1. Brooke Benton MS, RD, LDN, CDE

2.  Anthropometrics  Biochemical/Laboratory  Clinical Data  Dietary Methods

3.  The measurement of body size, weight and proportions  Adherence to technique is critical to obtaining accurate and precise measurements  Among children, length, stature, weight and head circumference are the most sensitive and commonly used indicators

4.  Body Weight  One of the most important measurements in nutrition assessment  Obtained using an electronic or balance beam scale  Attention must be give to regular calibration  Overweight is a body weight above some reference weight  Usually defined in relation to stature

5.  Approaches to assessing body weight include:  Height-Weight tables  Relative weight  Height –Weight indices

6. Height Weight Table Height Acceptable Weight Range If aged 19-34 Acceptable Weight Range If aged 35+ 5 feet 0"97-128 pounds108-138 pounds 5 feet 1"101-132111-143 5 feet 2"104-137115-148 5 feet 3"107-141119-152 5 feet 4"111-146122-157 5 feet 5"114-150126-162 5 feet 6"118-155130-167 5 feet 7"121-160134-172 5 feet 8"125-164138-178 5 feet 9"129-169142-183 5 feet 10"132-174146-188 5 feet 11"136-179151-194 6 feet 0"140-184155-199

7. ARE YOU OVERWEIGHT?

9. Risk of Associated Disease According to BMI and Waist Size BMI Waist less than or equal to 40 in. (men) or 35 in. (women) Waist greater than 40 in. (men) or 35 in. (women) 18.5 or lessUnderweight -- N/A 18.5 - 24.9Normal -- N/A 25.0 - 29.9OverweightIncreasedHigh 30.0 - 34.9ObeseHighVery High 35.0 - 39.9ObeseVery High 40 or greaterExtremely ObeseExtremely High

10.  The distribution of body fat may be as important a consideration as total quantity of fat  Classified into 2 types  Upper body (Android)  Lower Body (Gynoid)  Body composition analysis can provide estimates of the body’s reserves of fat, protein, water and several minerals

11.  Visceral Fat  Organ fat or intra-abdominal fat  Located inside the peritoneal cavity, packed between internal organs  Subcutaneous Fat  Found underneath the skin  Can be measured using body fat calipers

12.  Measurement of skinfolds is the most widely used method of indirectly estimating percent body fat  Advantages  Inexpensive equipment  Portable equipment  Measurements obtained quickly  Measurements correlate with body density

13.  Archimedes principle  Measuring the density of the entire body  Usually by hydrostatic (underwater) weighing  Hydrostatic weighing not practical for large groups  Requires  Considerable subject cooperation  Special equipment  Experience  Financial Investment

14.  Uses specially designed two-chambered unit for measuring the body’s volume  Then used to calculate body density and composition  Advantages  Better tolerated than underwater weighing  Requires less subject cooperation  Disadvantages  Costly and complex equipment

15.  Measure indirectly using dilution techniques where a tracer of known concentration and volume is given to a subject  Time is allowed for the tracer to equilibrate with the subjects body water  Concentration of the tracer is a sample of the subjects blood, urine, or saliva

17.  Biochemical/Laboratory tests based on blood and urine can be important indicators of nutritional status  influenced by non-nutritional factors as well  Lab results can be altered by medications, hydration status, and disease states or other metabolic processes, such as stress  As with the other areas of nutrition assessment, biochemical data need to be viewed as a part of the whole.

18.  Indicator of depleted protein status  Low albumin are associated with increased morbidity and mortality in hospitalized patients  Normal level: 35 - 50

19.  Most widely used screening test for iron- deficiency anemia  Normal values vary depending on age  Low values indicate anemia  High values indicate dehydration

21.  Enzyme found in liver, kidneys, skeletal muscles, and heart muscle  Elevated levels could indicate injury to the liver caused by hepatitis, cirrhosis, and bile duct obstruction  May also be elevated to a lesser extent in MI (heart attack), musculoskeletal diseases, and acute pancreatitis  Decreased levels may result from chronic renal dialysis  Normal Value: 1 – 21 units/L

22.  Enzyme found in liver, bone, placenta, and intestine  Elevated levels found in conditions involving increased deposition of calcium in the bone (healing fx, bone tumors) and certain liver diseases  Normal value: 13 – 39 units/L

23.  Enzyme found in heart muscle, liver, skeletal muscles, kidneys, pancreas  Elevated levels seen in heart attack, liver diseases, pancreatitis, musculoskeletal injuries and expose to drugs toxic to the liver  Normal value: 7 – 27 units/L

24.  Urea, the end product of protein metabolism and main method of nitrogen excretion, is formed in the liver and excreted by the kidneys in urine  Elevated levels indicate mainly renal failure  Decreased levels can result from liver disease, over hydration, malnutrition  Normal Value: 8 – 25 mg/dL

25.  Used to evaluate renal function  Elevated values are seen when 50% or more of the kidney’s nephrons are destroyed  Normal Value for females: 0.6 – 0.9 mg/dL  Normal Value for males: 0.8 – 1.2 mg/dL

