Clinical Nutrition and Nutritional Assessment

Clinical Nutrition and Nutritional Assessment

• This lecture covers clinical nutrition and nutritional assessment.
• The objectives include: introduction, nutritional sources (carbohydrates, proteins, lipids, vitamins, trace elements), nutritional requirements (adults and children), assessment and classification of malnutrition, and methods for nutritional assessment.

Human Nutrition

• A healthy diet provides balanced nutrients to meet metabolic needs, avoiding excess or shortage.

• Malnutrition encompasses both insufficient and excessive food consumption.

• This can include consuming wrong types of food or inability to properly use nutrients to maintain health.

• Malnutrition is a significant cause of death in children under five years old.

Malnutrition Prevalence

• Malnutrition is the leading cause of death in children under 5.
• 55% of cases are related to malnutrition.
• Other causes and their percentages:
  • Perinatal causes: 18%
  • Acute respiratory infections (ARI): 19%
  • Diarrhea: 19%
  • Measles: 7%
  • Malaria: 5%
  • Other conditions: 32%

Energy Needs

• Energy needs depend on:
  • Basal metabolism
  • Rate of growth
  • Physical activity
  • Onset of puberty
  • Presence of chronic disease
• Basal metabolic rate is closely related to resting energy expenditure. It's predominantly measured during the post-absorptive state in a temperate environment.

Calculation of REE

• WHO, Schofield, and Harris Benedict equations are used to calculate REE (resting energy expenditure).
• REE increases in stressful conditions, like minor surgeries, hospitalizations, and major surgeries. Stress multiplies REE by a factor of 1.3, 1.5, or 1.7, depending on the stress level.
• The Harris-Benedict equations calculate the daily caloric needs based on weight, height, and age (differentiated by sex).

Macronutrients

• Carbohydrates are the main energy source (4 kcal/gm). They're also crucial for synthesizing non-essential amino acids. Stored in the form of glycogen in the liver and muscles.
• Proteins are complex nitrogen-containing compounds not primarily used for energy production: they are conserved if enough non-nitrogen calories are supplied by carbohydrates and fats.
• Fats provide 20-40% of total energy intake (9 kcal/gm). They're crucial for fat-soluble vitamins.

Vitamins and Trace Elements

• Vitamins and trace elements are essential micronutrients needed in small amounts for various bodily functions.
• Vitamins are categorized into fat-soluble (A, D, E, K) and water-soluble (B-group vitamins and vitamin C).

Normal Growth Pattern in Children

• Dramatic physical changes occur in the first year of life.
• Birth weight triples; birth height increases by 50%.
• Growth patterns are measured in terms of weight gain (2-3 kg/year) and height gain (6-8 cm/year), as well as motor, social, and cognitive developmental gains..

Energy Requirements (RDA)

• Recommended Dietary Allowances (RDA) for children's energy requirements are presented across different age groups, based on healthy and active children.
• These values are presented as kcal/kg ranges for different age groups.

Daily Protein Requirements (RDA)

• Daily protein requirements are outlined by age and are presented in terms of gram/kg/day for children at various developmental stages.

Bedside Calculation of Daily Energy Requirement

• An easy-to-implement approach for calculating daily caloric needs for children, based on their weight. The formula categorizes children by size and computes daily energy needs accordingly.

Protein-Energy Malnutrition (PEM)

• PEM, or protein-energy malnutrition, was first recognized by the WHO in 1976.
• This condition is very common in underprivileged nations.
  • 300,000 deaths annually in children less than five years old.
• It can be classified as primary (inadequate intake) or secondary (resulting from other issues like malabsorption or chronic diseases). Worldwide prevalence was approximately 17-18% in 2015.

Consequences of Chronic Malnutrition

• Chronic malnutrition results in impaired growth and development, increased susceptibility to infections, poor wound healing, and impaired neurological and cognitive development,. Malnutrition negatively impacts all age groups, with young children, pregnant women, and lactating women being particularly vulnerable.

Classification of Malnutrition (Acute)

• Acute malnutrition presents as wasting (marasmus) or as nutritional edema (kwashiorkor). Wasting is indicated by rapid loss of fat and muscle. Characterized by low weight relative to age, and normal height relative to age.

Classification of Malnutrition (Chronic)

• Chronic malnutrition manifests as stunting, indicated by low weight relative to age, and low height relative to age.

Obesity

• Obesity is considered another form of malnutrition and is associated with:
  • Atherosclerotic heart disease
  • Hypertension
  • Metabolic syndrome
• Prevalence varies significantly between different populations, especially in Turkey.

Methods of Nutritional Assessment

• Nutritional assessment methods are summarized as ABCD:
  • Anthropometric methods: These methods measure physical aspects such as height, weight, head circumference, midarm circumference, and skinfold thickness.
  • Biochemical, laboratory methods: These involve measuring serum protein levels (prealbumin, RBP, transferrin) and total lymphocyte counts.
  • Clinical methods: Clinical evaluation focuses on identifying signs like pallor, glossitis, rickets, etc.
  • Dietary evaluation methods: This entails evaluating dietary intake through patient interviews and dietary histories to identify dietary inadequacies or excesses.

Clinical Manifestations of PEM

• Clinical symptoms associated with Protein-Energy Malnutrition (PEM) include pallor, fatigue, glossitis, angular cheliosis, skin pigmentation, thin and sparse hair, spongy and bleeding gums, edema, easy bruisability, enlarged epiphysis of long bones, rickets/osteoporosis, easy fractures, peripheral neuropathy, loss of balance, diarrhea, muscle cramps, and abdominal distention, hepatomegaly, and ascites.

This quiz focuses on the fundamentals of clinical nutrition and nutritional assessment, addressing essential nutrients and their sources. It also examines malnutrition, its prevalence, and methods for nutritional assessment, particularly in children. Test your knowledge on these critical topics related to health and nutrition.