Nutritional Assessment Lecture Notes PDF

‫بسم هللا الرحمن الرحيم‬ Nutritional assesment By Dr. zainab saeed aly Nutritional assessment: ✓To identify individuals or population groups at risk of becoming malnourished ✓To identify individuals or population groups who are malnourished ✓To develop health care program ✓And to measur...

‫بسم هللا الرحمن الرحيم‬ Nutritional assesment By Dr. zainab saeed aly Nutritional assessment: ✓To identify individuals or population groups at risk of becoming malnourished ✓To identify individuals or population groups who are malnourished ✓To develop health care program ✓And to measure the effectiveness of the developed programe The clinical nutritional assessment includes: 1. Nutrition-Based Patient History 2. Present history of current diseases and pathologies 3. Medical history 4. General clinical examination with special attention to organs like hair, angles of mouth, gums, nails, eyes, tongue, bones, muscles and thyroid glands 5. Anthropometric Assessment 6. Laboratory investigation  1. Nutrition-Based Patient History A comprehensive food and nutrition history (diet history) is generally not possible with most patients in the acute care setting, although components of the history are vital in nutrition assessment. Goal of nutrition history: ✓ to identify nutrient intake and imbalances ✓collecting all dietary factors important in generating the nutrition diagnosis and subsequent intervention. Types of needed data in nutrition history: ✓Food intake. ✓Eating habits and patterns. ✓Lifestyle patterns related to nutrition and health. methods for obtaining a patient’s food intake ✓ typical daily intake (TDI) ✓simplified food frequency (FF) Typicaldaily intake (TDI): In the TDI, the patient is asked what he or she typically eats daily to identify patterns of deficiency or excess in particular food groups. In contrast to a 24-hour food recall, in which the patient recounts his or her intake beginning with the last meal eaten, the TDI begins with the first meal of the day. To avoid a judgmental approach, it is best not to label meals as breakfast, lunch, and dinner, but rather based on time of day. For example, you could ask, “What is the first thing you typically eat or drink when you get up for the day?” The TDI should also indicate the amount of food eaten and the site of eating. Typical Daily Intake (TDI) Form: Meal Timing Food Item Amount Where eaten 8:00 a.m. Oatmeal 1 cup Kitchen table at home Food frequency (FF): A simplified FF is not as detailed as a comprehensive FF questionnaire but is advantageous for two reasons: The first advantage is that the simplified FF is a quick method for determining whether the patient avoids any major category of food. The second is that it will provide a crosscheck of the TDI. Food Frequency (FF) Form: Food Item/Group Amount/Day Amount/Week Milk or other dairy products (yogurt, cheese) Meat, poultry, and eggs Fish Nuts, legumes, and legume products Fruits Vegetables Starches (breads, cereals, grains) Fats, added (oils, margarine, salad dressing) Snack foods (chips, pretzels, crackers) Desserts/Sweets Dining out Fast food Restaurant dining Beverages Alcohol Coffee, tea Carbonated beverages Fruit juices Comparison with an appropriate standard: After collecting the food intake information, it is compared with an appropriate standard, such as the Dietary Guidelines for Americans or the Dietary Reference Intakes. A simplified evaluation form of general aspects of diet can also be used. Simplified group Evaluation Form of Dietary Servings/day Intake recommended Adequate/exce ss dairy protiens Fruits vegetables starch Fats/sweets 2. Present history of current diseases and pathologies: DM Liver diseases Anemia Thyroid dysfunction 3. Medical history: some medications can cause nutritional defiencies and drug nutrient interactions drug Side effects and nutrient deficiency Amphotericin b (antifungal Vit D and iron deficiency medication) antacids Hypokalemia, hypo magnesimia and hypophosphatemia Phenobarbital (sedative and anti Vit D,deficiency seizure drug) Cholestyramine (lowers the blood Deficiency of vit A,D,E,K and cholesterol) malabsorption Methotrexate (chemotherapy agent Folate deficiency and immune suppressant) corticosteroids Hyperglycemia, hypophosphatemia Mercaptopurine (for leukemia) Purine metabolism(DNA synthesis/ repair)  General clinical examination hair Spare and thin Protein, zinc, biotin deficiency Easy to pull out Protein deficiency Corkscrew/ coiled hair Vit C, A deficiency  mouth glossitis Niacin, B12, folic acid Bleeding and spongy gum Vit C, A, K, FOLIC ACID and niacin deficiency Angular stomatitis, cheilosis, fissured B2, B6 deficiency tongue leukoplakia Vit A, B12, folic acid deficiency Sore mouth and tongue Vit B12, B6, C, folic acid and iron deficiency, leukoplekia Sore moth and tongue Gum bleeding Angular stomatitis  eyes Night blindness Vit A deficiency Cod liver oil, salmon, mackerel, guava, mango Photophobia, blurring, Vit B2, vit A deficiency Salmon, leafy greens, conjunctival liver and organ meat, inflammation eggs, milk, legumes Nails spooning Iron deficiency Shellfish, liver and organ meat, legumes, broccoli, pumpkin seeds Transverse lines Protein deficiency Egg, fish, milk, yogurt, cheese, beef Pumpkin seeds broccoli legumes spinach skin pallor Follic acid, iron, B12 deficiency Follicular hyperkeratosis Vit B, C deficiency Pigmentation, Niacin deficiency (vit desquamation B3) purpura Vit K deficiency (concerned with the production of certain clotting factors and control bleeding) Follicular hyperkeratosis Purpura is a condition that causes purple spots on the skin due to bleeding under the skin. It can be caused by low platelet levels, medications, infections, or other factors. Skin pigmentation Transverse lines on nails: caused by protein deficiency  Thyroid gland ❑ is an endocrine gland in vertebrates. In humans, it is in the neck and consists of two connected lobes. The lower two thirds of the lobes are connected by a thin band of tissue called the isthmus. The thyroid gland is a butterfly-shaped gland located in the neck below the Adam's apple. ❑ The thyroid gland secretes three hormones: the two thyroid hormones – triiodothyronine (T3) and thyroxine (T4) – calcitonin ❑The thyroid hormones influence the metabolic rate and protein synthesis and growth and development in children. Calcitonin plays a role in calcium homeostasis. Secretion of the two thyroid hormones is regulated by thyroid-stimulating hormone (TSH), Symptoms of hypothyroidism vary between individuals and they tend to develop slowly. Commonly noted symptoms include: Fatigue Weight gain Increased blood cholesterol level Increased sensitivity to cold Constipation Dry skin Puffy face Muscle weakness, aches, tenderness, and stiffness Joint pain, stiffness, or swelling Irregular menstrual periods or amenorrhea Irregular menstrual periods or amenorrhoea Dry hair or hair loss Hypothyroidism in children could lead to: Delayed and poor growth Delayed puberty Poor mental development Causes of hypothyroidism: 1. Autoimmune (hashimoto disease) 2. Iodine deficiency 3. Thyroid gland removal 4. Thyroiditis One of the basic line of treatment is To maintain normal iodine levels: Organ Meats, dried seaweed: is the go-to remedy because of its incredible supply of this essential mineral Cod, Fortified Iodized Salt, Shrimp, Black Eyed Peas, Tuna, Boiled Eggs, Yogurt, Banana, Strawberries