Nutritional Assessment Le2 PDF

Nutritional Assessment Course Code:NUT3153 Le2 Dr.Awatif Almehmadi 1  Anthropometric measurements Definition and Purpose: 1. Anthropometry involves measuring body size, weight, and proportions. 2. The core element...

Nutritional Assessment Course Code:NUT3153 Le2 Dr.Awatif Almehmadi 1  Anthropometric measurements Definition and Purpose: 1. Anthropometry involves measuring body size, weight, and proportions. 2. The core elements of anthropometry are height, weight, body mass index (BMI), body circumferences (waist, hip, and limbs), and skinfold thickness (predicted measure of fat mass) 3. It serves as a sensitive indicator of health, development, and growth in infants and children. Nutritional Assessment: 1. Anthropometric measures help evaluate nutritional status. 2. They can identify both obesity (from overnutrition) and emaciation (from protein-energy malnutrition). Clinical Applications: 1. Valuable for monitoring the effects of nutritional interventions related to disease, trauma, surgery, or malnutrition. 2. Considered the method of choice for estimating body composition in clinical settings.  Gender Female have and need more body fat and, they tend to have less muscle bulk than male Fat accumulation differs in regions for men and women Factors Affecting Aging Anthropometry (body size, shape As individual age, percentage body fat increase and lean mass and bone mineral density decrease. and composition) The increase in fat mass is distributed more specifically in the abdominal region. Ethnicity Body proportions and diminish differ depending on ethnicity, i.e., Asian tend to have less %body fat compere to western population.  Most Common Measurements Weight Stature (standing height), recumbent length Skinfold thicknesses, Circumferences (head, waist, limb, etc.), Limb lengths, and breadths Knee height  Reliability (reproducibility) : the degree to which repeated measurements of the same variable give the same value. Accuracy : the extent to which the measurements is Mesurments close to true vale (refinance). standers Accurate anthropometric measurements have three critical components these are: 1.Technique. 2.Equipment. 3.Trained measurers.  Measurement Standards Standard technique (procedures) must be followed each time to ensure precise measurements. Precise measurements are important because: Measurements are used to monitor growth, assess nutrition status. A small measurement error can result in a large error on the growth chart. For example, an error of ¾ of an inch can result in a 25% ile deviation on the chart. Growth problems (including growth retardation and obesity) can be detected early by careful measuring, recording , and plotting of growth measures at regular intervals. Frequent causes of errors in measurement due to technique Failure to use a right angle headboard when measuring height. z Failure to balance scales at zero before each use. Measuring height with shoes on, with feet away from wall or with barrettes in hair, etc. Weighing in excess clothing and shoes. Measuring an infant unassisted. Failure to repeat the measuring procedure a second time. (Repeating the procedure is essential to obtain accurate measurements). Misreading the scale or tape measure. Assuring Accurate, Reliable Equipment Maintenance is a regular, daily event. it requires that scales be checked and ‘zeroed’ before each daily clinic. it requires that length boards and stadiometers be checked and zeroed before each daily clinic. Calibration is a monthly event. It requires that scales be ‘tested’ with standard weights on at least a monthly basis. It requires that movable scales be calibrated after each time the scale is moved. It requires that length boards and stadiometers be checked with standard length rods on at least a monthly basis. It requires that moveable length boards and stadiometers be checked with standard rods after each time the equipment is moved. How to Avoid Measurement Errors ? Make sure that measurements are accurate by: Using the correct equipment and checking it regularly for accuracy. Using the correct technique and always following standard procedures. Frequent causes of errors in measurement due to equipment: Failure to use correct equipment. Failure to maintain and calibrate equipment.