Nutritional Assessment Le1 PDF

Nutritional Assessment Course Code:NUT3153 Le1 Dr.Awatif Almehmadi 1 The nutritional status of an individual is a balance between the intake of the nutrients and the expenditure of these in processes of growth, reproduction and health maintenance. It infl...

Nutritional Assessment Course Code:NUT3153 Le1 Dr.Awatif Almehmadi 1 The nutritional status of an individual is a balance between the intake of the nutrients and the expenditure of these in processes of growth, reproduction and health maintenance. It influenced by food intake , quantity , quality and physical health. The spectrum of nutritional status spreads from obesity to severe malnutrition. Factors Influencing Nutritional Status Socioeconomic Factors: Income, education, and access to food. Lifestyle Factors: Physical activity, smoking, and alcohol consumption. Medical Conditions: Chronic diseases, infections, and digestive disorders. Psychological Factors: Eating disorders, stress, and depression. The Nutrition Care Process (NCP) is a systematic approach to providing high quality nutrition care. The NCP consists of four distinct, interrelated steps: Nutrition Assessment Nutrition Diagnosis Nutrition Intervention Nutrition Monitoring/Evaluation Nutrition Assessment defined as a systematic approach to collect, classify, and synthesize important and relevant data (indicators) needed to identify nutrition-related problems and their causes. This step also includes reassessment for comparing and re-evaluating data from the previous interaction to the next and collection of new data that may lead to new or revised nutrition diagnoses based on the client’s status or situation. Finding Nutrition Assessment Data: For individuals, data can come directly from the client through interview, observation and measurements, a health record, and the referring health care provider. For population groups, data from surveys, administrative data sets, and epidemiological or research studies are used. Nutrition Assessment Data is categorized into the following 6 Domains: 1)Food / Nutrition-Related History (FH). 2)Anthropometric Measurements (AD). 3)Biochemical Data, Medical Tests, and Procedures (BD). 4)Nutrition-Focused Physical Findings (PD). 5)Client History (CH). 6)Assessment, Monitoring, and Evaluation Tools (AT). Food/Nutrition-Related History consists of Food and Nutrient Intake, Food and Nutrient Administration, Medication and Herbal Supplement Use, Knowledge/Beliefs/Attitudes, Behavior, Factors Affecting Access to Food and Food/Nutrition-Related Supplies, Physical Activity and Function, and Nutrition-Related Patient/Client-Centered Measures. Medication and Herbal Supplement Use includes prescription and over-the counter medications, including herbal preparations and complementary medicineproducts used. Client History consists of current and past information related to personal, medical, family, and social history. Personal History includes general patient/client information such as age, gender, race/ethnicity, language, education, and role in family. Patient/Client/Family Medical/Health History includes patient/client or family disease states, conditions, and illnesses that may have a nutritional impact. Social History includes items such as socioeconomic status, housing situation, medical care support, and involvement in social groups.  Nutrtional assessment system in clinical setting (or group of people with defined criteria) Anthropometric methods , Laboratory Method Clinical Methods (medical Dietary method measurements of physical (Biochemical data), it history and physical dimension and gross include measurements of ; examination used to composition of the body ( detect sing and symptom body size, shape and Static functional test associated with nutrient composition) measure nutrient in deficiency biological fluid or tissue or urinary execration rate of the nutrient or its metabolite. Functional test (biochemical physiological) i.e. papillary andvisual threshold test 6  Dietary Assessment Assessing food and fluid intake is an essential part of nutrition assessment. It provides information on dietary quantity and quality, changes in appetite, food allergies , and reasons for inadequate food intake during or after illness. The results are compared with recommended intake such as recommended dietary allowance (RDA)to counsel clients on how to improve their diets to prevent malnutrition or treat conditions affected by food intake and nutritional status (e.g., cardiovascular disease, cancer, obesity, diabetes, and hyperlipidemia). Factors affecting food consumption The division of foods into two categories, "away-from- home" and "household" food. Factors that influence the choices to acquire and consume foods include household income; the price of food; personal factors such as age, sex, ethnic group, education, and physiological status (such as pregnancy); environmental factors such as advertising; and characteristics of food such as label information. These factors determine food preferences and attitudes. Consumer demand for various products also influences the availability of foods in the food supply (marketplace). Who needs information on individuals and groups food and nutrient intake? 