Nutrition Assessment and Screening Quiz

COM 5005 Lecture 6: Nutrition Screening, Assessment, and Malnutrition

• Learning objectives for lecture 6 include recalling health trends in nutritional status of the U.S. population, listing nutrition screening tools, defining the Nutrition Care Process, identifying nutritional assessment components, defining malnutrition, and differentiating between malnutrition classifications.

• Lecture 6, COM 5005, Winter 2025, was taught by Stephanie N. Petrosky, D.C.N., M.H.A., RDN, FAND.

• The session outline includes nutrition screening (identifying risk, risk factors, and screening tools), nutrition assessment (components and physical exam findings, assessment tools), and nutrition diagnosis (forms, classification, and patient care applications).

• Case studies of a 56-year-old labor worker (BMI 28, with diabetes and hypertension), a 16-year-old soccer player (BMI 18, vegan), and a 70-year-old accountant (BMI 24, smoker) were presented to illustrate the relevance of nutrition.

• Research findings from JAMA suggest that U.S. health improved between 1990 and 2016, but some states experienced increased mortality and morbidity, linked to drug use disorders, high BMI, and alcohol use disorders, affecting individuals between 20 and 55 years old.

• Health care expenditure in 2021 was $4,255.1 billion, with notable allocations to hospital care (31.1%) and Physician Services (14.9%).

• Global nutrition trends indicate progress towards targets for childhood stunting and wasting, sodium intake, obesity, and raised blood pressure. Various trends exist for each gender and population group.

• An editorial from 1974 emphasized iatrogenic malnutrition—physician-induced malnutrition—as a significant factor affecting patient recovery.

• Malnutrition significantly impacts public health and the economy, with an average cost of hospitalization for people with malnutrition and readmission near $17,000.

Terminology in Nutritional Care

• Nutrition status reflects the body's nutrient consumption and utilization, examining nutrient stores, intake, and demands.

• Nutrition screening identifies patients at risk for nutrition issues.

• Nutrition assessment is a systematic process for collecting, verifying, and interpreting data to understand nutritional problems.

Nutrition Risk Factors

• Age (elderly and children), altered nutritional needs (pregnancy, lactation, adolescence), socioeconomic factors, unintended weight loss (>10% in 6 months), impaired nutrient digestion/absorption/utilization, and altered metabolic conditions (critical illness, cancer, diabetes) are key nutrition risk factors.

Nutrition Care Process (NCP)

• The NCP is a systematic approach employing four interrelated steps: screening, assessment, diagnosis, and intervention/evaluation/monitoring.

Nutrition Care Algorithm

• A flowchart illustrating the steps in patient care, beginning with admission, screening, assessment, and periodic re-screening to monitor progress and ultimately discharge planning or termination of therapy.

Nutrition Screening Tools

• Tools like MUST (Malnutrition Universal Screening Tool), NRS-2000 (Nutrition Risk Screening 2000), DETERMINE Checklist, MNA (Mini Nutrition Assessment), and SGA (Subjective Global Assessment) facilitate nutritional risk identification, particularly in older adults.

Nutrition Assessment: Overview

• Nutrition assessment provides a systematic framework for identifying, understanding, and interpreting nutrition-related problems. Data collection considers dietary intake, associated health issues, psychosocial factors, and readiness for change.

Assessment: Key Components

• A nutrition assessment includes patient history, anthropometrics, biochemical data, clinical/nutrition-focused physical exam, and functional assessment.

1. Patient History: Data Collection

• Key components include dietary history (recall or food frequency), medical record review, family history, socioeconomic data, clinical findings (medical tests), and previous medical history.

Sample Tools

• Several sample tools for collecting nutrition-related data, including 24-hour recalls, food records/diaries, and the Mini Nutritional Assessment (MNA), were described.

2. Anthropometrics

• Anthropometric indicators like height/stature/length and weight are measured to assess nutritional status, considering age-specific standards.

Anthropometrics: Comparisons

• Evaluation and interpretation of height, weight, and head circumference, as well as body mass index (BMI), and waist circumference are crucial assessment components.

Sample Tool: CDC Growth Charts

• Charts are used for comparison and interpretation of growth and development considering age and sex.

Anthropometrics: Body Composition

• Body composition (distribution and size of components contributing to total body weight), referring to fat mass, fat-free mass, waist circumference, and hip-to-waist ratio, assesses nutritional status.

Anthropometrics: Skinfold Measurement

• Skinfold measurements assess subcutaneous tissue energy reserves. Measurements can be used to estimate body density and body fat percentage.

Anthropometrics: Bioelectrical Impedance Analysis (BIA)

• BIA involves measuring body composition using electrical currents, while phase angle measures cellular integrity. BIA has limitations and may not suit all patients.

Anthropometrics: InBody Scanner

• The InBody Scanner presents a more user-friendly method for assessing body composition, frequently used in outpatient settings and for health and fitness coaching.

3. Biochemical: Medical Tests and Procedures

• Biochemical assessments measure nutritional markers present in blood, urine, feces, and tissue samples. Including hematological (general health markers), protein (immunocompetence, inflammation, vitamins, and minerals), and somatic protein measurements (creatinine height index).

Biochemical Indicators

• Comprehensive panels covering key biochemical markers like blood urea nitrogen, serum chloride, electrolytes, and others are described for various assessments.

Biochemical: Hematological Indicators, Visceral Protein Status and Somatic Protein Status and Micronutrient Status

• Key hematological markers (hemoglobin, hematocrit, MCV, MCH, MCHC, ferritin, serum folate, serum B12), visceral proteins (albumin, transferrin, retinol-binding protein, C-reactive protein), somatic proteins (creatinine height index), and micronutrients (vitamins and minerals) are all assessed.

4. Clinical/Nutrition Focused Physical Examination (NFPE)

• The NFPE is a systematic physical examination for assessing nutritional status by evaluating physical appearance and signs of malnutrition, nutrient deficiencies, and nutrient toxicities.

Facial Features

• Facial features can indicate specific conditions or degree of malnutrition.

Nutrition-Focused Physical Examination

• Aspects of physical examination (e.g. fat loss, muscle loss, skin turgor, edema) are described.

Classic Malnutrition: Kwashiorkor, Marasmus

• Classic malnutrition syndromes Kwashiorkor (severe protein deficiency) and Marasmus (severe energy deficiency) and their respective signs and symptoms are detailed—including edema, growth failure, and skin changes.

Causes of Malnutrition

• The factors contributing to malnutrition include primary (Frank inadequate intake) and secondary (impaired utilization or storage, excessive losses, and increased needs) issues.

Compare Perspectives: Medical versus Nutritional Dx

• The process and approach for medical and nutritional problem determination diverge when assessing diabetes, injuries, obesity, dependence on ventilation, and anorexia nervosa.

Etiology-Based Malnutrition Definitions

• An approach for classifying malnutrition based on underlying causes (inflammatory response, starvation related, acute/chronic disease) and whether acute or chronic.

Sample Tools: Global Leadership Initiative on Malnutrition (GLIM) 2019

• The GLIM framework provides guidance for identifying and grading malnutrition based on phenotypic and etiologic criteria.

• The GLIM scoring framework is presented.

Summary Points

• Factors impacting malnutrition, methods of evaluation (nutrition screening, assessment, diagnosis, and intervention), and criteria for identifying malnutrition are highlighted. A conclusion that medical diagnoses are distinct from nutritional diagnoses is drawn.