ASSESSMENT OF NUTRITIONAL STATUS Mgr. Dana Hrnčířová, Ph.D. Dpt. of Nutrition, 3rd Faculty of...
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Transcript of ASSESSMENT OF NUTRITIONAL STATUS Mgr. Dana Hrnčířová, Ph.D. Dpt. of Nutrition, 3rd Faculty of...
ASSESSMENT OF NUTRITIONAL STATUS
Mgr. Dana Hrnčířová, Ph.D.Dpt. of Nutrition, 3rd Faculty of Medicine, Charles University
NUTRITIONAL STATUS (NS) A part of general health status Adequate = good balance between the body's
needs and the intake of nutrients
Malnutrition imbalance between the body's needs and the
intake of nutrients
MALNUTRITION (broadly) undernutrition, overnutrition specific deficiencies
develops in stages: nutrient levels in blood and/or tissues change
intracellular changes in biochemical functions and structure
symptoms and signs appear (morbidity and mortality can result)
well-nourished person
clinically under-nourished person
clinically intoxicated person
irreversible changes
UNDERNUTRITION Protein Energy Malnutrition (PEM)
inadequate intake of macronutrients
Marasmus
deficiency of protein and non–protein nutrients
Kwashiorkor protein deficiency (oedema)
Marasmic kwashiorkor combined form of PEM
Causes of malnutrition Loss of appetite, anorexia Digestion and absorption disorders Catabolic state – surgery, injuries, endocrine
disorders Loss of proteins and liquids by fistulas, injuries
…
Pain Stress Infection …
Consequences of Undernutrition
PRIMARY: Protracted wound healing Increased tendency to infections (impaired
immune functions) Hypoproteinosis (oedema) Decreased gut motility Myosthenia (muscle failing) Tendency to thrombosis, embolism Urinary tract infections
SECONDARY: increased morbidity prolonged hospitalization time prolonged recovery time increased mortality
Consequences of Undernutrition
ASSESSMENT OF NUTRITIONAL STATUS 1) Clinical assessment
nutritional and medical history, dietary assessment
physical examination
2) Biochemical Laboratory Tests
3) Anthropometric Measurements
NUTRITIONAL HISTORY Inevitably intertwined with the medical history Nutritional disorders Basic illnesses Nutrition related illnesses Digestion (diarrhoea, constipation) Weight (stable, variable) Weight loss / gain Loss of liquids? Increased energy demand?
DIETARY ASSESSMENT
Past intake 24-hour recall (week and weekend day) Food-frequency questionaire Diet history / dietary patterns in last 6 months
Current intake Estimated food records Weighed food records
Smoking habits Alcohol consumption Cooking techniques (boiling, frying, grilling, roasting, …)
24 – Hour Record
food/drink quantity eaten food/drink quantity eaten
morning meal
snack 1
noon meal
snack 2
evening meal
late evening meal
night meal
Sex: _________ Date of birth: _____________ Weight: _____ kg Height: _____ cm Today’s date: ___________ List all foods and beverages you consumed in past 24 hours:
PHYSICAL EXAMINATION Blood pressure (HT>140/90) Fragility of gum capillaries (paradontosis, vit.
C def.) Somatoscopy
PHYSICAL EXAMINATION - somatoscopy Skin – petechia, dermatitis, hyperkeratosis,
seborea, hyperpigmentation, dry skin, oedema Head – hair quality, xerophthalmia, lips-angular
cheilitis, tongue-glositis, papilla atrophy, gums-bleeding, teeth-caries, spots
Neck – examination of thyroid gland Chest – rib abnormalities, exudate Abdomen – acsites, liver size Limbs – oedemas, reflexes, sensation Skeleton – deformities, fractures, pain Skeletal muscle – atrophy
BIOCHEMICAL LABORATORY TESTSSerum proteins
Total protein: 65-85 g/l Albumin: > 35 g/l (malnutrition < 28 g/l) Prealbumin Transferin Retinol binding protein
BIOCHEMICAL LABORATORY TESTS Complete blood count (haematocrit, haemoglobin,
RBC,WBC, lymphocytes, and differential count) Lymphocyte count:
Normal values > 1800/μlMildly reduced 1800 - 1500
Moderately reduced 1500 - 900
Severely reduced < 900
BIOCHEMICAL LABORATORY TESTSPlasma lipids (primary prevention) Triacylglycerides < 1,7 mmol/l Total cholesterol < 5,0 mmol/l LDL-cholesterol < 3,0 mmol/l HDL-cholesterol > 1,0 mmol/l men
> 1,2 mmol/l women
ANTHROPOMETRIC MEASUREMENTS Indexes (to assess body weight) Body circumferences SkinFolds
Rohrer’s index (RI)
RI = body weight (gr) / height (cm)3 x 100
standards: men 1,2 – 1,4women 1,25 – 1,5
Body Mass Index (BMI) BMI is often used as a predictor of future disease risk.
