1. Clinical Nutrition Assessment
Dr Niikee Schoendorfer
UQ Medical School

2. Session objectives
Understand the role that nutrition and lifestyle play in the development of chronic disease
Provide an assessment of patients diet and lifestyle
Gain practical skills in the provision of basic nutritional and lifestyle advice
Identify useful adjunct patient information resources

3. What Causes Chronic Disease?
Many chronic diseases are preventable
Adopt healthy behaviours –
controlling body weight
eating nutritious foods
avoiding tobacco use
increasing physical activity
As we get older our bodies start to show some wear and tear. Blood pressure can increase; the blood vessels that feed the heart with vital oxygen can start to become blocked with cholesterol; some people may develop diabetes, cataracts in their eyes or even get cancer.
Eating plenty of vegetables, legumes and fruits and including some nuts and seeds throughout life, can help to protect against these common problems. This is has been shown in many scientific studies from around the world.
Recommendations
Enjoy a variety of yellow, green and red vegetables, both salad and cooked.
Eat at least five serves of vegetables a day.
Eat at least two pieces of fresh fruit each day.
Try nuts as a snack.
Cereals play an important role in meeting the body’s need for nutrients. They are excellent sources of B-group vitamins and contain useful amounts of vitamin E, essential fatty acids and minerals. They also provide dietary fibre.
Switch from white bread to wholemeal bread.
Eat wholegrain cereal for breakfast.
Include a variety of cereal foods in your meals such as pasta, noodles, rice, couscous and polenta.
Eat at least four to five serves of cereal foods a day. Active men may need up to twice this amount.
Beef, lamb, pork, fish, poultry, eggs, shellfish, nuts and legumes are all excellent sources of protein.
Protein intake is important for every system of the body to function correctly.
These foods are also an important dietary source of iron. Iron deficiency is a significant health problem in Australia. Low iron intakes are common in young women and vegetarians.
Enjoy lean red meat three or four times each week.
Choose lean cuts of meat rather than sausages and processed meats.
Try to eat one or two fish meals a week.
Milk, yoghurts and cheeses are part of the dairy food category.
Dairy foods are a good source of protein, vitamin A and some B vitamins but their most unique contribution is as a source of calcium.
The calcium in dairy foods is also well absorbed into the body compared to other plant sources.
Use low-fat dairy foods at two or more meals each day.
Low-fat milk and yoghurt are excellent choices.
Be moderate with full fat cheeses.
Water is essential for life. We can do without some nutrients for weeks, even months, but a few days without water can be life-threatening.
Water makes up about two-thirds of our body weight. We need it to absorb nutrients from food, transport them around the body and flush away our waste products.
Through perspiration the body uses water to lower body temperature when the weather is warm.
Regular drinks replace water lost from the body during the day. In a mild climate an average person needs to drink about a litre and a half of fluids each day.
In hotter parts of Australia much more may be needed to prevent the body becoming dehydrated.
Recommendation
Drink plenty of water!

4. What Causes Chronic Disease?
Source: Australian Institute of Health and Welfare (AIHW) Chronic diseases and associated risk factors in Australia, Canberra: AIHW.
rheumatoid arthritis
osteoarthritis

5. Health Statistics in Australia
Source(s): Australian Health Survey: Updated Results,
Health Statistics in Australia

6. Health Statistics in Australia
Source(s): Australian Health Survey: Updated Results,
Health Statistics in Australia

7. Health Statistics in Australia
Source(s): Australian Health Survey: Updated Results,
Health Statistics in Australia

8. Health Statistics in Australia
Source(s): Australian Health Survey: Updated Results,
Health Statistics in Australia

9. Health Statistics in Australia
Source(s): Australian Health Survey: Updated Results,
Health Statistics in Australia

10. Health Statistics in Australia
Source(s): Australian Health Survey: Updated Results,
Health Statistics in Australia

11. Health Statistics in Australia
Source(s): Australian Health Survey: Updated Results,
Health Statistics in Australia
Sedentary – 0
Low – up to 1 hour/wk
Moderate – recommended 2-3 hrs/wk
High – over 3 hrs/wk

