Nutri&onal assessment. Dr Hadeel Ali Ghazzawi Nursing Department Applied Nutri7on 2014

Transcription

1 Nutri&onal assessment Dr Hadeel Ali Ghazzawi Nursing Department Applied Nutri7on 2014

2 Introduction Collec&ng, integra&ng, and analyzing nutri&on- related data Die&&an to evaluate pa&ent s nutri&onal status and the extent of any malnutri&on Data gathered will provide the objec&ve basis for recommenda&ons and evalua&on of care Includes a chart review and pa&ent interview

3 The nutri&onal status of an individual is ocen the result of many inter- related factors. It is influenced by food intake, quan&ty & quality, & physical health. The scale of nutri&onal status spread from obesity to severe malnutri&on

4 Purpose of nutri&onal assessment 1. Iden&fy individuals or popula&on groups at risk of becoming malnourished 2. Iden&fy individuals or popula&on groups who are malnourished

5 3. To develop health care programs that meet the community needs which are defined by the assessment 4. To measure the effec&veness of the nutri&onal programs & interven&on once ini&ated

6 5. Es&mates func&onal status, diet intake and body composi&on compared to normal popula&ons 6. Nutri&onal status predicts hospital morbidity, mortality, length of stay, cost 7. Baseline body composi&on and biochemical markers determine if nutri&on support is effec&ve

7 Methods of Nutri&onal Assessment Nutri&on is assessed by two types of methods; direct and indirect. The direct methods deal with the individual and measure objec&ve criteria, while indirect methods use community health indices that reflects nutri&onal influences.

8 Direct Methods of Nutri&onal Assessment These are summarized as ABCD Anthropometric methods Biochemical, laboratory methods Clinical methods Dietary evalua&on methods

9 Indirect Methods of Nutri&onal Assessment These include three categories: Ecological variables including crop produc7on Economic factors e.g. per capita income, popula7on density & social habits Vital health sta&s&cs par7cularly infant & under 5 mortality & fer7lity index

10 ANTHROPOMETRIC METHODS

11 Anthropometric Methods Anthropometry is the measurement of body height, weight & propor&ons. It is an essen&al component of clinical examina&on of infants, children & pregnant women. It is used to evaluate both under & over nutri&on. The measured values reflects the current nutri&onal status & don t differen&ate between acute & chronic changes.

12 Inexpensive, noninvasive, easy to obtain, valuable with other parameters Height, weight and weight changes Segmental lengths, fat folds and various body circumferences and areas Repeated periodically to note changes Changes are not obvious for 3-4 weeks

13 Measurements Mid- arm circumference Skin fold thickness Head circumference Head/chest ra&o Hip/waist ra&o

14 Ideal body weight IBW (kg) for men = [(height (cm) - 154) x 0.9] + 50 IBW (kg) for women = [(height (cm) - 154) x 0.9] Add 10% for large- framed and subtract 10% for small- framed %IBW = (current wt/ibw) X % mild malnutri7on 70-79% moderate malnutri7on 60-69% severe malnutri7on <60% non- survival

15 %UBW: usual body weight = (current wt/ubw) X % mild malnutri7on 75-84% moderate malnutri7on 0-74% severe malnutri7on % weight change = usual weight present weight/usual weight X 100 Significant weight loss >5% in 1 month >10% in 6 months

16 Anthropometry for children Accurate measurement of height and weight is essen&al. The results can then be used to evaluate the physical growth of the child. For growth monitoring the data are ploied on growth charts over a period of &me that is enough to calculate growth rate, which can then be compared to interna&onal standards

17 Measurements for adults Height: The subject stands straight & bare footed on a stadiometer with a movable head piece. The head piece is leveled with skull vault & height is recorded to the nearest 0.5 cm.

18 Weight Use a regularly calibrated electronic or balanced- beam scale. Spring scales are less reliable. Weigh in light clothes, no shoes Read to the nearest 100 gm (0.1kg)

19 Waist/Hip Ra&o Waist circumference is measured at the level of the umbilicus to the nearest 0.5 cm. The subject stands straight with relaxed abdominal muscles, arms at the side, and feet together. The measurement should be taken at the end of a normal expira&on.

