 24-Hour diet recall
– Food frequency questionnaire
– Food diaries
– Direct observation
• Food guide pyramid
Slide 11-3
Subjective Data—
Health History Questions
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Eating patterns
Usual weight
Changes in appetite, taste, smell, chewing, swallowing
Recent surgery, trauma, burns, infection
Chronic illnesses
Vomiting, diarrhea, constipation
Food allergies or intolerances
Medications and/or nutritional supplements
Self-care behaviors
Alcohol or illegal drug use
Exercise and activity patterns
Family history
Slide 11-4
Objective Data—Physical Exam
• Equipment needed
– Skinfold calipers—Lange or Harpenden
– Measurement tape
– Anthropometer
– Pen or pencil
– Nutrition assessment data form
Slide 11-5
Objective Data—Physical Exam
(cont.)
• Anthropometric measures
– Derived weight measures
• Body weight as percent of ideal body weight
• Percent usual body weight
• Recent weight change
Slide 11-6
Objective Data—Physical Exam
(cont.)
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Body mass index =
Weight (kg)
Height (m)2
or
Weight (lbs)
Height (in)2 x 705
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Waist-to-hip ratio =
Waist circumference
Hip circumference
Slide 11-7
Objective Data—Physical Exam
(cont.)
• Skinfold thickness
– Technique of measurement
– Repeat three measurements and then take
average
• Mid-upper arm circumference (MAC)
Slide 11-8
Objective Data—Physical Exam
(cont.)
• Derived anthropometric measures
– Mid-upper arm muscle circumference (MAMC)
MAMC = MAC – (p × TSF)
– Mid-arm muscle area (MAMA)
MAMA = (MAC – MAMA)2
4p
– Arm span or total arm length
– Frame size by elbow breadth
Slide 11-9
Laboratory Studies
in Nutritional Assessment
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Hemoglobin
Hematocrit
Cholesterol
Triglycerides
Total lymphocyte count
Skin testing
Slide 11-10
• Serum proteins
– Serum albumin
– Serum transferrin
– Prealbumin
• Nitrogen balance
• Creatinine-height index
Abnormal Findings
Classification of Malnutrition
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Obesity
Marasmus (protein-calorie malnutrition)
Kwashiorkor (protein malnutrition)
Marasmus/kwashiorkor mix
Slide 11-11
Abnormal Findings
Abnormalities Caused by
Nutritional Deficiencies
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Pellagra
Scorbutic gums
Follicular hyperkeratosis
Bitot’s spots
Kwashiorkor
Rickets
Magenta tongue
HIV-associated malnutrition
Slide 11-12