Human Nutrition

#4243
Dr. Moustafa I. Elnaggar
lecturer of Physical Therapy
Heliopolis University
Egypt
 LEARNING OBJECTIVES

By the end of this lecture

Understand the basic anthropometric

techniques, applications & reference
standards

Know the different methods for

assessing the nutritional status
 Nutritional assessment
It is related to the individual’s
• (1) food and nutrient intake (diet history),
• (2) lifestyle,
• (3) medication intake,
• (4) social and medical history and
• (5) anthropometric, body composition and
biochemical measurements.
 Anthropometric data

 Biochemical tests

 Clinical observations

 Diet evaluation and personal histories

 Anthropometric data

 Anthropometric measurements are

measurements of body size, weight, and
proportions.
 These measurements can be used to assess
nutritional status, as well as growth and
development of infants and children
 Height:
T he subje ct sta nds e re ct & ba re footed on
a stadiometer with a movable head piece.
The head piece is leveled with skull vault &
height is recorded to the nearest 0.5cm.
 Weight. One of the most important
measurements in nutritional assessment is body
weight.
 Hospitalized patients should be weighed at
consistent times—for example, before breakfast
after the bladder has been emptied.
 Clinic patients should be weighed without
shoes in light, indoor clothing or an examining
gown.
Anthropometry for children
Accurate measurement of height and weight
is essential. The results can then be used to
evaluate the physical growth of the child.

For growth monitoring the data are plotted on

growth charts over a period of time that is
enough to calculate growth velocity, which can
then be compared to international standards
The international standard for assessing body
size in adults is the body mass index (BMI).

Classification BMI (kg/m2)

Underweight <18.5

Normal weight 18.5–24.9

 BMI =
 Weight (in kg)/
Overweight 25–29.9
Height (in m2)
Obesity Class 1 30–34.9

Obesity Class 2 35–39.9

Extreme Obesity Class 3 >40

Other anthropometric Measurements

 Mid-arm circumference

 Skin fold thickness

 Head circumference

 Head/chest ratio
 Hip/waist ratio
 Waist/Hip Ratio

Waist circumference is measured at the

level of the umbilicus to the nearest 0.5cm.

 The subject stands erect with relaxed

abdominal muscles, arms at the side,
and feet together .

 The measurement should be taken at

the end of a normal expiration .
 Waist circumference
Waist circumference predicts mortality
better 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
identified

MALES FEMALE
LEVEL 1 94«cm 80« cm
LEVEL2 102«cm 88«cm
A WHR of 0.7 for women and 0.9 for men has been
shown to correlate strongly with a general status of
healthy.
 while values of WHR over 1.0 for men and over 0.8 for
women are indicative of the presence of central obesity
and increased risk of related diseases (associated with
higher risk of diabetes and hypertension).
WHRs above 0.95 for men or 0.8 for women indicate a
heightened risk of heart attack
Classification of risk of diabetes (type 2), hypertension
and cardiovascular disease associated with body weight.

Classification of overweight and Increased risk for obesity-related health problems,

obesity by BMI and waist e.g. type 2 diabetes, hypertension and
circumference cardiovascular disease
Waist circumference Waist circumference
Women <88 cm Women >88 cm
Men <102 cm Men >102 cm
Underweight (BMI <18.5)
Normal (BMI 18.5–24.9) Eventually high (thin obese)
Overweight (BMI 25–29.9) Increased High
Obese Class I (BMI 30–34.9) High Very high
Obese Class II (BMI 35–39.9) Very high Very high
Extremely high Extremely high Extreme Obesity Class 3 (BMI
>40)
 Initial LaboratoryAssessment
Hemoglobin estimation is the most important
test, &useful index of the overall state of
nutrition.

Stool examination for the presence of ova

and/or intestinal parasites

● Urine microscopy for albumin, sugar and

blood
 Biochemical tests
 Serum albumin
 Patients with low serum albumin levels are in poor nutritional
condition and at high risk of death.
 Serum creatinine
 This protein is used as a nutritional marker, because of its
relation to muscle mass. Measuring serum creatinine is the most
commonly used indicator of renal function.

 Serum transferrin
 This is an iron-transport protein, which serves as a sensitive
marker of total nutrition status and more specifically as a marker
of iron deficiency.
 Serum transferrin receptor (sTfR) level is a new specific and
sensitive indicator of tissue iron status and iron deficiency.
 Clinical observations
 It utilizes a number of physical signs, (specific & non
specific), that are known to be associated with
malnutrition and deficiency of vitamins &
micronutrients.
 General clinical examination, with special attention to
organs like hair, angles of the mouth, gums, nails, skin,
eyes, tongue, muscles, bones& thyroid gland
 Clinical Signs Of Nutritional Deficiency

Hair
Spare&thin protein and zinc deficiency
Easyto pull out protein deficiency
Coiled hair Vit.C & Vit.A deficiency

Mouth
Bleeding & spongy gums Vit. C,A,K,& folic acid

Sore mouth&tongue Vit B12,6,c,folic acid & iron

 Clinical Signs Of Nutritional Deficiency

Nails
Spooning Iron deficiency

protein deficiency

Thyroid gland
 Goiter is a reliable
 Sign of iodine
 deficiency
 Dietary history
It consists of
A. a 24-hour recall,
B. a food frequency questionnaire
C. and a three-day food record.
 Some of the most frequent and necessary information collected is:
1. the usual dietary and meal plan,
2. the number of meals,
3. the usual meal size
4. and the common amount of food,
5. the usual location of eating,
6. the consumption of ready-made meals, snacks and fast food,
7. possible food allergies,
8. food preferences and the frequency of consumption.