(Keep weights at far right when scale is not in use.) Failure to properly install/maintain the equipment.  In adult , Body weights are usually monitored carefully during clinical care, with height it can predict body mass index (BMI). BMI can be used as a simple tool to predict fat mass. Body Weight In infant and children, Body weights are compared with healthy ranges, which can be obtained from weight tables and growth curves or calculated by specific equations.  Weight scales Beam balance and electronic scales are the most accurate. Electronic scales are preferred over balance-beam scales due to: Lighter weight and portability ,Faster and easier use, Digital output (metric or English units),Higher weight capacity (up to 1000 lb). Special scales are used for infants ( Infantometer) that allow them to lying or sit. Children who can stand are weighed in the same way as adults. Elderly or hospitalized patients require special built-in scales available in clinical setting Standardized conditions are necessary when weighing to obtain valid information.  Weighing Infants An accurate and reliable scale for weighing infants can be either beam balance or electronic. It is desirable that the scale have a maximum weight of 20 kilograms or 40 pounds and weigh in 10 gram or 1/2-ounce increments. Infants can be weighed nude or with the diaper weight subtracted. Place the infant lying down in the middle of the pan. Recording Measurements: Average the results of two or three reading. Record the average weight to the nearest 10 g (0.01 kg) or 0.5 oz. Plot the weight on the growth chart. Safety and accuracy dictate that the scale have a large enough tray to fully support the infant. The scale should be easily ‘zeroed’ without any weight on it. It should have advantage that enable calibration.  Weighing Infants Suspended scale and weighing sling are used in large population group (survey) for infant and children 2 years. Spring balance scales such as bathroom scales should not be used to weigh children or adolescents. These scales are not accurate over a variety of weights. Preferred after an empty blader and before meal. Ensure the subject stands still in the center of the scale, evenly distributing body weight on both feet. Read weight to the nearest 100 g (0.1 kg) or 0.2 lb. Two measurements taken in immediate succession should agree within 100 g (0.1 kg) or 0.2 lb. Repeat the measurement if there is a discrepancy with past values. Note that weight can vary throughout the day—about 1 kg for children and 2 kg for adults. Record the time of measurement to account for weight fluctuations. For high accuracy, use an examination gown of known weight and adjust for clothing weight. For less stringent requirements, subtract an estimated weight of clothing if exact measurement is not critical. Weighing Nonambulatory Persons Weighing nonambulatory persons Methods for Weighing: Bed Scale: Position the subject comfortably in the weighing sling. Gently raise the sling until the subject is suspended off the bed. Wheelchair Scale :Have the subject sit upright in the center of the chair. Ensure the subject leans against the backrest.  Height assessment readily obtainable measurement that can help identify children at risk of malnutrition or obesity. The stature or height of an individual has clinical implications in assessing nutritional status, estimating body mass index (BMI), and diagnosing underlying disorders in children and adults. Commonly Used Instruments for Measuring Height Measuring tape A horizontal length scale (HLS) is a flexible horizontal scale used to Height measure an infant's recumbent length. The infantometer measures the recumbent length of an infant with greater accuracy by securely holding the infant in position. The stadiometer consists of a ruler and a sliding horizontal headpiece which can be fixed above the head to measure height. Osteometric board: It is an anthropometric instrument consisting of a flat board with a fixed end and a crosspiece. It is used to measure the length of long bones.  