1. Lecture 2b 17 Jan. 2011 Nutritional assessment

2. Health, drug, personal and diet histories Anthropometric measurements Laboratory tests Physical examination

3. Health, drug, personal and diet histories Health history -The need for diet modifications including weight reduction -Potential health problems that modified diets might help to prevent or delay -Symptoms and clinical findings that can affect food intake or alter nutrient needs -Disorders and treatments that demand a great deal of time, motivation or financial resources -Physical disabilities that interfere with a person’s ability to purchase, prepare, and/or eat adequate amounts of food

4. Health, drug, personal and diet histories Medication history All prescription and OTC including doses and dose frequency Nutrient and herbal supplements-types, amounts and number of times taken

5. Health, drug, personal and diet histories Personal history Intellectual, spiritual, social, physical, psychological and financial factors affecting nutritional status Nutrient and herbal supplements-types, amounts and number of times taken

6. Health, drug, personal and diet histories Diet history How much of what a person is eating

7. Health, drug, personal and diet histories Diet history Do you have favourite foods? Do you dislike any foods? Are there any foods you do not eat for any reason? Are you allergic or intolerant to any foods? Are you on a special diet? How many times a day do you typically eat meals and snacks? How many times do you typically eat out? How is your appetite? Who does grocery shopping in your household?

8. Diet History continued -24 hour recall- everything eaten and consumed in last 24 hours -food frequency questionnaire-how many servings of each food group in a typical day, week or month

9. Diet History continued -food records- the patient’s food records recorded by patients-records are maintained over several days as well as a person’s response and compliance with medical nutrition therapy or tolerance for foods- such records may include patient’s mood when eating, symptoms associated with eating, what the patient was doing while eating, and physical activity records, administration of medications, and illness.

10. Anthropometric measurements -length, height, weight-infants and children -head circumference-infants -children- 2 and over- height and weight used to calculate BMI -adults-BMI -ibw and ubw- page 601 – 2 in Rolfes et al 8 th edition

11. Laboratory tests -serum protein-protein intake status (PEM) and body’s metabolism, degradation and distribution of the specific protein -albumin-slow to respond to nutritional status -detects state of hydration -serum transferrin-protein energy intake and iron intake -transthyretin-rapidly drop and increase (PEM) -retinol binding protein-see transthyretin -total lymphocyte count-pem –immune response

12. Laboratory tests -cholesterol- up with saturated fatty acids (sfa),trans - down with polyunsaturated fatty acids (pufa) -triglycerides-down with oleic acid, up with saturated fats and obesity -HDLc-up with pufa down with sfa,trans -LDLc-up with saturated fatty acids (sfa), trans down with polyunsaturated fatty acids (pufa) -blood glucose-up with obesity-relationship to above

13. Physical examinations Looking for signs of nutrient deficiency and toxicity -hair -skin -eyes -posture -tongue -gums -fingernails

14. Fig. 1-8, p. 22