1. Education, research and health care. 2. The food industry 3. Authorities and politicians 1-Education, research and health care. In education as well as in food information, data from dietary surveys is often basic information. For instance, it is important that food and nutrition books are based on accurate information on what people eat. To be able to give dietary counseling to various patient groups, such as to patients with diabetes and coronary heart disease, you need to know what these patients eat. In large-scale nutritional epidemiological studies, it is important that accurate dietary data are used to investigate the relationship between diet and health/disease. 2-The food industry The food industry needs knowledge about people’s attitudes toward various foods, their preference of taste etc. 3- Authorities and politician o Health authorities are interested in dietary surveys, especially nutritional epidemiological studies regarding relationships between diet and disease /health. o It is important that they know about connections between, for example coronary heart diseases or various cancer forms. Health authorities have the responsibility for the entire population health and therefore should have continuous information on how the consumption of various foods changes over time. o Authorities that have the responsibility for decision making. Politicians in decision making positions for a number of nutritional economical areas , such as deciding taxes on foods.  Dietary information types Dietary data on a national level. Per capita consumption. Food balance sheet Dietary data on the household level. Household based surveys. Food account. Household food record. Household 24-h recall method. Food consumption of individuals. Dietary assessment methods. 24-hour dietary recall. Food diary or Record. Food Frequency Questionnaire. Dietary history.  The most used method of assessing the food available nationally for consumption is based on food balance sheets Measuring FAO describes food balance sheets as (a tool that food provides a comprehensive picture of the pattern of a country’s food supply during a specified reference consumption period. It is the determination of the amount of food consumed per at the capita per day assuming equal distribution on the national level. national The data of food balance sheet is calculated from the annual level production of food Changes in stocks imports and exports, and the distribution of food over various uses within the country. Dietary data on a national level. per capita consumption. Per capita consumption is the available amount of food/energy/nutrients per person and day. This data is obtained by taking the sum of food production plus imports minus the sum of exports and foods for animals. Losses due to storage, transportation, distribution etcetera should be drawn of the total amount. These data can be obtained from national statistic, Food Consumption Statistics and FAO Food Balance Sheets. This type of data can be used in ecological studies, to follow trends in food production and give a broad view for comparison between countries. Per capita consumption = [Food production + imports]– (export + food for animals).  FBS Components FBS made up of 3 sets of data: 1-Supply Production, imports and change in stocks. 2-Utilization Exports, feed, seed, and other use. 3-Per capita food supply Population and nutrient content , calories, protein and fat. Remarks The accuracy of food balance sheets, which are in essence derived statistics , is of course dependent on the reliability of the underlying statistics of supply and utilization of food and of population. Production statistics may not be available for all commodities needed. Import and export data may be reasonably accurate in the majority of countries, but in some countries significant amounts of trade across national boundaries go unrecorded.  Steps to carry out food balanced sheet Estimate the quantities produced in the country, (e.g. wheat) in a year : Adding the amount produced, imported, and stored from the previous year. Subtracting what have been exported, used for animal feeds, used in agriculture, used in industry, wasted, or stored for the next year. Dividing the final quantity by the year population to get the food consumption per capita per year. Dividing the food consumption per capita per year by 365 to get the food consumption per capita per day. The results represent food consumption level per capita per year for wheat. This can be repeated for other food items. The per capitasupply of each item is then converted into nutritional carbohydrates,protein, fat, elements, vitamins and minerals using the food analysis tables. Several different terms have been used to describe FBS National food accounts. Food moving into consumption. Food consumption statistics. Food disappearance data. Consumption level estimates. The usages of food balance sheet Food balance sheet data Food supply data can also can be used to formulate provide useful information agricultural policies at the national level on concerned with the trends in food production, distribution, consumption and, changes and consumption of foods. in nutrient intakes.  Strengths and limitation of the FBS Strength Can give a total view of a country’s food supplies. Indicates food habits and dietary trends. Used to plan international nutrition policies and food Programs. May be the only data available on a country’s food consumption. Limitations Accuracyof data may be questionable. Only represents food available for consumption. Does notrepresent food actually consumed. Does notindicate how food was distributed. Does notaccount for wasted food.  