Nurul Syazwani - (Community Nutrition)

7/27/2019 Nurul Syazwani - (Community Nutrition)

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ASSESSMENT OFNUTRITIONAL

STATUS

Nurul Syazwani BintiRamli

080100315

(K5)


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LEARNING OBJECTIVES

To know the different methods for

assessing the nutritional status

To understand the basicanthropometric techniques,

applications, & reference standards


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Methods of Nutritional Assessment

Nutrition is assessed by two types of

methods; direct and indirect.

The direct methods deal with the

individual and measure objective

criteria, while indirect methods use

community health indices that reflectsnutritional influences.


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Direct Methods of NutritionalAssessment

These are summarized as ABCD

Anthropometric methodsBiochemical, laboratory methods

Clinical methodsDietary evaluation methods


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CLINICAL ASSESSMENT

It is an essential features of all nutritionalsurveys

It is the simplest & most practical method

of ascertaining the nutritional status of agroup of individuals

It utilizes a number of physical signs,

(specific & non specific), that are knownto be associated with malnutrition anddeficiency of vitamins & micronutrients.


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CLINICAL ASSESSMENT/2

Good nutritional history should be

obtained

General clinical examination, withspecial attention to organs like hair,

angles of the mouth, gums, nails, skin,

eyes, tongue, muscles, bones, & thyroid

gland.

Detection of relevant signs helps in

establishing the nutritional diagnosis


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CLINICAL ASSESSMENT/3

ADVANTAGES

Fast & Easy to perform

InexpensiveNon-invasive

LIMITATIONS

Did not detect early cases


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Anthropometric Methods

Anthropometry is the measurement ofbody height, weight & proportions.

It is an essential component of clinical

examination of infants, children &pregnant women.

It is used to evaluate both under & overnutrition.

The measured values reflects thecurrent nutritional status & dontdifferentiate between acute & chronic

changes .


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Other AnthropometricMeasurements

Mid-arm circumference

Skin fold thickness

Head circumference

Head/chest ratio

Hip/waist ratio


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Anthropometry for children

Accurate measurement of height andweight is essential. The results canthen be used to evaluate the

physical growth of the child.

For growth monitoring the data areplotted on growth charts over aperiod of time that is enough tocalculate growth velocity, which canthen be compared to international

standards


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Growth Monitoring ChartPercentile chart

Growth Chart

80

85

90

95

100

105

110

115

120

125

130

135

140

145

150

155

160

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185

190

195

2 4 6 8 10 12 14 16 18

Age (years)

Height

(cm)


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Measurements for adults

Height:The subject stands erect & bare

footed on a stadiometer with amovable head piece. The headpiece is leveled with skull vault

& height is recorded to thenearest 0.5 cm.


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WEIGHT MEASUREMENT

Use a regularly calibrated

electronic or balanced-beam scale.

Spring scales are less reliable.

Weigh in light clothes, no shoes

Read to the nearest 100 gm

(0.1kg)


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Nutritional Indices in Adults

The international standard for assessingbody size in adults is the body mass index

(BMI).

BMI is computed using the following

formula: BMI = Weight (kg)/ Height (m)

Evidence shows that high BMI (obesity level)

is associated with type 2 diabetes & high risk

of cardiovascular morbidity & mortality


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BMI (WHO - Classification)

BMI < 18.5 = Under Weight

BMI 18.5-24.5 = Healthy weight range

BMI 25-30 = Overweight (grade 1

obesity)

BMI >30-40 = Obese (grade 2 obesity)

BMI >40 = Very obese (morbid or

grade 3 obesity)


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Waist/Hip Ratio

Waist circumference is measuredat the level of the umbilicus to thenearest 0.5 cm.

The subject stands erect withrelaxed abdominal muscles, armsat the side, and feet together.

The measurement should be takenat the end of a normal expiration.


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Waist circumference

Waist circumference predicts mortality betterthan any other anthropometricmeasurement.

It has been proposed that waistmeasurement alone can be used to assessobesity, and two levels of risk have beenidentified

MALES FEMALE

LEVEL 1 > 94cm > 80cm

LEVEL2 > 102cm > 88cm


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Waist circumference/2

Level 1 is the maximum acceptablewaist circumference irrespective of

the adult age and there should be nofurther weight gain.

Level 2 denotes obesity and requires

weight management to reduce therisk of type 2 diabetes & CVScomplications.