20 Waist circumference Waist circumference predicts mortality beier than any other anthropometric measurement. It has been proposed that waist measurement alone can be used to assess obesity, and two levels of risk have been iden&fied MALES FEMALE LEVEL 1 > 94cm > 80cm LEVEL2 > 102cm > 88cm

21 Waist circumference/2 Level 1 is the maximum acceptable waist circumference irrespec&ve of the adult age and there should be no further weight gain. Level 2 denotes obesity and requires weight management to reduce the risk of type 2 diabetes & CVS complica&ons.

22 Hip Circumference Is measured at the point of greatest circumference around hips & buiocks to the nearest 0.5 cm. The subject should be standing and the measurer should squat beside him. Both measurement should taken with a flexible, non- stretchable tape in close contact with the skin, but without inden&ng the soc &ssue.

23 Interpreta&on of WHR High risk WHR= >0.80 for females & >0.95 for males i.e. waist measurement >80% of hip measurement for women and >95% for men indicates central (upper body) obesity and is considered high risk for diabetes & CVS disorders. A WHR below these cut- off levels is considered low risk.

24 Frame Size Determined using wrist circumference and elbow breadth Determines the op&mal weight for height to be adjusted to a more accurate es&mate Wrist circumference: measures the smallest part of the wrist Elbow breadth: measures the distance between the two prominent bones on either side of the elbow

25 Skinfold Thickness Es&mates subcutaneous fat stores to es&mate total body fat Compared with percen&le standards from mul&ple body sites or collected over &me

26 Bioelectrical Impedance Analysis (BIA) Measures electrical conduc&vity through water in difference body compartments Uses regression equa&ons to determine fat and LBM Serial measures can track changes in body composi&on Obesity treatments

27 DEXA: dual- energy X- ray absorp7ometry Whole body scan with 2 x- rays of different intensity Computer programs es&mate Bone mineral density Lean body mass Fat mass Best es&mate for body composi&on of clinically available methods

28 Anthropometrics: addi7onal methods Research methods: precise, but cost prohibi&ve Total body potassium Underwater weight (hydrodensitometry) Muscle strength and endurance

29 BIOMEDICAL, LABORATORY ASSESSMENT

30 Ini&al Laboratory Assessment Hemoglobin es7ma7on is the most important test, & useful index of the overall state of nutri7on. Beside anemia it also tells about protein & trace element nutri7on. Stool examina7on for the presence of intes7nal parasites Urine dips7ck & microscopy for albumin, sugar and blood

31 Specific Lab Tests Measurement of individual nutrient in body fluids (e.g. serum re&nol, serum iron, urinary iodine, vitamin D) Detec&on of abnormal amount of metabolites in the urine (e.g. urinary crea&nine/hydroxyproline ra&o) Analysis of hair, nails & skin for micro- nutrients.

32 CLINICAL ASSESSMENT

33 It is an essen&al features of all nutri&onal surveys It is the simplest & most prac&cal method of ascertaining the nutri&onal status of a group of individuals It u&lizes a number of physical signs, (specific & non specific), that are known to be associated with malnutri&on and deficiency of vitamins & micronutrients.

34 Good nutri&onal history should be obtained General clinical examina&on, with special aien&on to organs like hair, angles of the mouth, gums, nails, skin, eyes, tongue, muscles, bones, & thyroid gland. Detec&on of relevant signs helps in establishing the nutri&onal diagnosis

35 Clinical signs of nutri&onal deficiency HAIR Spare & thin Easy to pull out Protein, zinc, biotin deficiency Protein deficiency Corkscrew Coiled hair Vit C & Vit A deficiency

36 Clinical signs of nutri&onal deficiency MOUTH Glossitis Bleeding & spongy gums Angular stomatitis, cheilosis & fissured tongue leukoplakia Sore mouth & tongue Riboflavin, niacin, folic acid, B12, pr. Vit. C,A, K, folic acid & niacin B 2,6,& niacin Vit.A,B12, B-complex, folic acid & niacin Vit B12,6,c, niacin,folic acid & iron

37 Clinical signs of nutri&onal deficiency EYES Night blindness, exophthalmia Vitamin A deficiency Photophobia-blurring, conjunctival inflammation Vit B2 & vit A deficiencies

38 Clinical signs of nutri&onal deficiency NAILS Spooning Iron deficiency Transverse lines Protein deficiency

39 Clinical signs of nutri&onal deficiency SKIN Pallor Follicular hyperkeratosis Flaking dermatitis Pigmentation Bruising, purpura Folic acid, iron, B12 Vitamin B & Vitamin C PEM, Vit B2, Vitamin A, Zinc & Niacin Niacin, PEM Vit K,Vit C & folic acid

40 Clinical signs of nutri&onal deficiency Thyroid gland in mountainous areas and far from sea places Goiter is a reliable sign of iodine deficiency.