Supply Domestic utilization Food supply per caput Commodity Product Change Imports Exports Availab Feed Seed Food Other Waste Food Kg/yea Grams/ Calorie Protein Fat/day ion in stock le Manu- uses r day s/day /day supply facture Numbe Grams Grams r 1 2 3 4 5 6 7 8 9 10 12 13 14 15 16 17 Wheat 3790 -140 359 3291 250 224 2652 165 Wheat Flour 1989 44 73 1960 59 1901 68.8 188.4 686 20.5 2.1 Rice Paddy 629 629 25 585 19 Rice Milled 392 +35 77 350 11 339 12.3 33.6 121 2.3 0.2 Barley 84 12 96 23 2 68 3 Pearl Barley 20 20 20 0.7 2.0 7 0.2 - Malt of Barley 26 3 23 23 Definition :defined as the total amount of food available for consumption in the household ,generally excluding that eaten away from home unless taken from the home during a specified time. Household data are useful for comparing food consumption patterns in different communities and geographic areas , and for dietary changes; in various population groups. However, they do not give information on the distribution of food among the individual members of the family. Household Household based surveys give information of the household’s expenses for foods. Measurements This can later be transformed to foods. Usually, a household member keeps record on all expenses and type of foods during a specific time period, usually one to four weeks and preferably evenly distributed during the year. This type of data can be used to monitor differences due to socioeconomic status, geographical area, type of family …….etc. Household surveys do not give information on the distribution of the consumption between the family members, cooking methods or losses. These surveys are often performed of economical reasons rather than nutritional reasons. Household Methods for Household Measurements Measurements 1. Food Account. 2.Household food record. 3.Household 24-h recall method. 4.List-recall method. 5.Inventory method. These methods all involve collecting information on demographic and socio- economic characteristics of the household ,thereby, enabling data to be presented in terms of income level, family size, region of the country and so on. Food Account Method The food account method aims to record all food purchase and food brought into the household from other sources during a seven-day period or longer. This measure assumes that there have been no Household significant changes in household food distribution. Measurements 24-hour diet history Interviewer inquiresin detail about food consumed over specified time. Quantitative assessments made. More Commonly used for individual than household intakes. This method covers only 24-hr. period Household Food Record Method Aim to weigh or measure in household units the foods available for consumption in the household. This is done by the caretaker or during daily visits by field investigators. Foods not eaten by the household members should be subtracted from the total amount available for consumption. List-Recall Method Household This method requires that theinterviewer uses a list of major food items in a structured questionnaire to help the Measurements respondent recall the amount and price or purchase value of all foods used in the household within a specified period, usually over a period of seven days. Inventory Method The inventory method entails taking an inventory of all food in a household at the beginning and end of a specified period, usually one week. The types and weights of all foods brought into the house are recorded daily during the period. An inventory is made of food in the house at the beginning and end of this period. The advantage to this method is that it gives a more accurate estimate of nutrient availability than the account method. Household Measurements Strengths and weakness of household methods Strengths : Suitable for large scale surveys. Designed for monitoring diet trends at the population level. Weaknesses: Data not collected at the individual level.  1- Direct methods (individuals) Dietary Dietary records, Diet history, 24-hour dietary recall, observed food consumption (food frequency questionnaire) assessment 2- Integration of innovative technologies (individuals) Personal digital assessment, Image assisted dietary assessment, Mobile based technologies. methods for Purpose of measuring an individual's diet Measuring diet is mainly dedicated towards improving human individuals health by: Investigating the relationship between diet and diseases. Identifying the groups at risk for nutrient deficiency or excess nutrients using: Determining the average nutrient intakes in comparing different groups. Ranking individuals within a group. Estimating an individual’s usual intake.  