Length (also referred to as recumbent length) is obtained with the subject lying down, in a supine or face-up position, and generally, is reserved for children up to 24 months of age or for children who cannot stand erectly without assistance Measuring the length of infants and young children by using a Length for infants measuring board with fixed headboard and a movable footboard. It has a firm, flat horizontal surface with a measuring tape in (0.1 cm), (0-24 m) a fixed headpiece at a right angle to the tape, and a smoothly moveable footpiece. by(infantometer) The critical components of a lengthboard are: 1)a fixed headpiece and 2) a moveable footpiece which is vertical to the surface of the table that the length board is on. Two examiner are required to measure the length of the infant , the first has the task of keeping the baby's head (located in the supine position) stands firmly against the headrest of the instrument, and the second has the task of extending slightly the lower limbs of the child, and places the soles of your feet against the floor moving  Stature Measurement Applicable Age2 to 3 years and older who can stand unassisted. Use a measuring stick or non-stretchable tape measure on a flat, vertical surface (e.g., a wall).Employ a right-angle headboard for accuracy. Stadiometer : Hight for Ensure the subject is barefoot and in minimal clothing. Position the subject: Heels together ,arms at sides legs straight children above shoulders relaxed head looking straight ahead heels, buttocks, scapulae, and back of the head against the stadiometer, if possible. 2 > yr Measurement Process: Have the subject inhale deeply, hold their (stadiometer) breath, and maintain an erect posture. Lower the headboard onto the highest point of the head, compressing the hair if necessary. Read the measurement to the nearest 0.1 cm or 1/8 inch. Remove hair ornaments that may interfere with the measurement. Special considerations: If the subject cannot touch all four points (due to obesity or spinal curvature), use two or three contact points or estimate height from knee height.  Measuring children height by stadiometer < 2yr  Measuring children height by stadiometer >2yr  Two ways for height measurements in adult : 1.Direct method that include measuring standing height by using stediometer. 2. Indirect way that used for estimation of height in Height bedridden or wheelchair people or those who have such severe spinal curvature that measurement measurements of height would be inaccurate, stature can be estimated Indirect way that is the prediction in adults (estimation) of height indirectly using other anthropometric measurements related to body dimension such as: Knee-height. Arm span, recumbent length. Demi span length. Ulna length - Forearm length.  Importance of following anthropometric indices after birth and during childhood Birth weight , reflect preterm infant growth and development (intrauterine growth and development) Identify malnourished or overweight infant after birth i.e. (low birth weight infant, small for gestational age (SGA) infant (preterm infant) After birth , Important to measure the Linear growth of the infant and children as part of health surveillance which may detect underweight, overweight, obesity, short stature. Measurements like, weight , height and head circumference for example can be plotted in growth chart recommended for different age, gender and population group  Growth charts are percentile curves that show the distribution of a child’s body measurements including weight and length/height. The charts are used by pediatricians, nurses, and parents to monitor the growth of infants and children. Physical growth and development of infants and children reflect the societal value placed on their health and wellness. Growth charts are essential tools for: Evaluating physical growth and development. Growth Assessing nutritional status and general well-being of infants, children, and adolescents. charts Determine adequate nourishment. Screen for inadequate growth, which may indicate medical, nutritional, or developmental issues. Help monitor growth Infants and children undergoing medical treatment. Adjusting dietary intake, including enteral or parenteral nutrition support, to meet specific needs. Growth charts should be used as part of a broader clinical assessment, not as the sole diagnostic tool.  