14—Nutrition assessment

Nutrition and Fitness

Dr. Siham Gritly

Nutritional assessment

• nutrition assessment: a comprehensive analysis of a person’s nutrition status that uses health, socioeconomic, drug, and diet histories; anthropometric measurements; physical examinations; and laboratory tests.

Dr. Siham Gritly

Types of nutritional deficiency

• malnutrition: any condition caused by excess or deficient food energy or nutrient intake or by an imbalance of nutrients.

• Under-nutrition: deficient energy or nutrients.

• Over-nutrition: excess energy or nutrients.

Dr. Siham Gritly

The severe wasting characteristic of marasmus Adapted

from Ellie Whitney and Sharon Rady Rolfes; Under standing Nutrition, Twelfth Edition. 2011

Dr. Siham Gritly

The edema characteristic of kwashiorkor is apparentin this child’s swollen belly. Malnourishedchildren commonly have an enlarged abdomen from parasites as well. Adapted from Ellie Whitney and Sharon Rady Rolfes; Under standing Nutrition, Twelfth Edition. 2011

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Obese children over nutrition

Dr. Siham Gritly

Dr. Siham Gritly

Stages in the Development of a Nutrient Deficiency

• 1-Primary deficiency caused by inadequate diet or Secondary deficiency caused by problem inside the body------assessment methods;-Diet history and Health history

• 2-Declining nutrient stores (subclinical) and Abnormal functions inside the body assessment methods;-Laboratory tests

Dr. Siham Gritly

• 3-Physical signs and symptoms, assessment methods; -Physical examination and anthropometric measures

Nutrition Assessment of Individuals

• Nutrition Assessment of Individuals, can be achieved by a registered dietitian; dietetic technician, or other trained health-care professional uses:

• 1- Historical information• 2- Anthropometric measurements• 3- Physical examinations• 4- Laboratory tests

Dr. Siham Gritly

1-Historical information

• One step in evaluating nutrition status is to obtain information about a person’s;

• health status, • Socio-economic status, • A diet history, drug use. • The health history• family history• Social factors, ethnic background, • educational level

Dr. Siham Gritly

Historical Data Used in Nutrition Assessments Adapted from Ellie Whitney and Sharon Rady Rolfes; Under standing Nutrition, Twelfth Edition. 2011

Type of History What It Identifies

Health history Current and previous health problems and family health history that affect nutrient needs, nutrition status, or the need for intervention to prevent or alleviate health problems

Socioeconomic history Personal, cultural, financial, and environmental influences on food intake, nutrient needs, and diet therapy options

Drug history Medications (prescription and over-the-counter), illegal drugs, dietary supplements, and alternative therapies that affect nutrition status

Diet history Nutrient intake excesses or deficiencies and reasons for imbalances

Dr. Siham Gritly

Dr. Siham Gritly

Diet history

• food record: an extensive, accurate record of all foods eaten over a period of several days or weeks. A food record that includes associated information such as when, where, and with whom each food is eaten is sometimes called a food diary.

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• The data may be collected by recording the foods the person has eaten over a period of 24 hours, 3 days, or a week or more or by asking what foods the person typically eats and how much of each.

• food frequency questionnaire: a checklist of foods on which a person can record the frequency with which he or she eats each food.

Dr. Siham Gritly

2- Anthropometric measurements

• anthropometric measurements such as those of height and weight skin fold thickness

• provide little information about specific nutrients. Instead, measurements may reveal problems such as growth failure in children wasting or swelling of body tissues in adults, and obesity.

Anthropometric MeasurementsUsed in Nutrition Assessments

Adapted from Ellie Whitney and Sharon Rady Rolfes; Under standing Nutrition, Twelfth Edition. 2011

Type of Measurement What It ReflectsAbdominal girth measurement Abdominal fluid retention and

abdominal organ sizeHeight-weight Over-nutrition and under-nutrition;

growth in childrenHead circumference Brain growth and development in

infants and children under age 2Skin-fold Subcutaneous and total body fatWaist circumference Body fat distribution

Dr. Siham Gritly

Dr. Siham Gritly

Skin-fold thickness using Calipers

• Skin-fold measures

• estimate body fat by using a caliper to measure the thickness of a fold of skin on the back of the arm (over the triceps), below the shoulder blade (subscapular), and in other places (including lower-body sites), and then comparing these measurements with standards

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Waist or Abdominal Girth (circumference)

• the purpose of determining waist girth is to gain a measure of the amount of abdominal fat (visceral fat), which has been linked to increased risk of coronary heart disease and diabetes.

• The waist measurement is taken by a tape at the narrowest waist level, or if this is not apparent, at the mid point between the lowest rib and the top of the hip bone (illiac crest).

Dr. Siham Gritly

Waist or Abdominal Girth values

Men Women

Risk cm inches cm inches

Very High > 120 > 47 > 110 43.5

High 100 - 120 39.5 - 47 90 - 109 35.5 – 43

Low 80 - 99 31.5 - 39 70 - 89 28.5 – 35

Very Low < 80 < 31.5 < 70 < 28.5

Adapted from Ellie Whitney and Sharon Rady Rolfes; Under standing Nutrition, Twelfth Edition. 2011

Dr. Siham Gritly

Waist–hip ratio

• Waist–hip ratio or waist-to-hip ratio (WHR) is the ratio of the circumference of the waist to that of the hips.