A self reported record of all foods, beverages, and possibly dietary supplements consumed over a period of one or more days (Preferably including one day in the weekend). Respondents record diet consumed throughout the reporting Dietary day. Respondents are given a recorded form and instructions to records help them record relevant details accurately. The record usually have the date, time, the food or beverages, and the amount consumed. Additional details could be added such as the brand name, preparation methods, and were consumed. There is no limit to the number of items reported. A food record is usually almost accurate if the food eaten is recorded the same day. Amount consumed determined by weighing with a scale or measuring volume using standard cups and spoons. The individual’s nutrient intake is calculated and averaged at the end of the desired period and then compared with dietary reference intakes (DRIs) or guidelines in the food pyramid guide. The amount of calories and all nutrient intake can be provided from this method. This method is often used in outpatient clinic settings. Types of food records : 1- Estimated food record Amounts of food and leftovers are measured in household measures (cups, tablespoons, teaspoons) or estimated using such measures as coffee cups, bowls, and glasses. The researchers then quantify these measures by volume and weight considered less accurate than the weighed food record. This method puts less burden on the respondent than the weighed food record. 2-Weighed food record Food and leftovers are weighed using scales or computerized techniques supplied by researchers. Considered more accurate than the estimated food record. Preferred by some researchers for gathering data on individuals. Requires a better degree of subject cooperation than the estimated food record and thus is likely to have a greater impact on eating habits than the estimated food record.  Strengths and limitations of food record Strengths Limitations 1- Dose not depended on the 1- Requires high degree of cooperation. memory. 2- Subject must be literate. 2- Can provide detailed intake 3- Takes more time to obtain data. data. 4- Act of recording may alter diet. 3- Can provide data about eating 5- Tend to forget to record all foods habits. eaten or modify feeding practices to be 4- Multiple-day data of usual healthier which may lead to intake. underestimates of intake 5- Reasonably valid up to 5 days. 24-hour recall A 24-houre recall is a record of all food and beverages consumed within the previous 24 hours, starting from the first thing consumed in the morning to the last thing consumed before getting up the next morning. A nutritionist or dietitian that has been trained in interviewing techniques can conduct the information from the respondent. Food intake per person or per consumption unit is calculated considering the age , sex and the number of family members. 24-hour recall Interview conducted face –to-face, structured with probing questions. Interviewers should be knowledgeable about foods available in the market. Regional and ethnic preparations and methods. They should be familiar with the dietary patterns of the respondents, have a list of foods commonly eaten by the target population, be familiar with composite dishes, their recipes, preparation methods, and be aware of how food is served. Lastly, they should have training on how to use standard probes and prompts properly, how to measure portion size, particularly for mixed dishes, and how to ask questions in a non- judgmental and non-influential manner during the recall.  24-hour recall Probing techniques: Food probe – types of food (kinds of milk) form purchased (fresh/frozen/canned/dry); method of preparation (boiled/baked/fried/breaded); brand name (commercial/ready to eat); parts eaten (whole item/half); ingredients (mixed dish, ingredients used and amounts); addition to foods (anything added to food during preparation or at the table, any dressing added, cream or sugar). Get an accurate and complete listing of all foods and drinks individually consumed within last 24 hrs. Specifically: What foods or drinks were consumed? How much was consumed? Time of consumption? Method of preparation? How was it served? Details of food (e.g low fat, 1%, whole).  24-hour recall Information on 24-hour recall is collected using an open-ended format. Quantitative information on food intake using portion size provides the calculation of energy and nutrient intakes. Estimation of portion size is facilitated by the use of measurement aids such as: standard household measures, photo atlases, food models, etc. Record of food amounts converted into nutrient intakes using food composition tables or databases. A single 24-hour recall is not enough to describe an individual’s usual intake of food and nutrients. Repeated visits make this method more expensive, so it is possible to conduct the recalls by telephone where appropriate.  24-hour recall method strength and limitation Strength Limitations -Subjects require no training or -A single 24-hour recall cannot literacy and need only to spend take account of day-to-day minimal effort in providing the variation in an individuals’ food information requested by the consumption. interviewer. -Due to its reflective nature, the -Processing data from a 24-hour 24 hr recall is less suitable for recall is cheaper and less time use with children and the elderly. consuming than processing data -It relies on the memory of the from dietary records. subject. -Useful for assessing average usual intakes of a large population, and are therefore often used for large dietary surveys  Diet history A detailed assessment to describe usual food intake and its variation over a long period of time (six months to a year). Collection of information on frequency of intake of various foods and usual meal pattern. Detailed questions on a list of foods and beverages consumed at each eating session such as: breakfast, snack, dinner, etc. Details on methods of preparation should be provided. The information should be collected by a trained interviewer. Details about usual intake, types, amount, frequency & timing needs to be obtained. This part of the nutritional assessment also provides information on the number of meals, snacks, and beverages consumed, special foods eaten, vitamin and mineral supplements ingested regularly, food allergies, intolerances, and unusual feeding behaviors.  