World Health Organization (WHO) and the Centers for Disease Control and Prevention, (CDC) Standards can be used to assess the growth as the following recommendations: The WHO growth standard charts should be used for children younger than 2 years of age. The CDC growth reference charts should be used for children aged 2 to 19 years. Growth The CDC growth reference charts are more suited for children 2 years and older because these charts can be used charts continuously up to age 20 years. CDC Charts: Reflect growth of children in various nutritional conditions in the U.S. WHO Charts: Represent growth under optimal nutritional and environmental conditions; a 'goal' standard for optimal growth. CDC Charts: Normal growth is between the 5th and 95th percentile WHO Charts: Normal range is between the 2nd and 98th percentiles (z-scores between -2.0 and +2.0).  Growth is influenced by genetic potential. The growth percentiles of one child may be around the 10th percentile and another may always be at the 90th percentile. If a child is growing steadily along their own trajectory Evaluating of growth and is healthy, those growth rates are normal and likely to be healthy. Growth Discussion of growth charts can be brief in those cases. Assure the parent/caregiver the child is growing steadily or well. Occasionally, a child may deviate from their normal growth with accelerated or slowed growth rates. Those cases warrant some additional assessment of the situation. Evaluating Growth Factors to conceded when evaluating a child’s growth: Inaccurate data: Incorrect measuring techniques or errors in recording measurements can dramatically impact the growth chart results. When a significant variation is noted on the charts, remeasure if possible. Consider accuracy of previous measurements. Normal growth patterns of children: Children do not grow in a continuous, smooth pattern. They experience times of “growth spurts” and growth-free intervals. Single measurement: One measurement is of limited usefulness. A child’s normal growth pattern may be at the high or low end of the growth charts. If there are additional factors related to health and eating that may be concerning, refer to the physician and/or remeasure the child in a few months for a better assessment of their growth. Using Growth Charts: Select the correct chart based on the patient’s age and gender. Specialized growth charts are necessary for children with certain disorders (e.g., Down syndrome, Turner syndrome, cerebral palsy). The clinical growth charts reflect modifications in the format of the individual charts, whereby two individual charts appear on a single page, and data entry tables have been added. The clinical charts have the grids scaled to metric units (kg, cm), with Imperial units (lb, in) as the secondary scale. Clinical charts are available for boys and for girls. The growth chart category by age group Infants, birth to 36 months: Length-for-age ,Weight-for-age, Head circumference-for-age and Weight-for-length 2- Children and adolescents, 2 to 20 years: Stature-for-age ,Weight-for-age and BMI-for-age 3- Preschoolers, 2 to 5 years: Weight-for-stature 29  Choose the chart that corresponds to the child’s age and gender ( WHO growth charts) it’s crucial to match the child’s characteristics (age and gender) accurately. When measuring a child, follow standardized methods for consistency measurements include length, head circumference, and weight. Accuracy matters, so ensure precise measurements. Record the following information: Exact age of the child (calculated to the nearest month),mother’s and father’s stature Charts for Birth (height),child’s gestational age in weeks (if known). up to 24 Months Plotting Data on the Chart: Locate the child’s age on the chart’s horizontal axis. Find the child’s length, weight, or head circumference on the vertical axis. Draw a small circle where the lines representing these two values intersect. Ensure the circle is correctly positioned relative to the percentile curves (e.g., 50th percentile represents the average value for that population). A complete growth chart includes both numerical data and plotted points.  Interpreting Percentiles: Percentile curves (e.g., 2nd , 5th , 10th , 25th , 50th , 75th , 90th , 95th , and 98th ) indicate how a child’s measurements compare to the reference population. For example: Charts for Birth If a child’s length-for-age is on the 50th percentile up to 24 Months curve, it’s considered average. If it’s on the 75th percentile, 75% of children of the same age and gender are shorter. Values below the 2nd or above the 98th percentile further investigations are needed. Monitoring Changes Over Time: If plotted values significantly change (e.g., cross two percentile lines), investigate the reasons. Regularly update the growth chart to track the child’s progress.  