BMI = BODY WEIGHT (kg) / HEIGHT (m)2
BMI as the sole criterion indicating overweight and obesity is only informative up to a certain point!
WHO Classification BMI
Underweight < 18,5
Desirable 18,5 - 24,9
Overweight 25,0 - 29,9
Grade 1 Obesity 30,0 - 34,9
Grade 2 Obesity 35,0 - 39,9
Grade 3 Obesity >40
BODY FAT DISTRIBUTION Not whole body fat but its distribution
determines risk of mortality and morbidity
ABDOMINAL FAT Hyperinsulinemia, dyslipidaemia,
hypertension, glucose intolerance Increases risk of DM II., cardiovascular
diseases
Waist circumference (WC) Waist/hip ratio /WHR)
Waist Circumference Perhaps better indicator of cardiovascular and
metabolic risks of obesity compared with WHR
Classification increased risk High risk
Men > 94 cm > 102 cm
Women > 80 cm > 88 cm
Classification of overweight and obesity according to BMI and
WC
In connection with the risk of some diseases
Classification
of body weight
BMI
(kg/m2)
Classification
of obesity
RISK OF DISEASES
(relative to normal body weight
and waist circumference)
WAIST CIRCUMFERENCE
men ≤ 102 cm
women ≤ 88 cm
men > 102 cm
women > 88 cm
underweight < 18,5 – –
norm
18,5 -
24,9 – –
overweight25,0 -
29,9 increased high
obesity 30,0 -
34,9 I high very high
35,0 -
39,9 II very high very high
extreme obesity ≥ 40 III extremely high extremely high
Waist to Hip Ratio (WHR) Indicator of cardiovascular disease risk
Fat distributed mostly in the abdominal area is associated with higher morbidity and mortality due to cardiovascular disease.
Waist – with abdomen relaxed, horizontal measure taken at the level of the narrowest part of waist below bottom of rib cage and above umbilicus
Hips – while standing erect, horizontal measure taken at a level of maximum circumference of hips
WHR = waist circumference / hip circumferenceClassification Moderately high risk High risk
Men 0,9 - 1,0 > 1,0
Women 0,8 - 0,85 > 0,85
Mid–arm muscle area Used to estimate lean body muscle mass
Derived from the TSF and the mid-arm circumference
Mid-arm circumference - midway between the olecranon process and the acromium, right arm in a relaxed position
Triceps skin fold - midway between the olecranon process and the acromium, on the posterior of the arm over the long head of the triceps brachii.
Mid–Arm Circumference (cm) – 0,314 x Triceps Skinfold (mm)
Muscle Mass Adequate Marginal Depleted Wasted
Men 25,3 - 22,8 22,8 - 20,8 20,8 - 17,7 < 17,7
Women 23,2 - 20,9 20,9 - 18,6 18,6 - 16,2 < 16,2
Measurement of skinfolds Cheek – horizontal fold on a join tragus – nostrils, right bellow the temple
Jowl – vertical fold between chin and laryngeal prominence
Chest – anterior axillary fold (oblique). Diagonal fold taken ½ the distance between the anterior axillary line and the nipple (1/3 distance women).
Axilla – at the intersection of a horizontal line level with the 10th rib and the anterior axillary line.
Triceps – vertical fold on posterior midline of upper arm, midway between the acromion (bony tip of shoulder) and olecranon processes (elbow joint).
Biceps – the pinch position is at the same level as for triceps, though on the anterior (front) surface of arm.
Subscapula - 2 cm below the lower angle of the scapula (bottom point of shoulder blade) on a line running laterally and downwards (at about 45 degrees).
Abdominal – vertical fold, is made 5 cm adjacent to the umbilicus (belly-button) taken on a line running laterally to the spina iliaca anterior
Suprailiac – taken in the anterior axillary line immediately superior to the iliac crest
Thigh – vertical fold above patella
Calf – 5 cm below popliteal fossa
Practical trainingBody circumferences
1. Mid-Arm Circumference Mid-Arm Muscle Area2. Waist Circumference3. Hip Circumference WHR
Skinfolds4. 10 skinfolds % of body fat5. 4 skinfolds % of body fat
Bioelectric impedance (BIA)
Thank you for your attention.