1. DNT 200 NUTRITION FOR HEALTH SCIENCES
NUTRITION INTERVENTION

2. NUTRITION INTERVENTION

3. NUTRITION INTERVENTION
Nutrition Assessment
Defining nutrition status
Assessor gathers information from many sources
Historical data
Anthropometric measurements
Biochemical analysis (laboratory tests)
Physical examinations
Nutritional assessments define a person’s nutritional status

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Nutrition Assessment
Historical data
Health history -- identifies health-related factors that affect nutrition status
Use records completed by attending physicians, nurses, or other health care providers
Ask the patient
Include socioeconomic history
Profoundly affects nutrition status
Identifies personal, financial, and environmental influences on food intake
Community customs can help the assessor evaluate nutrition status

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Nutrition Assessment
Historical data
Drug history -- used to note food-drug interactions
Diet history
Include
Portion sizes
How food is prepared
Beverage consumption including alcohol

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Nutrition Assessment
Methods
24-hour Recall
Provides data for one day only
Usefulness is limited -- does not provide enough accurate information to allow generalizations to be made about an individual’s usual food intake
Advantage -- easy to obtain

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24-Hour Recall Form

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Nutrition Assessment
Methods (con’t)
Usual Intake
Uses form similar to 24-hour recall
Ask “What is the first thing you usually eat or drink during the day?”
If data varies widely, the client may have difficulty in answering the questions resulting in useless data for estimating nutrient intake

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Nutrition Assessment
Methods (con’t)
Food Frequency Checklist
Purpose -- to determine how often an individual eats a specific type of food per day, per week, or per month
If used with a usual intake or 24-hour recall, permits cross checking of information to improve accuracy

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Food Frequency Checklist Form

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Nutrition Assessment
Methods (con’t)
Food Records (Food Diary)
Requires time, effort, and a cooperative patient
Record keeper assumes an active role -- may, for the first time, become aware of personal food habits and begin to assume responsibility for them
Are particularly valuable for overweight people trying to loose weight
Major disadvantages
- Poor compliance in recording data
- Conscious or unconscious changes in eating habits may occur while the person is keeping the record

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Nutrition Assessment
Analysis of food intake data
Informally -- requires a general knowledge of nutrients in the different food groups
Food composition table
Does not include data on the amount of nutrients actually absorbed
May be uncertainty about portion sizes
Provides only a starting point and should be combined with other sources to confirm or eliminate the possibility of suspected nutritional problems

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Nutrition Assessment
Anthropometric measurements
Are physical measurements that provide an indirect assessment of body composition and development
Purpose
Evaluate the progress of growth in pregnant women, infants, children, and adolescents
Determine under-nutrition and obesity in all age groups

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Nutrition Assessment
Types
Abdominal girth -- reflects abdominal fluid retention
Height-weight
Reflects over-nutrition and under-nutrition; growth in children
Can be difficult to evaluate
Fluid retention can mask significant weight loss
Bedridden patient may be difficult to weigh
Body mass index -- Especially useful in estimating risk to health associated with over-nutrition

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Nutrition Assessment
Types (con’t)
Percent IBW, UBW, recent weight change -- reflects over-nutrition and under-nutrition
Head circumference -- reflects brain growth and development in infants and children under 2

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Nutrition Assessment
Types (con’t)
Fat-fold -- reflects subcutaneous fat and total body fat
Mid-arm muscle circumference -- reflects muscle mass (protein status)

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Nutrition Assessment
Should be taken periodically and compared with standards and previous measurements
Requires minimal equipment but needs proper instruction and practice to ensure reliability

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Nutrition Assessment
Biochemical analysis
Are laboratory tests
Most based on blood or urine samples
Interpretation requires skill
No test reflects nutrition status alone

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Nutrition Assessment
Biochemical analysis (con’t)
Assessment of protein-energy malnutrition
Most commonly used tests
Serum albumin
Accounts for over 50% of total serum proteins
When protein status degenerates, serum albumin concentrations tend to decline slowly -- represent prolonged protein depletion
Correlate well with survival of the hospitalized population
Increase slowly with appropriate nutritional support -- measurement as an early response to nutritional therapy is of limited value
Normal value = 3.5 grams/dL or greater

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Nutrition Assessment
Biochemical analysis (con’t)
Total lymphocyte count
Lymphocytes (white blood cells) are important participants in the immune response
Their numbers are reduced as depletion occurs
Standard is 2,500 per cubic milliliter -- values below 1,500 are considered depleted

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Nutrition Assessment
Biochemical analysis (con’t)
Serum transferrin
Is a protein that transports iron -- its concentrations reflect both protein and iron status
Is relatively slow to respond to changes in protein intake
Standard is 200 or greater mg per dL

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Nutrition Assessment
Biochemical analysis (con’t)
Prealbumin and Retinol-binding protein
Measures response to nutrition therapy
Respond quickly to changes in protein intake

