NMDF121 Session 24 Nutritional Assessment

Size: px

Start display at page:

Download "NMDF121 Session 24 Nutritional Assessment"

Magdalen O’Neal’
5 years ago
Views:

1 NMDF121 Session 24 Nutritional Assessment Naturopathic Medicine Department Endeavour College of Natural Health endeavour.edu.au 1

2 Topic Summary Nutritional assessment methods Individual dietary assessment methods Population based dietary assessment methods Methods of measuring food consumption Energy balance Endeavour College of Natural Health endeavour.edu.au 2

Nutritional Assessment Methods Common nutritional assessment methods used to assess the nutritional status of individuals and groups within

3 Nutritional Assessment Methods Common nutritional assessment methods used to assess the nutritional status of individuals and groups within Australia are: Dietary Laboratory Clinical Ecological Anthropometric (Gibson, R. 2005) Endeavour College of Natural Health endeavour.edu.au 3

4 Dietary The first stage of nutritional deficiency is identified by dietary assessment methods. There are numerous types of dietary assessment methods, such as: 24 hour recall Food frequency questionnaires Weighted food records These can also involve methods such as interviews, focus groups and observations. Note with all self-report measures there can overreporting, under-reporting and mis-reporting. (Gibson, R. 2005) Endeavour College of Natural Health endeavour.edu.au 4

5 Dietary Dietary intake may be inadequate due to primary or secondary deficiencies. Primary deficiency = low levels of nutrient in the diet. Secondary deficiency = dietary intakes may appear to meet nutritional needs but conditioning factors such as certain drugs, dietary components or disease states interfere with ingestion, absorption, transport, utilization, or excretion of the nutrients. (Gibson, R. 2005) Endeavour College of Natural Health endeavour.edu.au 5

6 Laboratory The laboratory method includes: Static biochemical test Measure nutrients in biological fluids or tissues Functional tests Indirectly measure status via intermediate metabolites or enzymes dependant on nutrient cofactors Laboratory methods are especially useful for identifying the second and third stages in the development of a nutritional deficiency. (Gibson, R. 2005) Endeavour College of Natural Health endeavour.edu.au 6

7 Functional Investigations Other examples o CDSA and parasitology o Salivary hormones o Functional liver detoxification profile o Intestinal Permeability PI Healthscope 2011 Endeavour College of Natural Health endeavour.edu.au 7

8 Endeavour College of Natural Health endeavour.edu.au 8

9 Endeavour College of Natural Health endeavour.edu.au 9

10 Clinical methods include: The medical history Physical examinations Clinical Used to detect signs and symptoms of nutritional deficiency. Laboratory methods should be used in conjunction with clinical methods in order to confirm suspected issues Useful to monitor treatment progress and efficacy (Gibson, R. 2005) Endeavour College of Natural Health endeavour.edu.au 10

11 Ecological Ecological and geographic characteristics predict nutritional status of communities. This method includes the collection of information on a variety of factors that may influence nutrition status in communities, such as; Relevant socioeconomic data Demographic data Household composition Education Literacy Ethnicity Religion Income Employment Material resources Water supply Household sanitation Access to health and agricultural services Food availability and prices (Gibson, R. 2005) Endeavour College of Natural Health endeavour.edu.au 11

12 Anthropometrics Skin fold thicknesses from a variety of locations, body weight, and limb circumferences can be used to calculate fat, fat-free mass, and muscle size. Bioelectrical impedance and air displacement methods may also be employed Measurements can be made in the field but require skilled technicians for accuracy. Simple skin folds can provide some information about regional subcutaneous fat as well as about total fat and lean mass percentages (Gropper, 2005) Endeavour College of Natural Health endeavour.edu.au 12

13 Review Questions 1. List the 5 main types of nutritional assessment methods and provide a brief description of each to demonstrate a general understanding Endeavour College of Natural Health endeavour.edu.au 13