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Hip Circumference

Is measured at the point of greatest

circumference around hips & buttocks to

the nearest 0.5 cm.

The subject should be standing and the

measurer should squat beside him.

Both measurement should taken with aflexible, non-stretchable tape in close

contact with the skin, but without

indenting the soft tissue.


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Interpretation of WHR

High risk WHR= >0.80 for females &

>0.95 for males i.e. waist

measurement >80% of hip

measurement for women and >95%

for men indicates central (upper

body) obesity and is considered high

risk for diabetes & CVS disorders.A WHR below these cut-off levels is

considered low risk.


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ADVANTAGES OFANTHROPOMETRY

Objective with high specificity &sensitivity

Measures many variables of nutritional

significance (Ht, Wt, MAC, HC, skin foldthickness, waist & hip ratio & BMI).

Readings are numerical & gradable on

standard growth charts Readings are reproducible.

Non-expensive & need minimal training


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Limitations of Anthropometry

Inter-observers errors in measurement

Limited nutritional diagnosis

Problems with reference standards, i.e.local versus international standards.

Arbitrary statistical cut-off levels forwhat considered as abnormal values.


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DIETARY ASSESSMENT

Nutritional intake of humans isassessed by five differentmethods. These are:

24 hours dietary recall

Food frequency questionnaire

Dietary history since early life Food dairy technique

Observed food consumption


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24 Hours Dietary Recall

A trained interviewer asks the subject

to recall all food & drink taken in the

previous 24 hours.

It is quick, easy, & depends on short-

term memory, but may not be truly

representative of the persons usual

intake

d


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Food FrequencyQuestionnaire

In this method the subject is given a list

of around 100 food items to indicate his

or her intake (frequency & quantity) per

day, per week & per month.

inexpensive, more representative & easy

to use.


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Food FrequencyQuestionnaire/2

Limitations:

long Questionnaire

Errors with estimating serving size.

Needs updating with new commercial

food products to keep pace with

changing dietary habits.


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DIETARY HISTORY

It is an accurate method for assessing

the nutritional status.

The information should be collected by

a trained interviewer.

Details about usual intake, types,

amount, frequency & timing needs to

be obtained.

Cross-checking to verify data is

important.


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FOOD DAIRY

Food intake (types & amounts) should

be recorded by the subject at the time

of consumption.

The length of the collection period

range between 1-7 days.

Reliable but difficult to maintain.


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Observed Food Consumption

The most unused method in clinical practice, but

it is recommended for research purposes.

The meal eaten by the individual is weighed and

contents are exactly calculated.

The method is characterized by having a highdegree of accuracy but expensive & needs time &

efforts.


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Initial Laboratory Assessment

Hemoglobin estimation is the mostimportant test, & useful index of theoverall state of nutrition. Beside

anemia it also tells about protein &trace element nutrition.

Stool examination for the presence

of ova and/or intestinal parasites Urine dipstick & microscopy for

albumin, sugar and blood


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Specific Lab Tests

Measurement of individual nutrient inbody fluids (e.g. serum retinol, serumiron, urinary iodine, vitamin D)

Detection of abnormal amount ofmetabolites in the urine (e.g. urinarycreatinine/hydroxyproline ratio)

Analysis of hair, nails & skin for micro-nutrients.


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Advantages of BiochemicalMethod

It is useful in detecting early changes in

body metabolism & nutrition before the

appearance of overt clinical signs.It is precise, accurate and reproducible.

Useful to validate data obtained from

dietary methods


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Limitations of Biochemical Method

Time consuming

Expensive

They cannot be applied on large

scale

Needs trained personnel &

facilities


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7 25 07www.spaladytotherescue.com


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Overnutrition

vsUndernutrition

In the developing world

Nurul Syazwani Binti Ramli080100315

(K5)

D l i C t


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Developing Country:What is it?

When compared to other countries,developing countries:

Have lower incomes than the averageincome in other countries

Low economic status

Low social development

Lower income per capita compared toother countries

Less water


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Undernutrition Overnutrition

Undernutrition is

commonly seen indeveloping countrieswhere people suffer fromlack of nutrients such as;carbohydrates, proteinsand fats.

They have difficultymeeting their dietaryneeds and areunderweight.

Overnutrition occurs when

an individual has anexcessive consumption offood, far more than theirdietary needs.

Overnutrition leads to heart

disease, obesity and otherdietary disorders.

