NUTRI Chap 7-8 Week 9-3 PDF

# Chapter 7: Water and Electrolyte Balance ## Objectives At the end of the chapter, the students should be able to: 1. describe body fluid composition 2. explain the mechanisms controlling fluid and electrolyte movement 3. identify the major anions and cations in the fluid compartments of the bod...

# Chapter 7: Water and Electrolyte Balance ## Objectives At the end of the chapter, the students should be able to: 1. describe body fluid composition 2. explain the mechanisms controlling fluid and electrolyte movement 3. identify the major anions and cations in the fluid compartments of the body ## Water Water constitutes about 60% to 70% of the total body weight, so that deprivation of water by as much as 10% will already result in illness and 20% loss of body water may cause death. Water is next to oxygen in importance for the maintenance of life. Water found in a normal adult human body totals 45 liters. Two-thirds of this (30 liters) is found inside or within the cell, while one-third (15 liters) is outside the cell. ## Functions 1. Water is the universal solvent 2. Many chemical reactions require water. It serves as a catalyst in many biological reactions especially those that involve digestion, absorption, and circulation. 3. It is a vital component of tissues, muscles, glycogen, and others, and is essential for growth. 4. Water acts as a lubricant of the joints and the viscera in the abdominal cavity. 5. It is also a regulator of body temperature through its ability to conduct heat. ## Water Intake The amount of water needed by the body may be met by a direct intake of water, water ingested as such, or from water bound with foods, and from metabolic water which is a result of oxidation of foodstuffs in the body. Water produced as an end product of metabolism amounts to approximately 14 g/100 cal. For example, 100 g of fats, carbohydrates, and proteins when oxidized will yield 107 mL, 60 mL, and 41 mL of water, respectively. ## Water Output Water leaves the body via several channels such as through the skin as an insensible perspiration; through the lungs as water vapor in the expired air; through the gastrointestinal tract as feces; and through the kidneys as urine. Water may also be lost together with the electrolytes through tears; stomach suction; breathing; vomiting; bleeding; perspiration; drainage from burns; and discharge from the ulcer, skin diseases, and injured or burned areas. ## Table 40: Fluid Requirement Based on Caloric Expenditure Using the Holliday-Segar Method | Weight | Daily Requirement | |---|---| | 3-10 | 100 mL/kg | | 10-20 | 1000 mL + 50 mL/kg for each kg in excess of 10 | | >20 | 1500 mL + 20 mL/kg for each kg in excess of 20 | Source: Holliday & Segar, 1957 Note: This method is not suitable for neonates < 14 days old or for conditions associated with abnormal losses. ## Abnormalities of Water Balance ### Overhydration or Water Intoxication When large amounts of water are lost in the body usually caused by high environmental temperature, sodium is also lost. This phenomenon causes the brain to signal a need for increased water. If the water intake is increased without the corresponding increase in the intake of sodium, water intoxication results. Workers exposed to high environmental temperatures and travelers to tropical countries not accustomed to heat may become victims of this condition and experience muscle cramps, weakness, or drop in blood pressure. This is relieved by providing sodium in very small amounts with the intake of solids. This may also arise if too much fluid is given intravenously. If the intake of water exceeds the maximum rate of urine flow, the cells and tissues become water-logged and diluted. This may cause anorexia and vomiting, and if it occurs in the brain, it may result in convulsion, coma, and even death. ### Dehydration This condition becomes serious if the loss is about 10% of the total body water and fatal if the loss is from 20% to 22%. It is especially critical in babies. Electrolytes are also lost with the water in this condition, and the skin becomes loose and inelastic. ## Table 41: Average Daily Intake and Output of Water | Intake | mL/day | Output | mL/day | |---|---|---|---| | Oral fluids | 1,100-1,400 | Urine | 1,200-1,500 | | Solids foods | 800-1,000 | Intestinal | 100-200 | | Metabolic water 300 (oxidation of food) | | Lungs (water vapor) | 400 | | | | Skin (sweat) | 500-600 | | **Total** | **2,200-2,700 (approx. 