14 Anthropometric Measures Weight and height BMI (Body Mass Index) Mid arm circumference (biceps and triceps) Skin fold thickness Bioelectrical Impedance Analysis Air Displacement Plethysmography Endeavour College of Natural Health endeavour.edu.au 14

15 Skin Folds Most measurements should be taken on the right side of the body with the precision of the skin folds lies in the skill of the measurer. Offers limited accuracy in measuring visceral fat but is quite inexpensive and simple to perform. Skin fold sites of measurement include Triceps, biceps, subscapula, supraillaic, abdomen, thigh and calf Endeavour College of Natural Health endeavour.edu.au 15

16 BMI The degree of adiposity according to the relationship of weight to height, thus eliminating the dependence on frame size (Mahan 2000, p370) Metric Rule: weight (kg) / height (m 2 ) o Inaccurate in instances of short stature, body builder physique or in pregnancy o Additionally standard BMI calculation is not appropriate for children and adolescents due to their rapid growth and calculations for these groups must also be adjusted for age and sex. Endeavour College of Natural Health endeavour.edu.au 16

17 BMI classification in adults o BMI (kg/m2) Classification < 18.5 Underweight Healthy weight range Overweight Obesity I Obesity II 40.0 Obesity III o BMI = body mass index; kg/m2 = kilograms per metres squared Source: WHO (2000). Endeavour College of Natural Health endeavour.edu.au 17

18 Circumferences also used for Measurement 1. Waist - abdominal circumference (cm) 2. Hips gluteal circumference (cm) 3. Ratio of Waist to Hip circumference E.g. Waist 60cm, Hip 80cm ratio 0.75 Endeavour College of Natural Health endeavour.edu.au 18

19 Circumferences also used for Measurement Data that predict increased mortality from cardiovascular disease and raised blood pressure FEMALES MALES WHR > 0.8 WHR > 0.9 Waist circumference of > 88 Waist circumference of > 102 BMI > 25 BMI > 30 Endeavour College of Natural Health endeavour.edu.au 19

20 Bioelectrical Impedance Analysis BIA measures the impedance or opposition to the flow of an electric current (usually 50 khz) through the body fluids contained mainly in the lean and fat tissue. Generally low in lean tissue, where intracellular fluid and electrolytes are primarily contained, but high in fat tissue. In practice, a small constant current is passed between electrodes spanning the body and the voltage drop between electrodes provides a measure of impedance. Endeavour College of Natural Health endeavour.edu.au 20

21 Bioelectrical Impedance Analysis The resulting impedance reading is proportional to the total body water volume. Prediction equations are used to convert impedance to a corresponding estimate of total body water. Lean body mass is then calculated from this estimate using an assumed hydration fraction for lean tissue. Fat mass may then be calculated by subtracting lean mass from total body weight. (Sun 2003) Endeavour College of Natural Health endeavour.edu.au 21

22 Whole Body Air Displacement Plethysmography With ADP, the volume of an object is measured indirectly by measuring the volume of air it displaces inside an enclosed chamber (plethysmograph). Measured when a subject sits inside the chamber and displaces a volume of air equal to his or her body volume Offers several advantages over established reference methods, including a quick, comfortable, automated, noninvasive, and safe measurement process, Accommodates various subject types (e.g., children, obese, elderly, and disabled persons) Endeavour College of Natural Health endeavour.edu.au 22

23 Whole Body Air Displacement Plethysmography Endeavour College of Natural Health endeavour.edu.au 23

24 Review Questions 1. List the 6 main types of anthropometric assessment methods and provide a brief description of each to demonstrate a general understanding 2. How is BMI calculated? 3. What is considered to be an increased risk measure for WHR and waist circumference in both men and women? Endeavour College of Natural Health endeavour.edu.au 24

25 Nutritional Assessment Systems for Populations Endeavour College of Natural Health endeavour.edu.au 25

26 Nutritional Assessment: Populations Population based nutritional assessment systems can take one of four forms: Surveys Surveillance Screening Interventions Endeavour College of Natural Health endeavour.edu.au 26