Birth to 36 months: Boys NAME Length-for-age and Weight-for-age percentiles Birth 3 6 9 12 15 18 21 24 27 30 RECORD # 33 36 Length-for-age BOYS Birthto 6months(percentiles) in cm cm in AGE (MONTHS) 41 41 L 40 95 40 E 39 100 90 100 N 39 75 G 38 38 T 95 95 37 50 37 H 97th 25 36 36 90 10 90 35 5 35 70 85th 70 34 85 33 32 95 38 50th 80 17 31 L 90 36 30 E 29 75 16 65 15th 65 N 75 34 G 28 15 70 T 27 3rd H 32 26 50 65 14 25 30 W 24 E Length (cm) 25 60 13 I 23 28 60 60 10 G 22 55 12 H 5 26 21 T 20 50 11 24 19 18 45 10 22 17 55 55 16 40 9 20 15 8 18 16 16 7 AGE (MONTHS) 12 15 18 21 24 27 30 33 36 kg lb 50 50 14 Mother’s Stature W 6 Gestational Father’s Stature Age: Weeks Comment E 12 Date Age Weight Length Head Circ. I 5 Birth G 10 H T 4 8 45 Weeks 45 0 1 2 3 4 5 6 7 8 9 10 11 12 13 3 6 Months 3 4 5 6 33 2 Age (completedweeksor months) lb kg Birth 3 6 9 WHO ChildGrowth Standards Published May 30, 2000 (modified 4/20/01). SOURCE: Developed by the National Center for Health Statistics in collaboration with the National Center for Chronic Disease Prevention and Health Promotion (2000). http://www.cdc.gov/growthcharts  The growth charts for this age range (2 to 20 years) were developed by the CDC Instead of using “length” (as in charts for children up to 24 months), the charts for ages 2 to 20 years use “stature” (standing height) as the primary measurement. Charts for ages Head circumference is not included as a variable in these charts. 2 to 20 Years The tables for recording anthropometric data (including stature) and, when relevant, the mother’s and father’s stature, are in the upper left- hand corner of the charts. Percentile Curves: The stature-for-age and weight-for-age charts for both gender include seven percentile curves: 5th , 10th , 25th , 50th (median), 75th , 90th , and 95th. In the weight-for-stature charts, an additional 85th percentile curve is included. Interpreting Percentiles: Values below the 5th percentile and above the 95th percentile more investigations are needed..  Birth to 36 months: Girls NAME Weight-for-age GIRLS Length-for-age and Weight-for-age percentiles Birthto6months(percentiles) RECORD # Birth 3 6 9 12 15 18 21 24 27 30 33 36 in cm AGE (MONTHS) cm in 41 41 L 40 40 E 100 95 100 10 10 39 90 39 N 38 75 38 G 95 95 T 37 50 37 H 36 90 25 90 36 97th 35 10 35 9 9 5 34 85 33 32 80 17 38 85th 95 31 8 8 L 36 30 90 E 75 16 N 29 34 G 28 70 75 15 50th T 27 H 32 7 7 26 65 14 25 50 30 W 15th W e i g ht (kg) 24 E 60 13 I 23 25 28 G 22 12 H 6 6 55 21 10 5 26 T 3rd 20 50 11 24 19 18 45 10 22 5 5 17 16 40 9 20 15 8 18 4 4 16 16 7 AGE (MONTHS) 12 15 18 21 24 27 30 33 36 kg lb 14 6 Mother’s Stature Gestational W E 12 Father’s Stature Age: Weeks Comment 3 3 Date Age Weight Length Head Circ. I 5 Birth G 10 H T 4 8 2 2 3 6 Weeks 0 1 2 3 4 5 6 7 8 9 10 11 12 13 2 Months 3 4 5 6 lb kg 35 Birth 3 6 9 Age(completedweeksor months) Published May 30, 2000 (modified 4/20/01). WHOChildGrowthStandards SOURCE: Developed by the National Center for Health Statistics in collaboration with the National Center for Chronic Disease Prevention and Health Promotion (2000). http://www.cdc.gov/growthcharts 13 7  Interpretation of ht-for-age and wt-for- age Nutritional Percentile Interpretation Anthropometric Percentile Cut-off Status Index Values Indicator 50th Average for age WHO Growth Charts 2nd and 98th percentiles 10th- 90th Healthy for most Length-for-age < 2nd Short stature pediatric Weight-for-length < 2nd Low weight-for- 3rd – 10th or 90th -97th Slightly suspicious until length proven otherwise Weight-for-length > 98th High weight-for- 97th Unhealthy until proven length otherwise  References Casadei K, Kiel J. Anthropometric Measurement. 2022 Sep 26. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 30726000. Kopecký, M., Krejčovský, L. and Švarc, M. (2014) Anthropometric measuring tools and methodology for the measurement of anthropometric parameters. Olomouc: Palacký University. Lee, R.D. and Nieman, D.C. (2013) Nutritional assessment. New York, NY: McGraw-Hill. https://www.cdc.gov/growthcharts/cdc-charts.htm https://www.cdc.gov/growthcharts/who-charts.html