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Nutrition Assessment
Biochemical analysis (con’t)
Classifying protein-energy status
Acute malnutrition (kwashiorkor-type) (protein malnutrition)
Normal or above standard anthropometrics
Below normal indices of blood and organ proteins
Individual may be overweight -- therefore is easily overlooked
Chronic malnutrition (marasmus-type)
Below standard anthropometrics
Normal or above indices of blood and organ proteins
Mixed PEM

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Nutrition Assessment
Biochemical analysis (con’t)
Assessments can also reveal
Energy over-nutrition
Vitamin and mineral deficiencies and toxicity's
Poor dietary practices

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Nutrition Assessment
Biochemical analysis (con’t)
Assessment of nutritional anemias
A low hemoglobin or hematocrit level most frequently signals the presence of anemia
Laboratory tests can pinpoint the cause of anemia and distinguish between nutritional anemia and non-nutritional causes to include blood loss, infections, sickle cell anemia, and chronic liver disease

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Nutrition Assessment

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Nutrition Assessment
Physical examination
Most signs are non specific -- can reflect any of several nutrient deficiencies
Hair -- if dull, brittle, dry, loose or falls out may reflect PEM
Eyes -- pale eye membranes, spots, redness, adjusts slowly to darkness may reflect vitamin A, B-vitamins, zinc, and iron status
Teeth -- missing discolored, decayed, bleeding swollen and spongy gums may reflect mineral and vitamin C status

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Nutrition Assessment
Physical examination (con’t)
Face -- off color, scaly, flaky, cracked skin may reflect PEM, vitamin A and iron status
Glands -- swollen at front of neck may reflect PEM and iodine status
Tongue -- sore, smooth, purplish and swollen may reflect B vitamin status
Skin -- dry rough, spotty, “sandpaper” feel, sores, lack of fat under skin may reflect PEM, essential fatty acid deficiency, vitamin A, B vitamin and vitamin C status

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Nutrition Assessment
Physical examination (con’t)
Nails -- spoon-shaped, brittle, ridged, pale may reflect iron status
Internal systems -- abnormal heart rate, heart rhythm or blood pressure, enlarged liver or spleen, abnormal digestion, burning or tingling of hands, feet, loss of balance or coordination, mental confusion, irritability, fatigue may reflect PEM and mineral status
Muscles and bones -- “wasted’ appearance of muscles, swollen bumps on skull or ends of bones, small bumps on ribs, bowed legs or knock-knees may reflect PEM, mineral and vitamin D status

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Nutrition Screening
Uses preliminary nutrition assessment techniques to identify people who are malnourished or are at risk for malnutrition
Components
Review individual’s diet, drug, and health history -- does it reveal risk factors for poor nutritional status?
Weigh each person on admission and regular intervals
Check laboratory reports --do they suggest malnutrition?
Look at the person -- are there obvious signs of malnutrition
Check meals -- see if food is being eaten
Communicate problems and follow-up to see that problems are being managed

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The nutrition care process
Is an organized approach to problem solving consisting of five steps
Assess nutrition status
Analyze assessment data to determine nutrient requirements
Develop plans of action (including client education) to meet nutrient needs
Implement the nutrition care plan
Evaluate the effectiveness of the nutrition care plan through ongoing assessment and make appropriate changes as needed
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Nutrition care plans
Study the information gleaned from analyzing the nutritional assessment data
Does the diet history show inadequacies?
Is the body weight appropriate?
Are the lab values out of line?
Generate a problem list (this is the formal basis of the nutrition care plan)
Include current and past conditions that impair nutrition status
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Nutrition care plans (con’t)
Include areas which may present future problems
For each nutrition problem, specify the strategies needed to tackle it
Should provide detailed plans for reaching specific goals
Should be tailored to deal with each nutrition problem’s cause
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Nutrition care plan implementation
Provide appropriate diet and education
Maintain daily contact with client and other providers
Care plan may change as medical status changes
Evaluating nutrition care plans
Are the strategies meeting the needs of the client?
Have events occurred in the client’s life that have changed the nutrition status or altered the client’s needs? **

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Professional Communication Networks
Professionals communicate through the medical record
The medical record compiles
History
Diagnosis
Therapy
Prognosis
Progress notes
Describe new information gleaned from the client, laboratory tests or other objective measurements
Provide a written assessment of the data and describe the actions to be taken based on that assessment *

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Professional Communication Networks
Examples of important nutrition-related information found in the medical record
Evaluation of the client’s current diet
Nutrition assessment data
Recommended nutrition therapy
Client’s acceptance and tolerance of the diet
Problems with the client’s food intake
Documentation of diet counseling
Any planned follow-up or referral to another person or agency
Client’s response to nutrition care
Client’s response to diet counseling