2,500 mL/day)** | | **2,200-2,700 (approx. 2,500 mL/day)**| Sources: Lutz & Przytulski, 1994 FNRI-DOST RENI, 2002 ## Table 42: Methods of Estimation of Daily Food Requirements | Method of Estimation | Fluid Requirements, mL/kg | |---|---| | **Body Weight** | | | Adults, y | mL/kg | | Young active, 15-30 | 40 | | Average, 25-55 | 35 | | Older, 55-65 | 30 | | Elderly, >65 | 25 | | Children, kg | | | 1-10 | 100 | | 11-20 | Additional 50 mL/kg in excess of 10 kg | | 21 or more | Additional 20 mL/kg in excess of 20 kg | | | | | | At age > 50 | | **Energy Intake** | | | | 1 mL/kcal for adults | | | 1.5 mL/kcal for infants | | **Nitrogen + Energy Intake** | | | | 100 mL/g nitrogen intake + 1 mL/kcal | | **Body Surface Area** | | | | 1500 mL/mb | *Body surface area may be calculated based on the following formula: S = W 0.425 x H 0.725 x 71.84 or log x = (log W x 0.425) + (log H x 0.725) + 1.8564 where x = cm² body surface area, W = kg body weight, and H = cm height Body surface often used for “average” adult is 1.73 m² Sources: Zeman & Ney, 1996 FNRI-DOST RENI, 2002 ## Table 43: Normal Electrolyte Concentrations of the Extracellular and Intracellular Fluids (mEq/liter) | | Extracellular Fluids (Plasma & interstitial) (mEq/liter) | Intracellular Fluids (mEq/liter) | |---|---|---| | CATIONS (+) | | | | Sodium (Na+) | 135 to 147 | 10 | | Potassium (K+) | 3.5 to 5.5 | 150 | | Calcium (Ca++) | 4.5 to 5.5 | 1 to 2 | | Magnesium (Mg++) | 1.5 to 3.0 | 40 | | | | | | ANIONS (-) | | | | Chloride (CI) | 98 to 106 | 4 | | Bicarbonate (HCO3-) | 26 to 30 | 10 | | Phosphate (HPO4-) | 2 to 5 | 140 | | Sulfate (SO4-) | 2 to 5 | 10 | | Organic Acids (Lactic, pyruvic) (-) | 3 to 6 | 40 | | Proteins (proteinate -) | 15 to 19 | | Source: Escott-Stump, S., and Mahan, L.K., 2004 # Chapter 8: Nutritional Assessment ## Objectives At the end of the chapter, the students should be able to: 1. discuss the methods of assessing nutritional status 2. explain the significance and purpose of nutritional assessment. ## Recommended Dietary Allowances and Adequate Diet An adequate diet is composed of various nutrients which the body needs for maintenance, repair, living processes, and growth or development. It is a diet which meets in full all the nutritional needs of a person. There is no ideal diet since it is a matter of individual requirement. The purpose of daily meals is to supply the essential elements. Regional availability of foods, socio-economic conditions, taste preferences, food habits, age of family members, storage and preparation facilities, and cooking skills are factors to consider when nutritious meals are planned. The dietary standard changed from Recommended Dietary Allowances (RDA) to Recommended Energy and Nutrient Intakes (RENI) to emphasize that the standard is in terms of nutrients and not foods or diets. RENIs are levels of intakes of energy and nutrients which, on the basis of current scientific knowledge, are considered adequate for the maintenance of health and well-being of nearly all healthy persons in the population. Most nutrients are equal to the average physiologic requirement (AR), corrected or incomplete utilization or dietary nutrient bioavailability, plus two standard deviations (SD), or twice an assumed coefficient of variation (CV), to cover the needs of almost all individuals in the population. In the case of nutrient for which data on AR are insufficient, the RNI is “adequate intake” (AI) which is based on the experimentally observed average intake of healthy individuals. For energy, the recommended intake level is set at the estimated average requirement of individuals in a group (no SD), since intakes consistently above the individual’s requirement lead to overweight or obesity. Source: FNRI-DOST, 2002 ## Essentials of an Adequate Diet Proteins, carbohydrates, fats, vitamins, minerals, cellulose, and water should be provided in sufficient quantity through the daily meals to meet the needs of the body. ### The Milk Group The milk group is counted on to provide most of the calcium requirements. It provides riboflavin, high-quality protein, other vitamins and minerals, carbohydrates, and fats. The milk allowance is used in the form of fluid, whole or skim milk, buttermilk, evaporated milk, dry milk, and cheese. A portion