12. Health Statistics in Australia
Source(s): Australian Health Survey: Updated Results,
Health Statistics in Australia

13. Health Statistics in Australia
Source(s): Australian Health Survey: Updated Results,
Health Statistics in Australia

14. Health Statistics in Australia
Source(s): Australian Health Survey: Updated Results,
Health Statistics in Australia

15. Health Statistics in Australia
Source(s): Australian Health Survey: Updated Results,
Health Statistics in Australia

16. Health Statistics in Australia
Source(s): Australian Health Survey: Updated Results,
Health Statistics in Australia

17. Health Statistics in Australia
Source(s): Australian Health Survey: Updated Results,
Health Statistics in Australia

18. Health Statistics in Australia
Source(s): Australian Health Survey: Updated Results,
Health Statistics in Australia

20. Public Health Campaigns

21. Taking Measurements
Cardiovascular Disease/ Diabetes Risk Total Waist Measurement Waist : Hip Ratio Additional Weight Loss Measures Circumferences – - thigh - bicep - bust

27. Australian Dietary Guidelines
Recommendations:
Fruits and vegetables – variety of colours both cooked and raw, also include legumes, nuts and seeds
Cereals – preferably wholegrain
Meat, seafood and alternatives
Milk, Yoghurts and Cheese – reduced fat varieties
Drinking plenty of water
As we get older our bodies start to show some wear and tear. Blood pressure can increase; the blood vessels that feed the heart with vital oxygen can start to become blocked with cholesterol; some people may develop diabetes, cataracts in their eyes or even get cancer.
Eating plenty of vegetables, legumes and fruits and including some nuts and seeds throughout life, can help to protect against these common problems. This is has been shown in many scientific studies from around the world.
Recommendations
Enjoy a variety of yellow, green and red vegetables, both salad and cooked.
Eat at least five serves of vegetables a day.
Eat at least two pieces of fresh fruit each day.
Try nuts as a snack.
Cereals play an important role in meeting the body’s need for nutrients. They are excellent sources of B-group vitamins and contain useful amounts of vitamin E, essential fatty acids and minerals. They also provide dietary fibre.
Switch from white bread to wholemeal bread.
Eat wholegrain cereal for breakfast.
Include a variety of cereal foods in your meals such as pasta, noodles, rice, couscous and polenta.
Eat at least four to five serves of cereal foods a day. Active men may need up to twice this amount.
Beef, lamb, pork, fish, poultry, eggs, shellfish, nuts and legumes are all excellent sources of protein.
Protein intake is important for every system of the body to function correctly.
These foods are also an important dietary source of iron. Iron deficiency is a significant health problem in Australia. Low iron intakes are common in young women and vegetarians.
Enjoy lean red meat three or four times each week.
Choose lean cuts of meat rather than sausages and processed meats.
Try to eat one or two fish meals a week.
Milk, yoghurts and cheeses are part of the dairy food category.
Dairy foods are a good source of protein, vitamin A and some B vitamins but their most unique contribution is as a source of calcium.
The calcium in dairy foods is also well absorbed into the body compared to other plant sources.
Use low-fat dairy foods at two or more meals each day.
Low-fat milk and yoghurt are excellent choices.
Be moderate with full fat cheeses.
Water is essential for life. We can do without some nutrients for weeks, even months, but a few days without water can be life-threatening.
Water makes up about two-thirds of our body weight. We need it to absorb nutrients from food, transport them around the body and flush away our waste products.
Through perspiration the body uses water to lower body temperature when the weather is warm.
Regular drinks replace water lost from the body during the day. In a mild climate an average person needs to drink about a litre and a half of fluids each day.
In hotter parts of Australia much more may be needed to prevent the body becoming dehydrated.
Recommendation
Drink plenty of water!

28. Australian Dietary Guidelines
and take care to:
Limit saturated fat and moderate total fat intake
Choose foods low in salt
Limit your alcohol intake if you choose to drink
Consume only moderate amounts of sugars and foods containing added sugars.
Australian guide to health eating
Enjoy a wide variety of nutritious foods
Eat plenty of vegetables, legumes and fruits
Eat plenty of cereals (including breads, rice, pasta and noodles), preferably
wholegrain
Include lean meat, fish, poultry and/or alternatives
Include milks, yoghurts, cheeses and/or alternatives. Reduced-fat varieties
should be chosen, where possible
Drink plenty of water.
and take care to;
• Limit saturated fat and moderate total fat intake
• Choose foods low in salt
• Limit your alcohol intake if you choose to drink
• Consume only moderate amounts of sugars and foods containing added sugars.
Prevent weight gain: be physically active and eat according to your energy
needs.
Care for your food: prepare and store it safely
Encourage and support breastfeeding
(Taken from