27 Source: DoHA 2011, Australian Health Survey Endeavour College of Natural Health endeavour.edu.au 27

28 Surveys Surveys involve the systematic collection of data about populations and are often used to establish baseline data or to assess the overall nutritional status of a population. National nutritional surveys produce valuable information on the degree of existing nutritional problems. This information is used to allocate resources and to form policy to improve population nutrition. (Gibson, R. 2005) Endeavour College of Natural Health endeavour.edu.au 28

29 Australian Surveys 1995 National Nutrition Survey (still used for dietary data) participants 2 year olds plus 24 hour recall, with a small subgroup providing a second 24 hour recall. Also questionnaire on food behaviours (e.g. dieting) 2007 Children s Nutrition and Physical Activity Survey (Kids Eat Kids Play Survey) - children 2-16yrs - 24hour recall taken twice within 3 weeks - parental/guardian recall for younger children - Included PA measures: survey & pedometer Endeavour College of Natural Health endeavour.edu.au 29

Australian Surveys Australian Health Survey 2011-2013 Australia s largest, most comprehensive survey will incorporate multiple surveys both urban & rural participants one adult, one child

30 Australian Surveys Australian Health Survey Australia s largest, most comprehensive survey will incorporate multiple surveys both urban & rural participants one adult, one child from each dwelling nutrition, physical activity, anthropometry, biochemical data staged release of data first release informs this unit Endeavour College of Natural Health endeavour.edu.au 30

31 Surveillance Surveillance involves the continuous monitoring of the nutritional status of a selected population group. Surveillance is different to a survey in that the data is collected, analysed and utilised over an extended period of time. Often surveillance only involves at risk populations, as previously assessed by nutritional surveys. (Gibson, R. 2005) Endeavour College of Natural Health endeavour.edu.au 31

32 Screening Screening is a comparison of measurements on individuals with predetermined risk levels or cut off points. Screening uses measures that are simple cheap and able to be applied rapidly on a large scale. Screening can be carried out on a whole population, targeted to a specific subpopulation considered to be at risk or on selected individuals. (Gibson, R. 2005) Endeavour College of Natural Health endeavour.edu.au 32

33 Interventions Interventions target population sub groups often defined as at risk from nutritional surveys or nutritional screening. There are three types of nutritional interventions, these are: Supplementation Fortification Dietary approaches (Gibson, R. 2005) Endeavour College of Natural Health endeavour.edu.au 33

34 Methods for measuring food consumption The most commonly used methods for measuring food consumption of individual, and of groups/communities within Australia: 24 hour recall method Repeated 24 hour recalls Weighed food records 3-5 day dietary history Food frequency questionnaire (Gibson, R. 2005) Endeavour College of Natural Health endeavour.edu.au 34

35 The Energy Balance Endeavour College of Natural Health endeavour.edu.au 35

36 Balancing Energy Needs Energy in + Energy out = energy balance Positive energy balance: intake exceeds expenditure and excess energy is stored Negative energy balance: expenditure exceeds intake and energy is lost Endeavour College of Natural Health endeavour.edu.au 36

37 Estimated Energy Requirements o Humans need energy for basal metabolism which comprises a set of functions necessary for life. o Basal metabolic rate (BMR) represents about 45 70% of daily energy expenditure, depending on age, gender, body size and composition. o Physical activity is the most variable determinant of energy need and is the second largest user of energy after BMR. o EER = BMR + PAL + energy expended during digestion NHMRC 2005 Endeavour College of Natural Health endeavour.edu.au 37

38 Source: NHMRC 2005 Endeavour College of Natural Health endeavour.edu.au 38

39 Kilojoules and Calories in Food o A kilojoule is a unit of measure of energy, in the same way that kilometres measure distance. o Food energy can also be measured in terms calories (kilocalorie) which has the same energy value as kilojoules (kj). The unit of energy is the kilojoule (kj) or megajoule (1 MJ = 1,000 kj) kilojoules are equal to 1 kilocalorie Endeavour College of Natural Health endeavour.edu.au 39