may be used in cooking. ### The Meat Group The meat group provides generous amounts of high-quality protein, Iron, thiamine, riboflavin, niacin, phosphorus, and zinc are supplied. At least once a week, liver, kidney, and salt water fish such as salmon, oysters, and mackerel should be included in the animal protein allowance. There are several non-meat alternatives that provide the same nutrients as animal flesh. Vegetarians may combine plant sources such as grains and legumes, grains and nuts/seeds, and legumes and nuts/seeds to meet the complete or high-quality protein needs of the body. ### The Bread and Cereal Group The bread and cereal group furnishes thiamine, protein, iron, niacin, carbohydrate, and cellulose at a relatively low cost. The enrichment of bread and cereals with iron, thiamine, riboflavin, and niacin substantially contributes additional amounts of these nutrients to the diet. ### The Vegetable-Fruit Group The vegetable-fruit group is an important supplier of fiber, minerals, and vitamins particularly vitamins A and C. ## Assessment of Nutritional Status Nutritional status or nutriture is the degree to which the individual's psychological need for nutrients is being met by the food the person eats. It is the state of balance in the individual between the nutrient intake and the nutrient expenditure or need. The evaluation of the nutritional status involves examination of the individual's physical condition, growth and development, behavior, blood and tissue levels of nutrients, and the quality and the quantity of the nutrient intake. In a thorough nutritional status assessment, all of the following aspects are considered: 1. dietary history and intake data 2. biochemical data 3. clinical examination 4. anthropometric data 5. psychosocial data ## Methods of Assessing Dietary Intake ### 24-Hour Recall The individual completes a questionnaire or is interviewed by a dietitian/nutritionist or a nurse experienced in dietary interviewing and is asked to recall everything that he/she ate within the last 24 hours or the previous day. ### 24-Hour Recall Form and Food Group Evaluation The following question pattern may be used for conducting the 24-hour recall. The information should then be recorded in the chart at the end. “In order to get a more complete picture of your family's health, I need to know more about your eating habits. Would you please tell me everything you ate or drank all day yesterday? Let's begin with:" 1. What time did you go to bed the night before last? Was this the usual time? 2. What time did you get up yesterday? Was this the usual time? 3. When was the first time you had anything to eat or drink? What did you have and how much? 4. When did you eat again? Where? What and how much? 5. When did you eat next? What did you eat and how much? 6. Did you eat or drink anything else? a. Anything from 1st to 2nd meal? b. Anything from 2nd to 3rd meal? c. Anything from 3rd meal to bed time? 7. Was this day's food intake different from usual? If so, why? 8. Is weekend eating different? If so, why? ## Table 44: Food and Fluid Intake from Time of Awakening until the Next Morning 24-Hour Recall | Time | Food and Drink Consumed | | Milk Group | Meat Group | Vit. A Group | Vit. C Group | Vegetable-Fruit Group | Cereal Group | Bread & Butter | Fat, & Oil | Misc. | |---|---|---|---|---|---|---|---|---|---|---|---|---| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | TOTAL | | | | | | | | | | | | ## Sample 24-Hour Recall Form **Name:** **Date:** / / **Day of Week (encircle):** Sun Mon Tue Wed Thu Fri Sat | Time of Meal | Food or Beverage | Type of Preparation | Amount | |---|---|---|---| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | **Was this intake unusual?** Yes _ No _ **If so, how?** **Do you take any vitamin or mineral supplement?