30. How does your diet measure up?

31. Taken from
the Australian
Dietary Guidelines Summary

32. Recommended Food Servings

33. Recommended Food Servings

34. Recommended Food Servings

35. Recommended Food Servings

36. Recommended Food Servings

37. Portion Distortion

38. Creeping portion distortion
Are you aware of how much food portion sizes have increased in 20 years?
Slides marked by are adapted from “Portion Distortion” by the National Heart, Lung and Blood Institute Obesity Education Initiative at

39. BURGER Today 20 Years Ago 333 calories
How many calories are in today’s burger?

40. BURGER Calorie Difference: 257 calories Today 20 Years Ago

41. Maintaining a Healthy Weight is a Balancing Act
How long will you have to lift weights in order to burn the extra 257 calories?*
*Based on a 60kg person

42. Calories In = Calories Out
1 hour and 30 minutes

43. FRENCH FRIES 20 Years Ago Today 210 Calories How many calories are in
today’s portion of fries?

44. Calorie Difference: 400 Calories
FRENCH FRIES
20 Years Ago
Today
210 Calories
610 Calories
Calorie Difference: 400 Calories

45. How long will you have to walk leisurely in order to burn those extra 400 calories?*
*Based on 72kg person

46. Calories In = Calories Out
1 hour and 10 minutes

47. SOFT DRINK 20 Years Ago Today 85 Calories 250mL
How many calories are in today’s portion?

48. Calorie Difference: 165 Calories
SOFT DRINK
20 Years Ago
Today
85 Calories
250mL
250 Calories
600mL
Calorie Difference: 165 Calories

49. How long will you have to work in the garden to burn those extra calories?*
*Based on 72kg person

50. Calories In = Calories Out
35 minutes

51. SANDWICH 20 Years Ago Today 320 calories
How many calories are in today’s sandwich?

52. Calorie Difference: 500 calories
SANDWICH
20 Years Ago
Today
320 calories
820 calories
Calorie Difference: 500 calories

53. How long will you have to ride a bike in order to burn those extra calories?*
*Based on A 72kg person

54. Calories In = Calories Out
1 hour and 25 minutes

55. COFFEE 20 Years Ago Coffee (with whole milk and sugar) Today
Mocha Coffee (with steamed whole milk and mocha syrup)
45 calories
How many calories
are in today's coffee?

56. COFFEE Calorie Difference: 305 calories 20 Years Ago Today 45 calories

57. How long will you have to walk in order to burn those extra 305 calories?*  
*Based on 60kg person

58. Calories In = Calories Out
1 hour and 20 minutes

59. Maintaining a healthy weight is a balancing act
Larger portions add up
100 extra calories per day
4.5kg weight gain per year
Maintaining a healthy weight is a balancing act

60. MUFFIN 20 Years Ago Today How many calories are in today’s muffin?

61. MUFFIN Calorie Difference: 290 calories 20 Years Ago Today

62. How long will you have to vacuum in order to burn those extra 290 calories?*
*Based on a 60kg person

63. Calories In = Calories Out
1 hour and 30 minutes

64. CHOCOLATE CHIP COOKIE 20 Years Ago Today
55 calories
How many calories are in today’s large cookie?

65. CHOCOLATE CHIP COOKIE Calorie Difference: 220 calories 55 calories
20 Years Ago
Today
55 calories
275 calories
Calorie Difference: 220 calories

66. How long will you have to wash the car to burn those extra 220 calories?*
*Based on 60kg person

67. Calories In = Calories Out
1 hour and 15 minutes

68. SPAGHETTI AND MEATBALLS
20 Years Ago
Today
500 calories
1 cup spaghetti with sauce and 3 small meatballs
How many calories do you think are in today's portion of spaghetti and meatballs?

69. SPAGHETTI AND MEATBALLS
20 Years Ago
Today
500 calories
1 cup spaghetti with sauce and 3 small meatballs
1,025 calories
2 cups of pasta with sauce and 3 large meatballs
Calorie Difference: 525 calories

70. Which portion would you choose?

71. You can save 300 calories by choosing the 1 cup portion.

72. Why not fill up on vegetables??!!?

73. Useful web resources Activity calorie comparison
Public Health Resources
Nutrient Reference Values
Drug and Supplement Information