1. Nutritional Assessment of Community Nutrition using Clinical Parameters

2. Clinical Methods one of the most practical and important method used in assessing the nutritional status of a community. External examination of the body for changes in superficial epithelial tissues especiallly skin, hair, & buccal mucosa may be carried out. Similarly, organs close to the surface of the body may be examined, e.g. the parotid & thyroid gland. When two or more signs charateristic of a deficiency disease are present simultaneously, their diagnostic significance is greatly enhanced.

3. CLINICAL ASSESMENT

4. Clinical signs & symptoms of nutritional inadequacy SITESIGNDEFICIENCY GENERAL APPEARANCE Loss of subcutaneous fat Sunken or hollow cheeks Calories Calories, fluid HAIREasily plucked hair, alopecia Dry, brittle hair Corkscrew hairs Protein Protein, biotin Vitamin C NAILSSpooning Transverse depigmentation Iron Protein

5. SkinDry and scaly flaky paint Nasolabial seborrhea Psoriasiform rash Pallor Follicular hyperkeratosis Perifollecular hemoffhege Easy bruising Hyperpigmentation Vitmin A, zinc EFA, riboflavin Vitamin A, zinc Iron, vit. B12, folate Vit. A, EFA Vitamin C Vitamin K or C Niacin EyesNight blindness Photophobia, xerosis Conjuctival inflammation Retinal field defect Vitamin A, zinc Vitamin A Riboflavin, Vitamin A Vitamin E

6. MOUTHGlosssitis Bleeding gums Angular stomatitis Cheilosis Decreased taste or smell Tongue fissuring Tongue atrpohy Loss of tooth enamel Riboflavin, Pyridoxin, Niacin, Folic acid, Vit. B12, Iron Vitamin C, Riboflavin Riboflavin, pyridoxine, niacin Riboflavin, pyridoxin Zinc Niacin Riboflavin, niacin, iron calcium NECKGoitre Partid enlargement Iodine Protein HEARTHigh output failurethiamin CHESTRepiratory muscle weakness Protein, phophorus

7. AbdomenAscites hepatomegaly Protein Protein, fat ExtremetiesEdema Bone tenderness Bone/joint pain Muscle pain Joint swelling Protein Vitamin D Vitamin A or C Thiamin Vitamin C MusclesAtrophic muscles decreased grip strength Protein

8. NeourologicalDementia Acute disorientation Nystagmus Ophthalmoplegia Wide-based gait Perpheral neuropathy Loss of vibratory sense Loss of position sense Tetany Paresthesias Wrist or foot drop Diminished reflexes Thiamin, vit. B12, folate, niacin phosphorus., niacin Thiamin Thiamine, pyridoxine, vita.E Vit. B12 Ca, mg Thiamine, vit. B12 thiamine Iodine

9. Early clinical symptoms & signs of malnutrition are rather vague & often include weakness, lethargy, irritability, & light headedness. Many of the symptoms & signs are non specific for a single nutrient defict. And may be cause by insufficiency of several nutrients. E.g. flaking dermatitis may be due to protein, riboflavin, or linoleic acid deficiency

10. Advantages of Clinical Assessment Physical examinations should be an integral part of most nutrition surveys for the following reasons: It is inexpensive. It does not require any laboratory equipment. Cooperation of the subject can be achieved easily. A physical examination may reveal evidence of certain nutritional deficiencies which will not be detected by dietary or laboratory methods. The identification of even a few cases of clear-cut nutritional deficiency may be particularly revealing and provide a clue of malnutrition in a community. The nutritional examination may reveal signs of a host of other diseases which merit diagnosis and treatment.

11. DISADVANTAGES OF CLINICAL ASSESSMENT:  The major problems encountered in the clinical assessment of nutritional status are:  These have a low general prevalence in developed countries except in high risk groups.  Some clinical signs are non-specific of nutritional deficiency.  One clinical sign overlaps for more than one deficiency disorder.  It does not reflect the magnitude of the problem.  Skilled personel is required to carry out clinical examinations.

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