Assessment of Nutritional Status PDF

Assessment of Nutritional Status Dr. Yamamah AlHmaid  Assessment of the nutritional status aids in assessing the prevalence of nutritional disorders, planning corrective measures, and Introduction simultaneously evaluating the effectivenes...

Assessment of Nutritional Status Dr. Yamamah AlHmaid  Assessment of the nutritional status aids in assessing the prevalence of nutritional disorders, planning corrective measures, and Introduction simultaneously evaluating the effectiveness of the implemented strategies.  Physical and physiological measurements. Levels of Laboratory ( biochemical ). assessment of Physical examination nutritional (observation). status Dietary and personal history. Physical and physiological measurements ▪ Weight and height ▪ Body composition analysis -Including arm muscle area. -Body fat. ▪ Blood pressure Physical examination Observation General Appearance Skin, hair, nails, angles of the mouth, tongue, mucous membranes, eyes, joints, feet; evidence of weight gain or weight loss (wasting). Palpation I.e. skin, including skin folds; hair, eyes, mouth, mucous membranes, abdomen, skeletal structure, chest, pulse, and any swellings. Auscultation Chest sounds; heart sounds; abdominal sounds. Laboratory (biochemical) Assessment of nutritional status Indications and uses of biochemical parameters. Serum proteins Albumin, transferrin, prealbumin, retinol binding protein, etc. Immune markers of nutritional status Total leukocyte count. Lymphocyte count. Iron status serum ferritin, serum iron. haemoglobin (Hb); haematocrit; mean corpuscular volume MCV. Calcium and Vitamin A status Iodine status - Serum level of thyroxine,(T4). Dietary & personal history Dietary information Diet history 24-Hr recall Food record diary Food frequency Sources and methods of food preparation Eating habits Eating patterns  Undernutrition and micronutrient deficiencies contribute substantially to the global burden of disease. Undernutrition and infectious diseases exist in a baleful synergy: undernutrition reduces the immunological capacity to defend against diseases, Nutrition and diseases deplete and deprive the body of essential nutrients. Undernutrition and infectious diseases further exacerbate poverty through lost wages, increased health care costs, and impaired intellectual development that can significantly reduce earning potential. Growth Monitoring ❖Factors influencing growth: Family genes: childhood growth patterns and Adult heights Adequate nutrition Infectious diseases Endocrine: hormones such as growth hormone or disease of pituitary Systemic diseases: diabetes Stress Abuse etc. Effects of race / ethnicity / genetics Vs nutrition /attitude/ environment Anthropometric Indicators for Growth Monitoring Weight-For-Age Advantages Disadvantages Good basic indicator, combining acute and chronic Not sensitive to a stunted child who is growing well malnutrition, for monitoring ongoing programs. (below but parallel to a normal growth channel) or to the very tall child who may be malnourished Sensitive to small changes Measure is objective and repeatable. Easy for inexperienced health workers Measure is not time consuming. Anthropometric Indicators for Growth Monitoring Length/Height-for-Age Advantages Disadvantages Good indicator of past nutrition problems. In growth monitoring projects It should be supplemented by another indicator like weight-for-age or weight-for-height because changes in height occur relatively slowly. Measure is objective, repeatable. Requires two different techniques if programs include all preschoolers: recumbent (lying down) length (children 0-2 years) and standing height (children 3-5 years). More difficult for unskilled workers Anthropometric Indicators for Growth Monitoring Weight-for-Length/Height Advantages Disadvantages Good indicator to distinguish those who are well Depending on the cut-oft points chosen, weight-for- proportioned (weight/height) from those who are thin height can underestimate malnutrition by classifying (or heavy) for their height. those who are short and thin as normal. Measures are objective and repeatable. Weighing and measuring height will require more training time and may be too complicated and time consuming for the inexperienced clinic worker to do with frequency. Growth Monitoring Undernutrition is generally characterized by comparing the weights or heights (or lengths) of children at a specific age and sex with the distribution of observed weights or heights in a reference population of presumed healthy children of the same age and sex and then calculating z-scores. A child whose height-for-age is less than -2 SD is considered stunted A child whose weight-for-age is less than -2 SD is considered underweight, and one whose weight-for-height is less than -2 SD is called wasted. Stunting results from chronic undernutrition. wasting results from inadequate nutrition over a shorter period  Growth Monitoring ❖Interpret trends on growth charts A child’s growth line crosses a z-score line. There is a sharp incline or decline in the child’s growth line. The child’s growth line remains flat (stagnant); i.e. there is no gain in weight or length/height. A child’s growth line crosses a z-score line. Cecile’s length-for-age chart shows points plotted at five visits from the age of 6 months to 1 year and 6 months. Notice that Cecile’s height-for-age dropped from above -1 to below -2 in a period of 9 months, crossing two z-score lines. Her growth in length seems to have slowed down at an age when rapid growth is expected. She is now stunted. sharp incline or decline in the child’s growth line Farhan’s weight-for-age chart (below) shows a sharp decline from age 10 to 11 weeks, when he had diarrhoea and lost 1.3 kg. The chart shows a sharp incline after the episode of diarrhoea, during re-feeding, as Farhan gained back most of the lost weight. Flat growth line (stagnation) Kadira’s weight-for-height chart below shows a good trend. Kadira was overweight, but her weight remained about the same while she grew in height. She is no longer overweight. Thank you