• Waist/hips

• WHR is used as a measurement of obesity,

The Waist to Hip Ratio Calculator indicates your probable health risks. People with more weight around the waist, face more health risks than people who carry more weight around their hips

Male FemaleHealth Risk Based Solely on WHR

0.95 or below 0.80 or below Low Risk

0.96 to 1.0 0.81 to 0.85 Moderate Risk

1.0+ 0.85+ High Risk

Dr. Siham Gritly

Dr. Siham Gritly

• Waist/hip ratio - divide the waist circumference by the hip circumference. Above 0.95 for men (or 0.8 in women) indicative of a health risk

• WHO states that abdominal obesity is defined as a waist–hip ratio above 0.90 for males and above 0.85 for females, or a body mass index (BMI) above 30.0

Dr. Siham Gritly

3- Physical examinations

• A third nutrition assessment technique is a physical examination looking for clues to poor nutrition status.

Dr. Siham Gritly

Physical Findings Used in Nutrition Assessments 1 Adapted from Ellie Whitney and Sharon Rady Rolfes; Under standing Nutrition, Twelfth Edition.

2011

Body System Healthy Findings Malnutrition Findings What the Findings Refl ect

Hair Shiny, firm in the scalp Dull, brittle, dry, loose; falls out

PEM

Eyes Bright, clear pink membranes adjust easily to light

Pale membranes; spots; redness adjust slowly to darkness

Vitamin A, B vitamin, zinc, and iron

Teeth and gums

No pain or caries, gums firm teeth bright

Missing, discolored, decayed teeth; gums bleed easily and are swollen and spongy

Mineral and vitamin C status

Glands No lumps Swollen at front of neck PEM and iodine status

Tongue Red, bumpy, rough Sore, smooth, purplish, swollen

B vitamin status

Physical Findings Used in Nutrition Assessments 2

Skin Smooth, firm, good color

Off-color, scaly, fl aky, cracked, dry rough, spotty; “sandpaper” feel orsores; lack of fat under skin

PEM, essential fatty acid, vitamin A, B vitamin, and vitamin C status

Nails Firm, pink Spoon-shaped, brittle, ridged, pale Iron status

Internal systems

Regular heart rhythm, heart rate, and blood pressure; no impairment of digestive function, reflexes, or mental status

Abnormal heart rate, heart rhythm, o rblood pressure; enlarged liver, splee nabnormal digestion; burning, tingling of hands, feet; loss of balance, coordination, mental confusion, irritability, fatigue

PEM and mineral status

Muscles and bones

Muscle tone; posture, long bone development appropriate for age

“Wasted” appearance of muscles swollen bumps on skull or ends of bones; small bumps on ribs; bowed legs or knock-knees

PEM, mineral, and vitamin D status

Dr. Siham Gritly

Dr. Siham Gritly

4- Laboratory tests

• A fourth way to detect a developing deficiency, imbalance, or toxicity is to take samples of blood or urine, analyze them in the laboratory, and compare the results with normal values for a similar population.

• Laboratory tests are most useful in uncovering early signs of malnutrition before symptoms appear.

Dr. Siham Gritly

Nutrition Assessment of Populations

• Nutrition Assessment of Populations is to assess a population’s nutrition status,

• The data collected are then used by various agencies for numerous purposes, including the development of national health goals.

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• National Nutrition Surveys • The National Nutrition Monitoring program

coordinates the many nutrition-related surveys and research activities of various federal agencies.

• Surveys provide valuable information about the kinds of foods people eat

• Then researchers calculate the energy and nutrients in the foods and compare the amounts consumed with a standard.

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• The other survey examines the people themselves, using;

• * anthropometric measurements,• * physical examinations, • * laboratory tests.• The data provide valuable information on

several nutrition-related conditions such as growth retardation, heart disease, and nutrient deficiencies

Dr. Siham Gritly

• National nutrition surveys often oversample high-risk groups;

• *low-income families,• * pregnant women, • *adolescents, • * elderly,

Dr. Siham Gritly

references• Sareen S. Gropper, Jack L.Smithh and James L. Groff; 2007. advanced

Nutrition and Human Metabolism, fifth ed. Wadsworth CENGAGE learning•

Brodie, D. A. (1988). Techniques of measurement of body composition Part II. Sports Medicine, 5, 74-98.Heyward, V. H. (1991). Advanced fitness assessment & exercise prescription. Champaign: Human Kinetics Publishers.

Jackson, A.S. & Pollock, M.L. (1985) Practical assessment of body composition. The Physician and Sportsmedicine, 13, 5, 76-90

• Melvin H Williams 2010; Nutrition for Health, Fitness and Sport. 9th ed, McGraw Hill

• World Health Organization Report (WHO 1987) • Ellie Whitney and Sharon Rady Rolfes; Under standing Nutrition, Twelfth

Edition. 2011, 2008 Wadsworth, Cengage Learning