Nutritional Assessment

Over-nutrition(Obesity and over weight)

Associated problems Heart disease Cancer Hypertension Diabetes Joint disease Surgical complications Venous thrombosis

Under-nutrition(malnourished)

Problems associated Poor wound healing Sepsis Abcess formation Other infections such as pneumonia

Why is the assessment of nutritional risk important?

Potential to reduce the severity of the disease Potential for shortened recovery time

Ultimately leads to better patient outcomes and reduced health care costs

Elements of Nutritional Screening & Assessment

Health History Medical History Diet History

Health History

Weight gain or loss, history of N/V/D, or change in appetite

Menstrual history Family history - heart disease, etc. Lifestyle habits - smoking, exercise, eating

out, fast food, etc.

Medical History

Drugs that may affect appetite Drug interactions that may affect nutrient

absorption, metabolism, or excretion Supplement use, especially excessive

supplementation in the elderly

Inform clients of harmful effects of some supplements in megadoses:

A & D accumulate in the body B & C may increase risk of kidney stones

Diet History

Usual food and fluid intake Type and amount eaten

Eating patterns and habits # and timing of meals and snacks setting of meals eaten at home frequency of meals eaten out Snacks

Diet History

Food preferences and restrictionsreligious or culturalfood allergies or intolerances

Problems with eatingChewing or swallowingPhysical limitations-i.e., unable to cut or mash

foods Food buying and preparation

Types of Diet History

Diet Recall Food Record Recall Food Frequency

Diet Recall

Ask client to recall everything eaten on the previous day or on a typical day

Advantages Easy to administer Easy for client to participate

Disadvantages Only assesses one day’s intake Doesn’t reflect differences-seasons or holidays Relies on memory

Food Record Recall

Ask client to record intake over at least 3 days:

Advantages Takes only a small amt of time for interviewer More representative of clients diet Helps them review dietary habits

Disadvantages Need to be literate Time consuming for client Eat better during collection period

Food Frequency

Ask client via a questionnaire how often certain foods have been eaten in past 6-months Advantages

Interviewer not requiredQuick to completeProvides a view of dietary habits over a period of time

DisadvantagesCan’t assess # and timing of mealsMay not reflect cultural dietary habitsMay have difficulty completing forms

Food Guide Pyramid

Healthy Diet

The Dietary Guidelines from USDA describe a healthy diet as one that

Emphasizes fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products;

Includes lean meats, poultry, fish, beans, eggs, and nuts; and

Is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars.

Anthropometric Measurements

Height and Weight BMI Body Composition Body Proportion

Anthropometric Measures

Measure size, weight, and proportions of human body

Clinically significant weight changes >5% BW over 1 month >7.5% BW over 3 months >10% BW over 6 months

Height and Weight

Weight and height most common measurements Height-flat, vertical measuring surface, no shoes,

stand erect Weight-minimal clothing, no shoes, empty bags

including colostomies, same time each day, coordinate with diuretic dosing.

Body Mass Index

Assessment of optimal weight for height

< 18.5 Underweight 18.5 - 24.9 Normal 25.0 – 29.9 Overweight 30 – 39.9 Obesity > 40 Extreme Obesity

Body Composition

Proportion of fat versus muscle mass Skinfold calipers to measure skinfold

thickness Calipers used most often

Body Proportion – Waist to Hip Ratio

Where fat is accumulated on body?Apple shape - abdominal accumulation

Android obesity Increased risk for obesity-related diseases and early

mortalityPear shape - hip accumulation

Gynoid obesity

Laboratory Measurements

Serum albumin Decreased protein, poor wound healing, immune

system compromised

Nitrogen balance Index of Protein nutritional status

TLC (total lymphocyte count) Assess immune system, malnutrition causes

decrease TLC, also AIDS

Laboratory Measurements

Hgb & Hct Associated with anemia

Hgb A1C- compliance with Diabetes Fasting blood glucose

Screening for diabetics or glucose intolerance, Glucose levels increase when pancreas is not secreting

enough insulin or when insulin resistance is present in peripheral tissues

Cholesterol & Triglycerides Elevated lipid levels, and heart disease risk High LDL, low HDL

Laboratory Measurements

Creatinine-Height Index (CHI) Estimates amount of skeletal muscle mass

Skin Testing Immunity function

Dietary Deficiencies for Specific Client Populations

Healthy adults & children Low fiber, fruits & vegies

Vegetarians Need supplemental Vit B12-only found in

animal products

Athletes, active children & adults Need complex carbohydrates (muscle energy) Need iron-rich foods to correct anemia

Dietary Deficiencies for Specific Client Populations

Pregnant and breast feeding women Last 2 trimesters-caloric needs increase by

300cal/day Breast feeding requires 500 additional cal/day

Elderly men & women Drying of mouth, decreased sense of taste &

smell, decreased thirst, may diminish appetite Obese clients

63% of US population is overweight 25% of children are obese

Nutrition and Illness

Eating disorders 8 mil people have either anorexia or bulimia

HTN, diabetes, heart disease 43 mil people, more common in African

Americans Cancer

Increased caloric requirements Decreased appetite