Diet history Subjects are asked open-ended questions regarding their usual (present or past) dietary intakes; e.g. ”What do you eat on a typical day for…?” The interviewer carefully inquires about food consumption meal by meal, seeking information about variations in intake and trying to establish the usual pattern of consumption. Interviews of this type are time-consuming, often lasting for more than 1 hour, but they can provide considerable detail about an individual's eating habits, such as food preparation practices and seasonal variations in food choices. Dietary histories, unlike dietary records , require subjects to make judgments about their usual food habits. Thus, the answers may reflect what the subjects think they eat (or what they would like the interviewer to think they eat), rather than what is actually eaten. Compared to other assessment methods, there are a limited number of studies in validating dietary history.  Strengths and limitations of the diet history Limitations Strengths 1- Assesses usual nutrient intake. 1- Time consuming interview process. 2- Requires highly trained interviewers. 2- Can detect seasonal changes. 3- Difficult and expensive to code. 3- Data on all nutrients can be 4- May tend to overestimate nutrient obtained. intake. 4- Can correlate well with 5- Requires cooperative respondent with biochemical measures. the ability to recall a usual diet. Food frequency questionnaire (FFQ) It is a report of usual frequency of consumption of food items from a list of food items in reference to a specified period such as: past week, month, or year. It is used to capture a range of foods, specific nutrient(s) (quantitative FFQ) or a specific food group, including rarely consumed food items. It can be preformed as a face-to-face interview, by telephone or by self administration. FFQs can either be developed from basic principles or adapted from existing questionnaires. The FFQ chart should be organized into groups that have common nutrients for ease of evaluation. FFQ represents usual intake frequency. During illness food consumption patterns change depending on the illness and therefore it should be completed before hospitalization, depending on the purpose of which it is done. The FFQ list could have as many Items as needed, complete questionnaire might contain more than 100 items. Types of Food Frequency Questionnaire A- Simple or non-quantitative FFQ: It simply asks how many times a year, month, week, or day a person eats from specific food Item. B- Semi-quantitative FFQ: Gives the respondents an idea about the portion size. It ask how many times a year, month, week, or day a person eats ½ cups of some kind of food in addition to asking the frequency of consumption. C- Quantitative FFQ: asks the respondent to describe the size of his or her usual serving using measurement aids such as: standard household measures, photo atlases, food models, etc. Food Frequency Questionnaire Some types of food frequency questionnaires pose their questions in open-ended form, whereas others use closed- ended questions. For example, in the open-ended type of questionnaire, subjects would be asked how often they eat apples. In the closed-ended type of questionnaire, they might be asked whether they eat apples daily, four to six times per week, one to three times per week, less than once per week but more than once per month, less than once per month or never. FFQ Strengths and Limitations Strengths Limitations 1- Relatively easy to use and 1- long questionnaire complete. 2- Errors with estimating serving size. 2- Inexpensive. 3- Depended on ability of subject to 3-More representative of usual describe diet. food intake for long period of time. 4-Not appropriate for determining 4-Machine readable. absolute nutrient intake in large 5-Can capture portion size surveys. estimates (semi and quantitative 5-Not suitable for a population where FFQ), details about cooking and people have distinctly different preparation methods. dietary patterns. Integration of innovative technologies (individuals) Personal digital assessment: is a handheld computer that has dietary software program that can be used to register and self monitor dietary intake. It allows for the evaluation of short-term dietary intake. Image assisted dietary assessment: It is a method that uses images of food collected during eating episodes to enhance accuracy and reduce respondent burden. The purpose of using images is to support traditional self-report methods (24-hour recalls or records) or as a stand-alone method to provide the primary record of dietary intake. Mobile based technologies: allowing users to shoot images or make voice records using a smartphone or tablet. Which makes it is possible for the dietary assessments to be conducted in real-time.