Welcome to Seminaron

Nutrition Assessment and Management in Family Medicine

Part - 1

Meera Kaur, PhD, RDAssistant Professor, Family Medicine

kaur@cc.umanitoba.ca

Objectives• To understand the importance of routinely

incorporating nutrition into clinical practice for all ages.

• To identify methods to assess the nutritional status of healthy clients and those with acute or chronic illness.

• To identify the prevalence, risk factors and usual physical findings associated with malnutrition and obesity.

• To assess which patient would benefit from additional nutrition counseling.

• To be timely- little amount of clinical time and a lot of ground to cover.

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For all your nutrition needs…

enable you to feel comfortable with basic nutrition questions asked by your patients.

think about nutrition as a preventative health strategy, and to take action.

know where and when to consult an RD.

My Goals for you are to:

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What is Nutrition Assessment?

Nutrition 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

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Why nutrition assessment is important?

• Nutrition-related diseases are leading causes of morbidity and mortality around the globe

• Increasing need for better preventative health strategies.– Want to find help for these people before it is too late.

• Most people’s eating habits can be improved.– Health Canada Canadian Community Health Survey : Nutrition

(2006)

– Malnutrition is common .• 40-65% of hospitalized population are malnourished (Singh, Nutrition, 2006).

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Canadian Community Health Survey (2006)

Canadians consume:– 31% of calories from fat.

• Main contributor is pizza, sandwiches, subs, burgers, hot dogs

– 70% of children, and 50% of adults do not eat enough fruits and vegetables.

– 33% of children and 67% adults do not get enough milk products.

– 59% of adults were overweight or obese.

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AH Mokdad, Unpublished data PT Katzmarzyk, Can Med Assoc J 166:1039-1040, 2002

No Data <10% 10%-14% 15-19% No Data <10% 10%-14% 15-19% 20% 20%

Obesity Trends Among Canadian and U.S. Adults, 1985

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Obesity Trends Among Canadian and U.S. Adults, 2000

AH Mokdad, Unpublished data PT Katzmarzyk, Can Med Assoc J 166:1039-1040, 2002

No Data <10% 10%-14% 15-19% No Data <10% 10%-14% 15-19% 20% 20%

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Components of nutritional assessment

• What Nutrition Assessment includes:– Nutritional genomics– Anthropometrical measurement– Social/ life style assessment– Biochemical measurement– Clinical (Medical hx., Supplements,

Diet/Social hx, Review of systems, Physical examination)

– Subjective Global assessment

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Nutritional Genomics– Nutritional genomics is a science studying the

relationship between human genome, nutrition and health. It can be divided into two disciplines:

– Nutrogenomics: studies the effect of nutrients on health through altering genome, proteome, metabolome and the resulting changes in physiology.

– Nutrogenetics: studies the effect of genetic variations on the interaction between diet and health with implications to susceptible subgroups.

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Anthropometrical Measurement• Weight (Dry vs. Wet)• Height• Waist circumference vs. Body Mass Index

– BMI is not a direct measure of body fatness, varies with body composition.

– Can adjust for age.Waist Circumference allows us to assess body fatness

• >102 cm male and >88 cm women = increased health risk.

• Apple vs Pear• Skinfold measurement

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Measurements of lean body mass, body fat and bone mass

Social and Life Style Assessment• Lifestyle assessment

– Employment, exercise, who they live with/ who does grocery shopping and cooking.

– Walking– Taking medications– Managing money– ETOH

• Special diets in past• Dietary Hx

– 24-Hr Recall– Food frequency– Usual intake– Food record

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