Nutritional assessment

By Esubalew Woldeyes
Nutritional assessment
The process of determining the
nutritional status of individuals or
population through collection and
interpretation of data from dietary,
laboratory, anthropometric and
clinical studies
Methods of assessment

ABCDs
A=anthropometric
B=biochemical/biophysical
C=clinical
D=dietary
A) Anthropometry
A) Anthropometric
Definition=it is the measurement of
variation of physical dimensions and
gross composition of human body at
different level and degree of nutrition.
It is used both in community and
clinical setup
Purpose of anthropometric
measurement

1. Anthropometric
measurement of growth
Head circumference(circumference of
the head along supera orbital rige
anteriorly and occipial prominence
posteriorly .
 Length/height
Length= measured by measuring
board(sliding),measured in recumbent
position in children <2 yrs
Height =measured in childern >2yrs and
adult in standing position. The head
should be in Frunkfurt position ,occupit,
shoulder ,and buttock sould touch the
vertical stand
8
9
Cont
Weight =measured by spring
balance /salter scale for children <2
yrs, and by beam balance in adults.
Mid upper arm
circumference(MUAC)=
MUAC

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Nutrition indices derived from
above measurement
Nutrition indices are a combination of
measurements compared to a
reference
Indices

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 Other indices include (weight for
height ratio)
e.g BMI
Percentile
The percentile is the rank position of an
individual on a given reference table.
The fiftieth centile corresponds to the
weight that divides the distribution into
two equal parts; with fifty per cent of
weights being above the fiftieth centile
and fifty per cent of weights being below
it. Thus the fiftieth centile corresponds
to the median.

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Growth charts
22
Waterlow (1)
WFH Nutritional status HFA Nutritional
status

90-100% Normal > 95% Normal

85-90% Mild wasting 90-95% Mild stunting

75-85% Moderate 85-90% Moderate

< 75 % * Severe wasting < 85% Severe stunting

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Waterlow (2)
WFH (%)
Edema
< 70 80 -70
present Marasmic- Kwashiorkor
kwashiorkor
absent Marasmus Moderate
wasting

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Wellcome
Edema WFA ( Harvard)

60-80 % < 60 %

Absent Underweight Marasmus

Present Kwashiorkor Marasmic-

kwashiorkor

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Gomez
Wt-for- age = Wt. of subject x 100
Wt. of normal child of same age

Wt. for age Degree of malnutrition

90-109% normal
75-89% mild (grade I)
60-74% moderate (grade II)
< 60 severe (grade III)

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Anthropometric measurement for
body composition

Assessment of body fat

Skin fold test
Waist to circumference ratio
B) Biochemical/biophysical
Biochemical tests
This involves measurement of either
total amount of the nutrient in the
body , or its concentration in a
particular storage site in the body or
in the body fluids.
Examples
Visceral protein
Serum ferritin level
Albumin
Pre albumin(transthyretin)
Immunologic markers
TLS(total lymphocyte count)
Delayed cutaneous hypersensetivity
Serum HDL
Erythrocyte Folate
Tissue stores of Vitamin A, Vitamin D
C) Clinical
C) Clinical
These is methods used to detect
deviation from the normal state of
nutrition just by observation and
interpretation of clinical sign and
symptoms , through
1.History
2.Physical examination
History
Syptomes of malnitretion
Inability to see during the evening or
dim light
Easy bleeding of gum and swolen gum
Easy fatigablity, loss of
appetite,shortness of breath
Dental caries
Edema
Apathy(lack of interest)
Change in hair colour
Cont
In pediatric age group
Exposure to sun light
History of breast feeding(duration of
exclusive breast feeding ,frequency
Type of complementary feeding/initiation
of complementary feeding
Cont
Dietary history
Type of food, amount and frequency
Food intolerance
Drug/alcohol abuse
Food drug interaction
Cont
Social history
Income
Level of activity
Living situation
Cont
Surgical/medical history
Surgical procedures/trauma/burn
Chronic medical illness(TB, chronic liver
diseases,..)
Dietary supplement
Physical examination
General appearance
obese, wasted, mood ,emotion)
HEENT
Hair changes(grey easily plukable
hair),dental carries, dental florosis, gum
swelling, congecival pallor,bitot spot
,corneal ulceration,
Severe wasting
Multifactor anemia
Corneal opacity
Bitots spot
PE cont
Respiratory system
CVS
Abdomen=hepathomegally(in patient
with protein energy malnutrition .)
GUS(genitourinery system)
Muscloskeletal system(bone
deformity ,edema muscle atrophy)
PE cont
Intugementery (skin lesion,..)
CNS(apathy, loss of interest to
environment..)
Baggy pants
D) Dietary
Dietary surveys include assessment
of past or current intakes of nutrients
from food by individuals or a group in
order to know their nutritional status.
Methods
Food diary method
Food frequency questionnaire
24 hrs dietary recall
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