UNDER VS OVER


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Definition of terms:

Overweight refers to excessiveamounts of muscle or bone and wateras well as to body fat.

Obesity concerned only with anabnormally increased amount of bodyfat.


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Obesity

And its Associated RiskFactors


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Obesity

Obesity is a condition characterized bya large percentage of body fat

High cholesterol

High Blood Pressure

Heart disease

Diabetes Stroke

Cancer (certain forms)

Overview of Various Body


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Overview of Various BodyComposition Assessment Methods


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Overview of Various Body Composition Assessment Methods(cont.)

Energy Imbalance


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Energy ImbalanceWhat is it?

Energy balance can be compared to a scale.

An energy imbalance arises when the number of

calories consumed is not equalto the number ofcalories used by the body.

Weight gain usually involves the combination of

consuming too many calories and not expendingenough through physical activity.

Weight Gain

Calories Consumed > Calories Used

Weight Loss

Calories Consumed < Calories Used

No Weight Change

Calories Consumed = Calories Used

Energy Imbalance


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2009

Energy ImbalanceEffects in the Body

Excess energy is stored in fat cells, which enlarge or multiply.

Enlargement of fat cells is known as hypertrophy,whereas multiplication of fat cells is known as hyperplasia.

With time, excesses in energy storage lead to obesity.

Fat cellsJ La State Med Soc.2005; 156 (1): S42-49.

Mortality and Morbidity


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Mortality and MorbidityAssociated with Obesity

The effects of excess weight on mortality and morbidity have been recognized

for more than 2,000 years. It was Hippocrates who recognized that sudden

death is more common in those who are naturally fat than in the lean.

Today, obesity is increasing rapidly. Research shows that many factors related

to obesity influence mortality and morbidity.

Mortality


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MortalityWeight, Fat Distribution, and Activity

The following factors have been shown to increase

mortality in individuals:

Excess body weight Regional fat distribution

Weight gain patterns

Sedentary Lifestyle

Morbidity


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MorbidityAssociated with Obesity

Overweight affects several diseases, although its

degree of contribution varies from one disease

to another.

Additionally, the risk of developing a disease

often differs by ethnic group, and by gender

within a given ethnic group.

Morbidity


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Obstructive sleep apnea

Osteoarthritis

Cardiovascular disorders

Gastrointestinal disorders

Metabolic disorders

Endometrial, prostate

and breast cancers

Complications of pregnancy

Menstrual irregularities

Psychological disorders

Individuals who are obese are at a greater risk ofdeveloping:

MorbidityAssociated with Obesity

Trends in Adult Obesity in Malaysia


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Trends in Adult Obesity in Malaysia

Prevalence of overweight and obesity in Malaysian adults:

NHMS II (1996), NHMSIII (2006) and MANS (2002)

Ismail (2010)


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Prevalence of overweight & obesity bylocation

Poh BK, Ismail MN et al.(2004), Energy Requirements of Malaysian Adolescents.

IRPA Report.

Urban: 21.0 %

Rural: 16.3 %

Summary (based on local


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Summary (based on localstudies)

Malaysians have a sedentary lifestyle

Energy cost of habitual activities are lower ascompared to Caucasians

With food available almost around the clock (in urban

areas) ALL factors above adds up to be a recipefordisasterfor Malaysians


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National Nutrition Policy of Malaysia (2003)


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National Nutrition Policy of Malaysia (2003)


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Specific objective 1

To Improve nutritional status

The nutritional status of all Malaysians can be furtherenhanced through:

Improving breastfeeding and complementary

feeding practices

Improving food intake and dietary practices

Reducing protein-energy malnutrition

Reducing micronutrient deficiency

Reducing overweight and obesity

A Call by MOH


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A Call by MOH


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Reference Documents initiated by


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Reference Documents initiated byMASO


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A very curious thing


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The current nutrition and health scenario suggeststhat Malaysia have not benefited from the western

experience

We need to intervene strategically before the typical

dietary pattern associated with western affluence

become widespread and established within our

population

The problem is real and need urgent attention for it

may be just the tip of the ice-berg.

There is a need to carry out National Nutrition Surveyperiodically

There is a need forHealth Economic Analysis

Malaysia in the global spotlight!


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Malaysia in the global spotlight!

Hosting International Congress on Obesity (ICO)2014

Support from ALL related Ministries are needed!


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8

Adults16-17 years

TREAT OBESITY

SERIOUSLY!