NUTRITIONAL

ASSESMENT
PHOENIX RESEARCH INSTITUTE
NURSING DIP. 1ST YEAR
NUTRITION
BY P.M BANDA M.D(BSc HB, MBChB)
OBJECTIVES

 Introduction and Definition

 Nutrition assessment methods
1) Arthropometric Assessment
2) Biochemical Assessment
3) Clinical Assessment
4) Dietary Assessment
INTRODUCTION & DEFINITIONS

 WHAT IS FOOD NUTRITIONAL STATUS???????

Nutritional status can be defined as the condition of the
body as a result of the intake , absorption and use of nutrition
as well as the influence of disease-related factors.
CONT’

 WHAT IS NUTRITIONAL ASSESMENT???

A nutritional assessment is a structured way to establish the nutritional
status and energy requirements by objective measurements and
whereby, accompanied by objective parameters in relation to specific
disease indications, in order to adequately establish a well nutritional
treatment for the patient.
OTHER DEFINITIONS OF
NUTRITIONAL STATUS
 Can also be defined as the interpretation of arthropometric(body
measurement), biochemical(labolatory), clinical and dietary data to
determine whether a person or a group of people are well nourished
or malnourished (Undernutrition or Overnutrition).
 A nutritional assessment is an in-depth evaluation of both objective
and subjective data related to an individual's food and nutrient
intake, lifestyle and medical history.
INTRO

 Once the data about nutritional assessment is collected on

an individual, the health worker can assess, interpret and
evaluate the nutritional status of that person.
 The assessment leads to a plan of care, or intervention,
designed to help the individual either maintain the
assessed status or attain a healthier status.
WHY NUTRITIONAL ASSESMENT???

 Identify individuals or population groups at risk of becoming

malnourished.
 Identify individuals or population groups who are malnourished.
 To develop health care programs that meet the community needs
which are defined by the assessment.
 To measure the effectiveness of the nutritional programs and
intervention once initiated.
Components Of Nutritional Assesment

 Nutritional Assessment can be done using the ABCD

methods/components.
 They include the following.
1) Anthropometry
2) Biochemica/Biophysical methods
3) Clinical methods
4) Dietary Methods
ANTHROPOMETRY
 Anthropometry = Anthropo means human and metry means
measurement.
 This refers to the objective measurements of body muscle and fat or
refers to the measurement of the human individual.
 They are used to compare individuals, compare growth in the
young, and to assess weight loss or gain in the mature individual.
 It is used to evaluate for both under & over nutrition.
 The measured values reflects the current nutritional status and does
not differentiate acute from chronic malnutrition.
CONT’

 Components of anthropometry include:

1) Length/height
2) Weight
3) Skin fold thickness
4) Body parts circumference
WEIGHT
 Weight measurement is achieved by using a sling (spring balance),
also called the salter scale for children <2yrs old.
 In children >2 yrs old and in adults a beam balance is used.
 The measurement is recorded to the nearest 0.1kg.
 In both cases a digital scale can be used if available.
 Note: Always re-adjust the scale to zero before each weighing.
LENGTH Vs HEIGHT

 To measure the length a wooden measuring board also called a

sliding board is used for measuring the length of children <2 yrs old
to the nearest mm.
 It is not accurate as measuring a lying child always gives a greater
reading than the actual height by 1-2cm.
CONT’

 Height on the other hand is measured with the child or adult in a

standing position. It is usually done on children >2 yrs old.
 The head should be in Frankfurt position(the line passing from the
external ear hole to the lower eye lid is parallel to the floor).
 The shoulders, buttocks and the heels should touch the vertical
stand.
 The stadiometer or a portable anthropometer is used to measure
height and measurements are recorded to the nearest mm.
CONT’
CONT’
CONT’
BODY PARTS CIRCUMFERENCE
 WAIST CIRCUMFERENCE: The waist circumference is the 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 is taken at the end of expiration.
 HIP CIRCUMFERENCE: Is measured at the point of greatest
circumference around hips and buttocks to the nearest 0.5cm.
 Mid Upper Arm Circumference: An accurate way of measuring
fat free mass. It is the circumference of the upper arm mid way
between the shoulder tip and the elbow tip.
CONT’

Shakir tape method This special tape has colored zones: red, yellow
and green corresponding to <12.5 cm (wasted), 12.5 to 13.5 cm
(borderline) and over 13.5 cm (normal) MUAC respectively. MUAC is
commonly used in children between 6-59 months of age.
CONT’

MUAC NUTRITIONAL STATUS

>13.5 cm Not malnourished

11.5-13.5 cm Moderately malnourished

<11.5cm Severely malnourished

CONT’
CONT’
SKIN FOLD THICKNESS

 It is an indication of the subcutaneous fat.

 Triceps skin fold is the most representative of the total subcutaneous
fat up to sixteen years of age.
 It is usually above 10 mm in normal children whereas in severely
malnourished it may fall below 6 mm.
INDICATORS OR INDICES

 An indicator is a quantifiable fact or measurement that indicates the

state or level of something. It is important in determining whether
an individual is malnourished or not.
 An index is a combination of two measurements or one plus the
person’s age.
1) Weight for Age is an index or indicator used in growth monitoring
for assessing underweight.
2) Height for Age is an index used for assessing stunting a feature of
chronic malnutrition.
Cont’

3)Body Mass index(BMI) is the weight of the child or adult divided

by their height in metres squared.
4) Wasting (Thinness)-is when the child has low weight for its height.
Thinness is frequently associated with acute and short term
consequences such as severe infections or food deprivation. When a
child’s weight is less than -2SD of the normal weight for height curve,
it is classified as ‘wasted’.
WEIGHT FOR AGE
BMI CHART
Weight For Length
CLINICAL ASSESSMENT
 It is an essential feature of a nutritional survey.
 It utilizes a number of physical signs, specific and non specific, that
are known to be associated with malnutrition and deficiency of
vitamins and micronutrients.
 It involves checking for signs of deficiency at specific parts on the
body and taking a proper history to establish the possible cause of
malnutrition.
CLINICAL SIGNS

 Pallor—Nutritional deficiency anaemia e.g iron, folate,

Vit-B12 etc
 Bitot’s spots– Vit A def
 Pitting oedema—Kwashiooka
 Waisting– Marasmus
 Goitre--- Iodine deficiency
 Thin hair and alopecia--- Vit A def
DIETARY ASSESSMENT

 It involves taking a good history involving the past or current

intakes of nutrients. From food by an individual or a group to
determine their nutritional status.
 The history should include questions about the individual's lifestyle,
the number of meals eaten daily, where they are eaten and who
prepares the meals.
 Information about allergies, food intolerances, and food avoidances,
as well as caffeine and alcohol use, should be recorded.
 Normally, an individual who has diversified meals is highly likely to
achieve a balanced diet and well nourished.
BIOCHEMICAL/LABOLATORY
 Involves taking samples for labolatory analysis.
 The samples collected include; Urine, stool and blood.
1) Blood--- Hemoglobin and RCC
2) Urine---- dipstick, and microscopy for albumin, sugar and blood.
3) Stool examination---- Ova and or intenstinal parasites.
 Individual levels of nutrients in body fluids can be measured e.g
serum retinol, vit B12, iron.
 Enables detection of abnormal amount of metabolites in urine e.g
urine creatinine.
FACTORS AFFECTING LABOLATORY
RESULTS
 Laboratory results can be altered by medications,
hydration status, and disease states or other metabolic
processes, such as stress.
THE END