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Nutritional Assessment and
Counseling, ,
Department of Family Medicine
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Goal: To increase comfort level in assessin
nutrition and counseling about nutritionalconcerns during various life stages.
ect ves:
Define important aspects of a nutritional history. .
Review literature on common nutritional healthconcerns.
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, ,
Social history
Diet assessment
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Eating Disorders
es y
Oral health Xanthomas
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BMI---risk factor reduction
Estimate caloric requirement Assess readiness for chan e
Individualize recommendations
Dietary guidelines Food groups
Portion sizes
v se a ou supp emen s Physical activity
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Calculate BMR Women: BMR = 655 + ( 4.35 x weight in pounds ) + ( 4.7 x heightin inches ) - ( 4.7 x age in years )
en: = . x we g n poun s . x e g ninches ) - ( 6.8 x age in year )
Harris Benedict Formula
Multiply BMR by the appropriate activity factor: 1.2 sedentary (little or no exercise)
1.375 lightly active (light exercise 1-3 days/week)
. - 1.725 very active (hard exercise 6-7 days a week)
1.9 extra active (very hard exercise & physical job or 2xtraining)
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Address nutritional issues at all visits
Nutritional needs vary with life stage Infants
Adolescents
Adults
Elderly
Consider nutritional issues for hospitalized and peri-
surg ca pa en s Collaborate with registered dieticians
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Growth charts
emog o n assessmen
Lead risk assessment/screening Intake
-
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Feeding skills development
ommon ee ng pro ems
Oral health and preventive care Nutrition supplements
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Types of foods
or ons
Progression
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Modified adult diet
o ng azar s
Cows milk FITS study
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Vitamin D
uor e
Other
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Calcium
uor e
Dental care/ visits
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-
Frequency
or ons
Snacks Breakfast
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u u u
Diet history---food groups
ssess or common ee ng concerns
Quantity- total calories, restrictive behaviors
-
Sweetened beverages
.
Nutrient recommendations
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TV/computer use
s re uc on counse ng
Screening tests
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Fiber
Children older than 2 years: >= age + 5 g/day
20 to 35 g/day
10 to 13 g of dietary fiber per 1000 kcal.
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-
Cholesterol
Digestion and satiety
reven on managemen o a e es
Diverticulosis
Cancer prevention
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. .
Diets rich in whole grains protect against
ar ovascu ar sease .
Stroke (RR 0.79) Diabetes (RR 0.62)
All-cause mortality (RR 0.83)
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67% of consumers say they
products more often if they
believed they could decrease
disease.
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Obesity by 24% He et al.
- eng e . a
Ischemic Heart Disease by 15% Law et al.
ancer r s y Jansen et al.
Cognitive decline
rov e essen a nu r en s
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=
63% of Americans eat
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Decreases fiber by 80%
Increases Calories by 10%
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calcium vitamin D
9-18 years 1300 mg 200 IU
19-50 years 1000 mg 200 IU
51-70 years 1200 mg 400 IU
>70 years 1200 mg 600 IU
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# dairy servings x 300 mg One servin =
8 oz milk/yogurt
16 oz cottage cheese (2 cups) 1 oz hard cheese
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calcium citrate (Citracal) well absorbed with orwithout food
calcium (500 mg Tums has 200 mg Ca++)
hi h dietar calcium intake associated with lowerrisk of nephrolithiasis
high supplemental Ca++ intake associated with
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commonly available calcium
supplementsproduct (% elemental ca) elemental calcium (mg)/tablet vitamin D(IU)/tabletcalcium carbonate (40%)
500 mg 200 01260 m 500 0
Caltrate 600 + D 600 200
Os-Cal 500 + D 500 200Tums
E-X 300 0Ultra 400 0
Rolaids 220 0v
One-a-Day for Women 450 400Centrum Silver 200 400
calcium citrate (21.2%)
Citracal Tablets 200 0Citracal Caplets + D 315 200Citracal Liquitab 500 0Citracal Neutravescent 400 0
tricalcium phosphate (38%)Posture-D 600 125
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Diet history
upp emen use
Physical activity- FITT BMI
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Nutrition Facts Labels
upp emen s
Risk reduction Physical activity
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Weight gain
e s ory
Supplement use
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Recommend ortion size
Recommend food groups/supplements to meetnutrient needs:
Iron
Zinc Calcium
Protein
Fiber
Dietician referrals
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Substance use
Listeria
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Standardized tools
Diet history: food pyramid for 70+
http://commentator.tufts.edu/archive/nutrition/pyramid.html
- Living environment
Functional status epress on
Oral health
Physical exam
Screening
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Recommend appropriate supplements
ys ca ac v y an ex y ra n ng
Food-drug interactions Work with dietitians in care facilities
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Recommended