** Yes _ No _ **If yes, describe:** | Name or Type | Dose (if known) | How often | |---|---|---| | | | | | | | | | | | | Sources: American Dietetic Association, 1992 Grodner, M., & Escott-Stump, S., 2016 ## Evaluation | | Milk Group | Meat Group | Vit. A Group | Vit. C Group | Vegetable-Fruit Group | Cereal Group | Bread & Butter | Butter, Fat, & Oil | Misc. | |---|---|---|---|---|---|---|---|---|---| | Recommended Number of Servings Daily | | | | | | | | | | | Children 6 yrs or < | 2-3 c | 2 | 3/wk | 1 | 2 | 4 | 2 tbsp | | | | Adolescent | 4 c | 2 | 3/wk | 1 | 2 | 4 | 2 tbsp | | | | Adult | 2 c | 2 | 3/wk | 1 | 2 | 4 | 2 tbsp | | | | Pregnant or Lactating | 4 c | 2 | 3/wk | 1 | 2 | 4 | 2 tbsp | | | Evaluation: L = Low A = Adequate E = Excessive ## Food Frequency Questionnaire For frequency of food use, the following pattern of questions may be useful. Questions, however, should be modified based on the information from the 24-hour recall. For instance, if a patient said he/she had a glass of milk yesterday, he/she should not be asked, "Do you drink milk?" but rather "How much milk do you drink?" Answers should be recorded as 1/day, 1/wk, 3/mo, for example, or as accurately as possible. It may just have to be noted as "occasionally" or "rarely.” 1. Do you drink milk? If so, how much? What kind? Whole _ Skim _ 2. Do you use fat? If so, what kind? How much? _ 3. How many times do you eat meat? Eggs _ Cheese _ Beans _ 4. Do you eat snack foods? If so, which ones? How often? _ How much? _ 5. What vegetables do you eat? (in each group) How often? _ a. Broccoli _ Green pepper _ Cooked greens _ Carrot _ Sweet potato _ b. Tomato _ Raw cabbage _ Asparagus _ Beets _ Cauliflower _ Cooked cabbage _ Celery _ Peas _ Lettuce _ 6. What fruits do you eat and how often? a. Apples or apple sauce _ Apricots _ Banana _ Berries _ Cherries _ Grape or grape juice _ Peaches _ Pears _ Pineapple _ Plums _ Raisins _ b. Oranges _ Orange juice _ Grape fruit _ Grape fruit juice _ 7. Bread and Cereal Products a. How much bread do you usually eat with each meal? _ Between meals? _ b. Do you eat cereal? (daily, weekly) _ Cooked _ Dry _ c. How often do you eat foods such as macaroni, spaghetti, noodles, and the like? _ 8. Do you use salt? _ Do you "crave" salts or salty foods? _ 9. How many tsp of sugar do you use/day? _ (1 packet - 1 tsp) _ 10. Do you drink water? _ How often during the day? _ How much each time? _ How much would you say you drink each day? _ 11. Do you drink alcohol? _ How much? _ Beer, wine, others? _ How often? _ ## Selective Food Frequency Questionnaire for Inquiring About Cholesterol, Fat, Sodium, Iron, or Sugar Intake Frequency of Food Used: Record as times/week or day or N = never or R = rare **High or Moderately High in:** Use of | Nutrient | Foods | |---|---| | **CHOLESTEROL** | Eggs, Liver, Shellfish, Pork, Beef | | **SATURATED FAT** | Beef, Pork, Butter, Whole Milk, Cream, Pastries, Gravies, Ice Cream, Cakes, Pastries, Cookies, Coke, Soda Pop, Candy, Soft Margarine | | **SUGAR** | | | **UNSATURATED FAT** | Vegetable Oils | | **SODIUM** | Prepared Frozen Foods, Sausages or Franks, Snack Foods, Pretzel, Potato Chips, Salted Peanuts, Softened Water, Olives, Pickles, Smoked Fish, Canned Fish, Ham & other Canned Meat, Iron Supplements, Dark Green Leafy Vegetables, Enriched Cereals, Dried Beans, Meat, Fish, Poultry, Eggs | | **IRON** | | ## Dietary History The dietary history is more complete than either the 24-hour recall or food frequency questionnaire, although it usually includes both of these sources. The dietary history contains additional information about the following: 1. **Economics** a. Income _ b. Amount of money for food each week or month and individual perception of its adequacy for meeting food needs _ 2. **Physical Activity** a. Occupation _ b. Exercise _ c. Sleep - hours/day _ 3. **Ethnic and Cultural Background** a. Influence on eating habits _ b. Religion _ c. Education _ 4. **Home Life and Meal Patterns** a. Number of household members _ b. Person who does shopping _ c. Person who does cooking and relationship with this person _ d. Food storage and cooking facilities _ e. Type of housing _ f. Ability to shop and prepare food _ 5. **Appetite** a. Good, poor, any changes _ b. Factors that affect appetite _ c. Taste and smell perception _ 6. **Allergies, Intolerances, and Food Avoidances** a. Foods avoided and reason _ b. Length of time of avoidance _ 7. **Dental and Oral Health** a. Problems with eating _ b. Foods that cannot be eaten _ c. Problems with swallowing, salivation, and food sticking _ 8. **Gastrointestinal Concerns** a. Problems with heartburn, bloating, gas, diarrhea, constipation, distention _ b. Frequency of problems _ c. Home remedies _ d. Antacid, laxative, and other drugs used _ 9. **Chronic Diseases** a. Treatment _ b. Length of time of treatment _ c. Dietary modification _ 10. **Medication** a. Vitamin and/or mineral supplement _ b. Medications _ ## Food Diary or Record This method involves time, understanding, and motivation on the part of the patient or client. The subject is asked to write down everything he/she eats or drinks for a certain time period. Three days, particularly two weekdays and one weekend day, have been found to be a representative time period for most people. ## Observation of Food Intake Observation of food intake is the most accurate method of dietary intake assessment but also the most time-consuming, expensive, and difficult. It requires knowing the amount and kind of food presented to the person and the record of the amount actually eaten. ## Evaluation of the Food Intake Data ### Evaluation by Food Group Method The simplest, fastest, yet crudest way to evaluate food intake data is to determine how many servings from each of the four food groups were consumed during the recorded day. The number of servings is suggested in the basic four or seven food plans. #### General Rules for Menu Planning 1. Use the whole day as a unit rather than the individual meal. Make breakfast relatively simple and standardized, then plan dinner. Lastly, plan lunch and snacks to supplement the other two meals. 2. Use some food from each of the food groups daily (energy-giving foods, body-building foods, and body-regulating foods). 3. Use some raw fruits or vegetables at least once a day. 4. Plan to have for each meal at least one food with staying power or high in satiety value, one which contains roughage, and generally some hot food or drink. 5. Combine or alternate foods of bland form with those of a more pronounced flavor. 6. Combine and alternate soft and crisp foods. 7. Have a variety of color, food, and food arrangement. 8. When more foods are served at one meal, decrease the size of portions and use fewer rich foods. #### Some Don’ts for Menu Planning 1. Avoid using the same kind of food twice a day without varying the form in which it is served except staples like rice, bread, and milk. 2. Do not use the same food twice in the same meal even in different forms. 3. Do not use the same food too often from day to day. ## Other Considerations 1. **Meal Patterns.** Meal or menu patterns are helpful in planning but they must take into account the family’s habits and needs. For example, the traditional pattern for breakfast recommended by nutritionists are: * fruit * egg or substitute * bread or rice * hot beverage The following is a good menu guide for lunch and dinner: * meat, fish, or poultry * vegetable * rice * fruit or dessert 2. **Planning for the Week.** It is best to have a weekly menu plan. In hospitals, the practice of dietitians is to prepare a so-called “cycle menu.” ## Nutrition Survey Nutrition survey is an epidemiological investigation of the nutritional status of the population by various methods together with an evaluation of the ecological factors of the community. ## Significance of Nutritional Assessment 1. It is the first essential in nutritional planning. 2. It provides data and information for planning and evaluation. 3. It helps define priorities and responsibilities of public health system at the national, regional, provincial, city, municipal, and barangay levels. ## Methods of Nutritional Assessment ### A. Methods that provide direct information 1. Clinical examination 2. Biochemical examination 3. Anthropometric measurement 4. Biophysical technique ### B. Methods that provide indirect information 1. Studies on food consumption 2. Studies on health conditions and vital statistics 3. Studies on food supply situation 4. Studies on socio-economic conditions 5. Studies on cultural and anthropological influences ## Factors Considered in the Selection of Nutrition Survey Method 1. **Unit to be surveyed** Example: household, individual, at-risk group, etc. 2. **Types of information required** Example: food intake, height and weight measurement, hemoglobin level, socio-economic conditions, etc. 3. **Degree of reliability and accuracy acquired** 4. **Facilities and equipment available** Example: reasonable number, type, practicality 5. **Human resources** Example: nutritionist, medical technologist, medical nutritionist, biochemist, local extension worker, auxiliary worker; training required 6. **Time reference** Example: season of the year, day (weekend or weekday), number of days of food record collection (1 day, 3 days, 1 week) 