1. Nutritional Assessment Chapter 11

2. Slide 11-2 Defining Nutritional Status Optimal nutritional status Undernutrition Overnutrition Nutritional requirements at different ages – Infants and children – Adolescence – Pregnancy and lactation – Adulthood – The aging adult

3. Slide 11-3 Purposes and Components of Nutritional Assessment Purposes of nutritional assessment Nutrition screening – Admission nutrition screening tool – 24-Hour diet recall – Food frequency questionnaire – Food diaries – Direct observation Food guide pyramid

4. Slide 11-4 Subjective Data— Health History Questions Eating patterns Usual weight Changes in appetite, taste, smell, chewing, swallowing Recent surgery, trauma, burns, infection Chronic illnesses Vomiting, diarrhea, constipation Food allergies or intolerances Medications and/or nutritional supplements Self-care behaviors Alcohol or illegal drug use Exercise and activity patterns Family history

5. Slide 11-5 Objective Data—Physical Exam Equipment needed – Skinfold calipers—Lange or Harpenden – Measurement tape – Anthropometer – Pen or pencil – Nutrition assessment data form

6. Slide 11-6 Objective Data—Physical Exam (cont.) Anthropometric measures – Derived weight measures Body weight as percent of ideal body weight Percent usual body weight Recent weight change

7. Slide 11-7 Weight (kg) or Weight (lbs) Waist circumference Height (m) 2 Height (in) 2 x 705 Hip circumference Body mass index= Waist-to-hip ratio = Objective Data—Physical Exam (cont.)

8. Slide 11-8 Objective Data—Physical Exam (cont.) Skinfold thickness – Technique of measurement – Repeat three measurements and then take average Mid-upper arm circumference (MAC)

9. Slide 11-9 Derived anthropometric measures – Mid-upper arm muscle circumference (MAMC) MAMC = MAC – (p × TSF) – Mid-arm muscle area (MAMA) MAMA = (MAC – MAMA) 2 4  – Arm span or total arm length – Frame size by elbow breadth Objective Data—Physical Exam (cont.)

10. Slide 11-10 Laboratory Studies in Nutritional Assessment Hemoglobin Hematocrit Cholesterol Triglycerides Total lymphocyte count Skin testing Serum proteins – Serum albumin – Serum transferrin – Prealbumin Nitrogen balance Creatinine-height index

11. Slide 11-11 Abnormal Findings Classification of Malnutrition Obesity Marasmus (protein-calorie malnutrition) Kwashiorkor (protein malnutrition) Marasmus/kwashiorkor mix

12. Slide 11-12 Abnormal Findings Abnormalities Caused by Nutritional Deficiencies Pellagra Scorbutic gums Follicular hyperkeratosis Bitot’s spots Kwashiorkor Rickets Magenta tongue HIV-associated malnutrition