26.  Serum glucose measurement is useful in the diagnosis and treatment of diabetes  Before a meal: 70 – 130 mg/dL  2 hours after a meal: <180 mg/dL

27. A1cAverage Blood Glucose mg/dL. 5%100 6%135 7%170 8%205 9%240 10%275 11%310 12%345 The A1C test measures your average blood glucose control for the past 2 to 3 months Check A1C twice year at a minimum Goal of <7%

28.  Elevated values seen in renal failure, hypoparathyroidism, hyperthyroidism, and increased phosphapte intake  Low values seen in hyperparathyroidism, rickets, osteomalacia, and chronic use of antacids (bind phosphorus in the gut)  Normal value: 3.0 – 4.5 mg/dL

29.  Major intracellular cation and is involved in acid-base balance, fluid balance, and nerve impulse transmission  Elevated values indicated renal failure, inadequate adrenal gland fx, severe burns, or crushing injuries  Low values can result from diuretics, vomiting, diarrhea, and eating disorders  Normal value: 3.5 – 5.0 mEq/dL

30.  Major extracellular cation, involved in fluid balance and acid-base balance  Elevated levels seen in dehydration resulting from insufficient water intake or excessive water output (diarrhea, vomiting)  Low levels due to excessive sodium loss, conditions resluting in fluid retention (CHF), or water intoxication  Normal Value: 135 – 145 mEq/L

31.  Cholesterol  Elevated values associated with heart dz  Normal value: <200 mg/dL  LDL  Elevated values associated with heart dz  Normal value: <10o mg/dL  HDL  Elevated values indicate a healthy metabolic system  Normal value: >40 mg/dL (men), >50 mg/dL (women)  Triglycerides  Elevated values raise risk of a heart attack or stroke  Normal value: <150 mg/dL

33.  Clinical assessment of nutrition status involves a detailed history, thorough physical exam, and interpretation of the signs and symptoms associated with malnutrition

34.  Past and present dx of nutritional consequence (diabetes, heart dz, kidney dz, liver dz, gallbladder dz, GI issues, etc…)  Diagnostic procedures  Surgeries  Chemotherapy & radiation therapy  History of nutrition related problems  Existing nutrient deficiencies  Medications and their nutrition interactions  Psychosocial history (ETOH, smoking, finances, social support)  Signs or symptoms suggestive of vitamin or mineral deficiency

35.  Weight changes  Usual meal pattern  Appetite  Satiety  Discomfort after eating  Chewing/swallowing ability  Likes/dislikes  Taste changes/aversions  Allergies  Nausea/vomiting Bowel habits Living conditions Snack consumption Vitamin/mineral use Alcohol/drug use Previous diet restrictions Surgery/chronic diseases Ability to purchase and prepare food Access to and ability to pay for health care

36.  Clinical technique for assessing the nutritional status of a patient based on features of the patients history and physical exam  Based on 4 elements of the patients history  Recent loss of body weight  Changes in usual diet  Presence of significant GI symptoms  Patients functional capacity  Also looks at 3 elements of physical exam  Loss of subcutaneous fat  Muscle wasting  Presence of edema or ascites

37.  Nutritional screening instrument using easy to obtain data  Designed to provide primary care health professionals with a single tool to identify elderly patient at at nutritional risk  Should be used as part of a comprehensive exam  Points are assigned for each of the 18 items  These provide a malnutrition indicator score  >24 = good nutrition status  17 – 23.5 = increased risk for malnutrition and should receive further evaluation of their nutrition status  <17 = high risk for protein energy malnutrition and should be followed up with a comprehensive nutrition assessment

38.  http://www.mna-elderly.com/

40.  24-hour recall  Food Record or Diary  Food Frequency Questionnaires  Diet History  Duplicate Food Collections  Food Accounts  Photographic and Digital Video Methods

41.  Trained interviewer asks the respondent to recall in detail all the food and drink consumed during a period of time in the recent past  The interviewer then records this information for later coding and analysis  This is usually done for the last 24 hours  Memories of intake may fade rather quickly beyond the most recent day or two, so that loss in accuracy may exceed gain in representativeness.

42.  Respondent records, at the time of consumption, the identity and amounts of all foods and beverages consumed for a period of time  Usually ranging from 1-7 days  Household measures' such as cups, tablespoons, and teaspoons or measurements made with a ruler are sued to quantify portion size  Sometimes referred to as the estimated food record because portion sizes are estimated or household measures are used.  When food is weighed, the record may be referred to as a weighed food record.