40 Energy in Food o The energy value per gram of various food components includes: o Fat 37 kj (9 Cal) not all fatty acids may provide the same amount of energy o Alcohol 29 kj (7 Cal) o Carbohydrates 16 kj (4 Cal) not all carbohydrates may provide the same amount of energy o Protein 17 kj (4 Cal) o Dietary fibre 13 kj (3 Cal) if fermented by bacteria in the large intestine o Water 0 kj (0 Cal) Source: Better Health Channel 2013 Endeavour College of Natural Health endeavour.edu.au 40

41 Energy Intake Looking at food labels is an easy way of determining the energy within a food Example of food label of basmati rice kj content = 1480kJ per 100g Endeavour College of Natural Health endeavour.edu.au 41

42 Factors Contributing to Total Energy Expenditure: BMR (Basal Metabolic Rate) Lean Body Mass body composition Age Gender Body size or growth Hormonal status Physiological status Climate Diet Genetic differences Pharmacological agents Endeavour College of Natural Health endeavour.edu.au 42

43 Activity o Go to the NRV website and calculate your personal daily energy needs: o Alternatively you can use the calculations from Foodzone o How does this compare with your actual intake from your previous food diaries and food analysis? Endeavour College of Natural Health endeavour.edu.au 43

44 Activity o View the following video The single best thing we can do for our health (9mins) and answer the following questions 1. What is the medicine discussed? 2. How long do you need to be active in order to see a positive effect on your health? 3. What is the strongest predictor of death? 4. A women who goes from zero activity to 1 hour per week of exercise reduces her risk of heart disease by almost how much? 5. If you watch an average of 6 hours of TV a day, how many years less can you expect to live? Endeavour College of Natural Health endeavour.edu.au 44

45 References Gibson, R. (2005) Principles of Nutritional Assessment. Oxford University Press, Inc. New York. Gropper,S. S., Smith, J. L., Groff, J. L., (2005) Advanced Nutrition and Human Metabolism. Thomson Wadsworth: Belmont, CA Ingrid HE Rutishauser, Dr Karen Webb, Bonnie Abraham, Rick Allsopp Evaluation of short dietary questions from the 1995 National Nutrition Survey. Australian Food and Nutrition Monitoring Unit. Marks, G Relative Validity of Food Intake Estimates Using a Food Frequency Questionnaire Is Associated with Sex, Age, and Other Personal Characteristics. Queensland Institute of Medical Research estimates. J. Nutr. 136: National Nutrition Survey: Nutrient Intakes and Physical Measurements, Australia, b144fa3ca2568a c0!OpenDocument# [accessed online 28/09/13]. Roach, Crash Course: Metabolism and Nutrition. School of Medicine, London, UK. Sun SS, Chumlea WC, Heymsfield SB, et al. Development of bioelectrical impedance analysis prediction equations for body composition with the use of a multicomponent model for use in epidemiologic surveys.[see comment]. Am. J. Clin. Nutr. Feb 2003;77(2): The Bridging Study - comparing results from the 1983, 1985 and 1995 Australian national nutrition surveys. Endeavour College of Natural Health endeavour.edu.au 45

46 COMMONWEALTH OF AUSTRALIA Copyright Regulations 1969 WARNING This material has been reproduced and communicated to you by or on behalf of the Australian College of Natural Medicine Pty Ltd (ACNM) trading as Endeavour College of Natural Health, FIAFitnation, College of Natural Beauty, Wellnation - Pursuant Part VB of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Do not remove this notice. Endeavour College of Natural Health endeavour.edu.au 46

Introduction about Nutritional Assessment methods. Outlines 2/25/2012. Yasmeen Bashmil 1

Introduction about Nutritional Assessment methods Outlines Introduction. Nutritional assessment systems: surveys, surveillance, screening, intervention and assessment systems in the clinical setting. Nutritional