1. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Nutritional Assessment Chapter 11

2. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Chapter 11: Nutritional Assessment 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. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Chapter 11: Nutritional Assessment 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. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Chapter 11: Nutritional Assessment 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. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Chapter 11: Nutritional Assessment 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. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Chapter 11: Nutritional Assessment Slide 11-6 Objective Data—Physical Exam (cont.)  Anthropometric measures  Derived weight measures Body weight as percent of ideal body weight Body weight as percent of ideal body weight Percent usual body weight Percent usual body weight Recent weight change Recent weight change

7. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Chapter 11: Nutritional Assessment 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. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Chapter 11: Nutritional Assessment 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. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Chapter 11: Nutritional Assessment 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  4   Arm span or total arm length  Frame size by elbow breadth Objective Data—Physical Exam (cont.)

10. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Chapter 11: Nutritional Assessment 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. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Chapter 11: Nutritional Assessment Slide 11-11 Abnormal Findings Classification of Malnutrition  Obesity  Marasmus (protein-calorie malnutrition)  Kwashiorkor (protein malnutrition)  Marasmus/kwashiorkor mix

12. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 11: Chapter 11: Nutritional Assessment 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