7. **Funding or financial support** ## Features of Methods and Reference Standards Used ### 1. Clinical Assessment a. **Description** It deals with the examination of changes that can be seen or felt in superficial tissues such as skin, hair, and eyes. b. **Advantages** b.1 More coverage in a short time b.2 Inexpensive; no need for sophisticated equipment c. **Disadvantages** c.1 Non-specificity of signs (signs may be due to non-nutritional causes) c.2 Overlapping of deficiency states (dietary deficiencies are not restricted to an isolated nutrient) c.3 Bias of the observer (observations of two examiners are most often not consistent with each other) c.4 Clinical signs known to be of value in nutrition surveys and their interpretations (see Table 45) d. Clinical signs known to be of value in nutrition surveys and their interpretations (see Table 45) e. **Clinical symptoms of common nutritional problems:** e.1 **Protein-Energy Malnutrition** **Classification** * mild to moderate * severe * marasmus (dry form) * kwashiorkor (edematous form) * marasmic kwashiorkor ### 2. Biochemical Assessment a. **Description** Estimation of time desaturation, enzyme activity, or blood composition a.1 Tests are confined to two fairly easily obtainable fluids: blood and urine. a.2 Results are generally compared to standards, i.e., normal levels for age and sex. b. **Advantages** b.1 Objectivity, independent of the emotional and subjective factors that usually affect the investigator b.2 Can detect early subclinical states of nutritional deficiency c. **Disadvantages** c.1 Costly, usually requiring expensive equipment c.2 Time-consuming d. **Factors affecting accuracy of results** d.1 Standards of collection d.2 Methods of transport and storage of samples d.3 Techniques employed e . **Common biochemical parameters/tests** ## Table 48: Parameters and Nutrition Deficiencies | Fluid | Parameter | Nutrition Deficiency | |---|---|---| | Blood | Serum albumin | Protein deficiency | | | Amino acid imbalance | Protein deficiency | | | Serum vitamin A | Vitamin A deficiency | | | Serum carotene | Vitamin A deficiency | | | Serum alkaline phosphatase | Vitamin D deficiency | | | Serum ascorbic acid | Vitamin C deficiency | | | Hemoglobin | Iron and vitamin B12 deficiency | | | Hematocrit | Iron deficiency | | | Hydroxyproline excretion | Protein deficiency | | Urine | Urinary urea | Protein deficiency | | | Urinary creatinine | Protein deficiency | | | Urinary thiamine | Thiamine deficiency | | | Urinary riboflavin | Riboflavin deficiency | ### f. Biochemical tests applicable and interpretation #### f.1 Protein **Methods** * **Urea N/creatinine N ratio** * Index of dietary adequacy * From over two- to 24-hour urine sample * Index of 30 or lower in a random sample indicative of malnutrition * **Amino acid imbalance test** * Ratio of four dispensable amino acids and four indispensable amino acids in serum by paper chromatography * High (5-10) in kwashiorkor and low (less than 2) in well-fed children * **Hydroxyproline excretion in random urine** * Low (0.5-1.5) in clinically malnourished children; normal: 2.0 to 5.0 * **Serum albumin** * Lowered in severe protein depletion * Guide to interpretation (g/100 mL): * High 4.25 * Acceptable 3.52-4.24 * Low 2.80-3.51 * Deficient less than 2.80 #### f.2 Iron * **Hemoglobin determination** * Cyanmethemoglobin method by spectrophotometry * A.O. hemoglobinometer - simple technique, handy equipment * Others: Sahli's method; Tallquist method; copper sulfate specific gravity method * **Hematocrit - obtained from a finger prick** * A measure of red cell volume * Values below which anemia is said to exist | Hemoglobin (grams %) | |---|---| | 6 mos. to 6 years | 11 | | 6 years to 14 years | 12 | | adult males | 13 | | adult females – non-pregnant | 12 | | adult females – pregnant | 11 | #### f.3 Vitamin A * **Methods** * Serum vitamin A and serum carotene level by spectrophotometry using micro and macro methods. * Low serum vitamin A reflects prolonged severe, dietary deficiency probably up to 1 year in adults and up to 4 months in young children. * Serum carotene level is not indicative of vitamin A status per se but it is useful because it reflects recent ingestion of carotene-containing foods. ## Anthropometric Measurements a. **Definition** Anthropometry is the measurement of variations of the physical dimensions and