Nutritional Assessment

(Method, Clinical, Biochemical, Dietary, Functional and Anthropometric)

Dr. Rajan Bikram Rayamajhi

School of Public Health and Community Medicine

B. P. Koirala Institute of Health Sciences

Dharan, Nepal 1

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The nutritional status of an individual if often the result of interrelated factors. It is influenced by the adequacy of the food intake both in terms of quantity and quality and also by the physical health of the individual.

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Nutritional Assessment Methods:

1. Anthropometry A

2. Biochemical Evaluation B

3. Clinical Examination C

4. Dietary Assessment D

5. Ecological Studies E

6. Functional Assessment F

7. Vital and Health Statistics G *Pneumonics

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Clinical Examination

To assess levels of health of individuals or of groups in relation to the food they consume.

Simple, easy and most practical.

Physical signs: some specific and many non-specific associated with malnutrition.

Ex: Angular Stomatitis, Bitot’s Spot, Thyroid enlargement

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The chief drawbacks are many deficiencies are unaccompanied by physical signs, malnutrition cannot be quantified on the basis of clinical signs and biasness of the observer and observed.

When two or more nut. deficiency signs are present, the diagnostic significance is enhanced.

The drawback are mal nut. can’t be identified only on the basis of clinical signs and lack of specificity of most signs.

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Anthropometry

Height, weight, skin fold thickness and arm circumference are valuable indicators of nutritional status.

In young children chest and head circumference are measured too.

If recordings are made for a long time then they reflect the pattern of growth and development.

Ex: Mid arm circumference, Growth monitoring

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Laboratory and Biochemical Evaluation

I. Lab Tests:- i) Haemoglobin, RBC, Haemotocrit Hb level is an useful index of the overall state of nutrition irrespective of its significance in anemia.

ii)Stool : for intestinal parasites, history of parasitic infestation, chronic dysentery

iii) Urine: for albumin and sugar

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II. Biochemical Tests:- – Expensive and time consuming.

– They reveal current nutritional status.

– Some of the test are protein, Folate, vitamin A and Niacin

With increase knowledge of metabolic functions of vitamins and minerals, assessment of nutritional status by clinical signs has been given to more precise biochemical tests.

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Radiological Examination

• Routinely not carried out.

• If the clinical signs indicate appreciable incidence of rickets, osteomalacia, infantile scurvy, beriberi, fluorosis and PCM then only such tests are carried out.

• Such study will reveal the degree of incidence of mild forms.

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Functional Assessment

• The main purpose of these tests are to assess the degree of alteration in physiological functions associated with under and malnutrition

• Functional indices of nutritional status are emerging as an important class of diagnostic tools

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Reproduction

(Sperm Count) Energy, Zinc

Nerve Function

Nerve conduction Vit. B1,Vit. B12

Dark adaptation Vit. A , Zinc

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Assessment of Dietary Intake

• Food Consumption: 24 hour food frequency and household inquiries.

• Dietary survey: Household inquiries or Individual food consumption which includes :

weighing of raw food:It’s practicable and if properly carried our is fairly

accurate.All food that is eaten or discarded is also weighed.Usually carried out for 1-21 days but commonly done for

7 days; also called one dietary cycle. 16

Nutrition Assessment

Name of food stuffsConsumption amount in

24 hoursCalories

(kcal)Protein

(gm)

Rice 1500gm 5250 102

Pulses 250gm 837 50

Potato 50gm 50 -

Root vegetables 50gm 15 -

Leafy vegetables 500gm - -

Other vegetables 1000gm - -

Fats and oil 10tsp 450 -

Milk/dairy product 500ml 350 20

Meat 1000gm 1000 200

Sugar and jaggery 50gm 200 -

Total 8152 372

Weighing of cooked food:

The food is to be analysed in the state they are to be eaten and not easily acceptable.

Oral questionnaire method:

Diet survey done in a short time among large no. of people.Inquiries are made about the last 24 hrs retrospectively.Data is also collected about dietary habits and practices.

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Data collected is translated into mean intake of food materials and nutrients per adult man value or “consumption unit”

Diet survey gives dietary intake patterns, specific food consumed, nutrient intake.

It also indicates relative dietary inadequacies as judged by the present standards.

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Vital and health statisticsAnalysis of mortality and morbidity data will

identify groups at high risk and indicate the extent of risk to the community.

Mortality in age grp. 1—4 yrs. related to malnutrition.

Data on morbidity ( Hospital data or data from community ) in relation to PEM, anemia, xeropthalmia can be of value to provide additional information about the nutritional status of the community

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Ecological Studies

Food Balance Sheet: Supplies are related to census population to derive levels of food consumption in terms of per capita supply availability.

It gives an indication of the general pattern of food consumption in the country

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Health and Education Services: Primary health care services, feeding and

immunization program.

Conditioning Influences: Parasitic, bacterial & viral infections which

precipitate mal-nutrition among that community.

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Socio-Economic Factors: Family size, occupation, income, education customs, cultural patterns in relation to feeding practice of children, mother etc.

Food consumption patterns are likely to vary among various socioeconomic group.

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Thank You

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