41 Clinical signs of nutri&onal deficiency Joins & bones Help detect signs of vitamin D deficiency (Rickets) & vitamin C deficiency (Scurvy)

42 DIETARY EVALUATION ASSESSMENT

43 DIETARY ASSESSMENT Nutri&onal intake of humans is assessed by five different methods. These are: 24 hours dietary recall Food frequency ques&onnaire Dietary history since early life Food dairy technique Observed food consump&on

44 24 Hours Dietary Recall A trained interviewer asks the subject to recall all food & drink taken in the previous 24 hours. It is quick, easy, & depends on short- term memory, but may not be truly representa&ve of the person s usual intake

45 Food Frequency Ques&onnaire In this method the subject is given a list of around 100 food items to indicate his or her intake (frequency & quan&ty) per day, per week & per month. inexpensive, more representa&ve & easy to use.

46 DIETARY HISTORY It is an accurate method for assessing the nutri&onal status. The informa&on should be collected by a trained interviewer. Details about usual intake, types, amount, frequency & &ming needs to be obtained. Cross- checking to verify data is important.

47 FOOD DAIRY Food intake (types & amounts) should be recorded by the subject at the &me of consump&on. The length of the collec&on period range between 1-7 days. Reliable but difficult to maintain.

48 Observed Food Consump&on The most unused method in clinical prac&ce, but it is recommended for research purposes. The meal eaten by the individual is weighed and contents are exactly calculated. The method is characterized by having a high degree of accuracy but expensive & needs &me & efforts.

49 Dietary History and Intake Appe*te and intake: taste changes, den&&on, dysphagia, feeding independence, vitamin/mineral supplements Ea*ng pa0erns: daily and weekend, diet restric&ons, ethnicity, ea&ng away from home, fad diets Es*ma*on of typical calorie and nutrient intake: RDAs, Food Guide Pyramid Obtain diet intake from 24- hour recall, food frequency ques&onnaire, food diary, observa&on of food intake

50 Diet Assessment Evaluate what and how much person is ea&ng, as well as habits, beliefs and social condi&ons that may put person at risk Usual intake 24 hr recall: clear, easy Food frequency ques&onnaire: general idea of how ocen foods are consumed Compare to es&ma&on of needs

51 NUTRITION SCREENING

52 Nutrition Screening Includes height, weight, Uninten&onal weight loss, change in appe&te and serum albumin Data used to determine pa&ents at nutri&onal risk and the need for a detailed assessment Nutri&on care plan developed to reflect calorie, protein and other nutrient needs from the informa&on collected Implement plan Monitor and revise as needed

53 Screening: Nutri7on Care Indicators Nutritional history Appetite Nausea/vomiting (>3 days) Diarrhea Dysphagia Reduced food intake (<50% of normal for 5 days) Feeding modality TPN (total parenteral nutri*on )/PPN (Peripheral parenteral nutri*on ) TF (tube feeding) Diet restrictions

54 Unintentional Weight Loss >22 kgs in past 3 months Serum Albumin Diagnosis End-stage liver or kidney disease, coma, malnutrition, cancer of GI tract, Crohns, cystic Fibrosis, new onset diabetes, eating disorder

55 Components of Nutri7on Assessment Medical and social history Diet history and intake Clinical examina&on Anthropometrics Biochemical data

56 Medical and Social History Medical history: diagnosis, past medical and surgical history, related medica7ons, alcohol and drug use, bowel habits Psychosocial data: economic status, occupa7on, educa7on level, living and cooking arrangements, mental status Other: age, sex, level of physical ac7vity, daily living ac7vi7es

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