gross composition of the human body at different age levels and degrees of nutrition. b. **Common anthropometric measurements** b.1 **Weight (for age)** * Uses weighing scales such as beam balance scales or clinical scales which are ideal or a bar scale in absence of the scales initially mentioned * Assesses body mass * A sensitive indicator of current nutritional status * Uses reference values for age or height or both of population * Key anthropometric measurement **Advantages** * It is a simple as it is commonly used. * Weight can be determined fairly accurately by personnel with minimum training. **Disadvantages** * It depends on accurate age determination (which is sometimes difficult) * Interpretation on individual basis may be complicated by edema. * It does not distinguish between acute and chronic malnutrition but useful when serial measurements are taken; useful also in children less than 1 year old. b.2 **Height (for age)** * Assesses linear dimensions of the following: legs, pelvis, spine, and the skull * Less sensitive and generally an indicator of past nutritional status (chronicity of malnutrition) * Uses statiometer, anthropometric steel rods fixed accurately and vertically to the wall; for infants (below 2 years), an infantometer is used. **Advantages** * Inexpensive tools may be used. * It is simple to do in the field. **Disadvantages** * It is less sensitive to changes in growth rate. * Errors in measurement are easily made. * Other factors play a role. b.3 **Weight for height/length** * Most accurate indicator of present or current state of nutrition * An expression of leanness or wasting **Advantages** * It is nearly independent of age from 1 to 10 years. * It is also probably independent of ethnic group especially in ages of 1 to 5 years. **Disadvantage** * Height for age (mentioned above) is a disadvantage. b.4 **Skinfold thickness** * Assesses body composition, fat distribution, and, hence reserve of calories * Must be compared against standards for age and sex at all ages * Uses a reliable caliper (Harpenden, Lange, or USAMRNL) b.5 **Body circumferences** * The head/chest circumference ratio is of value in detecting PEM in early childhood. The head and chest circumferences are the same at six months of age. After this age, the skull grows slowly and the chest grows more rapidly. * The mid-upper arm circumference (MUAC) has been mainly used on children from 1 to 6 years old. Between 1 and 4 years, the reference values change a little, and the age need not be accurately known. b.6 **Birth weight** * It is related to maternal nutrition and socio-economic status * Usually taken as cut-off point for “low-birth weight babies" is 2,500 grams. **Advantage** * The advantage is the same as that in weight for age. **Disadvantages** * Births are often unattended by health personnel. * Other factors play a role (gestational age, infectious and toxemic episodes during pregnancy, etc.). ### c. Reference/Standards used c.1 **Weight-for-age -** Philippine undernutrition (FNRI) (based on Gomez’ classification) Depending on how far a child's weight compares with his/her standard weight, a child is classified as: * **normal,** when the child’s weight is between 91% and 110% of his/her ideal weight; * **first degree or moderately underweight,** when the child's weight is only 76% to 90% of his/her ideal weight; * **second degree or moderately underweight,** when the child's weight is only 61% to 75% of his/her ideal weight; and * **third degree or severely underweight,** when the child's weight is only 60% or less of his/her ideal weight. Source: FNRI, 1984 c.2 **Weight-for-height** - classification of nutritional status by McLaren and Read (1972) | Nutritional Status | | |---|---| | Overweight | 110% of standard weight | | Normal | 90-109% of standard weight | | Underweight, mild | 85-89% of standard weight | | Undernourished, moderate | 75-84% of standard weight | | Undernourished, severe | 75% of standard weight | c.3 **The weight-for-height and height-for-age-combination** of these anthropometric measurements permits further distinction between acute malnutrition (low weight-for-height, normal height-for-age) and chronic malnutrition (low weight-for-height, low height-for-age) as well as simple stunting. Thus, the diagram below shows the classification of nutritional status using cut-off points for use in the