43.  Assess energy and/or nutrient intake by determining how frequently a person consumes a limited number of foods that are major sources of nutrients or of a particular dietary component in question  Questionnaires consist of a list of approximately 150 or fewer foods or food groups that are important contributors to the population’s intake of energy and nutrients  Respondents indicate how many times a day, week, month or year that they usually consume the foods

44.  Used to assess an individual's usual dietary intake over an extended period of time, such as the past month or year  Diet history approach has been associated with the method of assessing a respondents usual diet developed by B.S. Burke during the 1940’s  Burke’s original method involved fours steps: 1. Collect general information about the respondent’s health habits 2. Question the respondent about hi or her usually eating pattern 3. Perform a cross-check on the data given in step2 4. Have the respondent complete a 3- day food record

45.  Used to measure dietary intake within households and institutions where congregate feeding is practices, such as penal institutions, nursing homes, military bases, and boarding schools  Accounts for all food on hand in the home or institution at the beginning of the survey period, all that is purchased or grown throughout the period, and all that remains by the end of the survey  The daily mean consumption per person is calculated for each food item from the total amount of food consumed during the survey period and the number of people in the household or institution

46.  Duplicate Food Collection Method  Photographic and Video Records  Computerized Techniques

48.  Prior to the development of computers and diet software the manual nutritional analysis of diets was difficult and time consuming  Manually calculating intake of  Energy  Protein  Carbohydrate  Total fat  Calcium  Iron  Vitamin C

49.  Factors to Consider  Establish needs for obtaining the software  Choose a dietary analysis systems that is suitable to needs and tasks  3 Characteristics used to compare Programs. 1. Aspects of the database 2. Software program operation 3. System output

50.  Develops and maintains a number of databases  USDA Nutrient Database for Standard Reference (SR)  Primary Data Set for USDA Nationwide Food Surveys (PDS)  SR and PDS serve as the core for commercial and foreign databases  Numerical foundation of all public and private work on the field of human nutrition

51.  Challenges in formulating high quality database  How many foods and nutrients to include  Use of non-USDA sources to give information on certain brand name foods and to fill in the missing data

52.  General operating features of diet analysis system are extremely important  Determining whether a software package is easy to use while generating desired info  These features include  Search and entry of food items  Comparison of results with a variety of dietary standards  Important features of Program  Ability to print out a variety of printed reports  Exporting the data to a variety of electronic files for further analysis

53.  Many websites provide nutrition-based information  Quality of this information ranges from excellent to very poor  Free dietary analysis on the Internet available since mid 1990’s  Top rated online assessment tool  MyPyramid Tracker  Enter food intake and receive a score on the overall quality of diet  Nutrient intake compared with the RDA for nutrients and a graphic comparison with MyPyramid

54. Dietary Guidelines Recommendatio ns Emoticon Number of cup/ oz. Equ. Eaten Number of cup/oz. Equ. Recommended Grain 1 oz equivalent6 oz equivalent Vegetable 0 cup equivalent2.5 cup equivalent Fruit 0 cup equivalent2 cup equivalent Milk 0 cup equivalent3 cup equivalent Meat and Beans 1.8 oz equivalent5.5 oz equivalent Dietary Guidelines Recommendatio ns EmoticonAmount Eaten Recommendatio n or Goal Total Fat 48.3% of total calories 20% to 35% Saturated Fat 13.7% of total calories less than 10% Cholesterol 359 mgless than 300 mg Sodium 457 mgless than 2300 mg Oils*** Discretionary calories (solid fats, added sugars, and alcohol) * **

55. Search the USDA National Nutrient Database for Standard Reference This interface allows simple searches. Enter up to 5 keywords which best describe your food item. Select a Food Group. Then click on the Submit button. If you don't get a match, check your spelling or try a related keyword. If you get too many food items, try a more specific keyword. If you enter two or more keywords, the program will search for food items which contain all of the keywords. Keywords do not have to be adjacent or in the same order as they appear in the food item. You can exclude food items by placing the word "not" in front of a keyword. For Example: Entering "apples not canned" will produce a list of food items containing the keyword "apples" but not the keyword "canned".

56.  Currently online dietary assessment programs fall far short of dietary programs in the following ways: 1. Slower and more cumbersome to use 2. Do not generally allow nutrient analysis from multiple days 3. Have databases with fewer foods and nutrients 4. Do not have as many special features 5. Lack an adequate help function

57.  Tufts University Nutrition Navigator  www.Navigator.tufts.edu www.Navigator.tufts.edu  Provides a rating of the accuracy of nutrition content and usability of nutrition websites  Mayo Health Oasis  www.mayohealth.org www.mayohealth.org  Provides consumers with good nutrition information in a fun, user-friendly format  Consumer Information Center  www.pueblo.gsa.gov www.pueblo.gsa.gov  Provides access to hundreds of educational materials  FDA Center for Food Safety and Applied Nutrition  www.vm.cfsan.fda.gov/list.html www.vm.cfsan.fda.gov/list.html  Provides government updates on food and nutrition issues and basic nutrition guidelines  Meals for You (My Menus)  www.MealsForYou.com www.MealsForYou.com  Provides thousands of recipes with menu plans, shopping lists, and nutritional analysis

58.  www.diabetes.org www.diabetes.org  Lee, R.D, & Nieman, D.C. (2010). Nutritional Assessment, 5 th edition. New York, NY: McGraw Hill Higher Education.