CAM102 Lecture Notes - Lecture 14: Diarrhea, Thyroid, Health Promotion
Learning Objectives
• To understand the different methods for nutritional assessment
• To be able to apply the knowledge gained to clinical assessment
What Are We Looking For?
Nutritional Assessment
Assess adequacy of energy and nutrient intakes, looking at nutrient quality
VS
Dietary Assessment
Estimate intakes of foods, energy and nutrients, what kinds of food are people eating and why?
Doctor or Dietitian Assessing Individual Patients
• Concern is assessment of an individual for health promotion purposes, or to deal with a major
clinical situation
• Intakes and expenditure
• When to refer/collaborate
Nutritional Assessment
Why?
• The purpose of nutritional assessment is to
• Identify individuals or population groups at risk of becoming malnourished
• Identify individuals or populations groups who are malnourished
• Often described as ABC + D
• Anthropometric methods
• Biochemical, laboratory methods
• Clinical methods
• (PLUS) Dietary evaluation methods (dietary assessment)
How?
a. Nutritional Assessment
• Anthropometric assessment
• Biochemical measures - lab tests (blood, urine)
• Physical symptoms (clinical methods)
• Looking for signs of malnutrition
• Intake assessment - estimated energy & nutrient intakes
• Compare with EAR and RDI - How? Issues?
b. Dietary Assessment
Quantitative Estimation of Intakes
• Complex and time-consuming - average intakes of many foods + composition of each
food
Qualitative Assessment
• Ask simple questions about food habits
• If following dietary guidelines, assume diet is probably adequate
A = Anthropometric Measures
Anthropometric Methods
• Anthropometry is the measurement of body height, weight & proportions
• Used to identify malnutrition
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• The easured alues reflets the urret utritioal status ad do’t differetiate etee
acute and chronic changes
Measures in General Population
• BMI (Kg/m^2)
• Waist circumference
BMI (WHO - Classification)
Waist Circumference
• Waist circumference predicts the mortality better than any other anthropometric
measurement
• It has been proposed that waist measurement alone can be used to access obesity
MALE
FEMALE
LEVEL 1
(increased risk)
>94cm
>80cm
LEVEL 2
(Significantly
increased risk)
>102cm
>88cm
Other Anthropometric Measurements
• Mid-arm circumference
• Skin fold thickness
• Head circumference
• Head/chest ratio
• Hip/waist ratio
Advantages of Anthropometry
• Objective
• Reproducible
• Non-expensive and need minimal training
Limitations of Anthropometry
• Inter-observers errors (although minimal)
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• Limited nutritional diagnosis
• Arbitrary statistical cut-off levels for what considered as abnormal values (BMI)
B = Biochemical Measures
Initial Laboratory Assessment
• Clinical Chemistry Panels
• Micronutrient testing
• Basic metabolic panel
• Comprehensive metabolic panel
• Haemoglobin
• Stool examination
• Urine dipstick & microscopy for albumin, sugar and blood
Biochemical Measures - Some Examples
May measure substance itself
Vitamin C in Blood
• Adequate intakes → cells have enough → don't extract much from blood → plasma levels are
high
• Low intakes → cells don't have much → extract a lot from blood → plasma levels fall
Some Lab Tests Reflect a Group of Nutrients
Blood [haemoglobin]
• Low if diet is deficient in iron or folate or vitamin B12 or protein
Plasma [homocysteine]
• Low if diet is deficient in folate or B12 or B6
Advantages of Biomedical Method
• Useful in detecting early changes
• Precise, accurate and reproducible
• AS a validation tool
Limitations of Biochemical Method
• Time consuming
• Expensive
• They cannot be applied on large scale
• Needs trained personnel & facilities
C = Clinical Methods
Clinical Assessment
Advantages
• Fast and easy to perform
• Inexpensive
• Non-invasive
Limitations
• Does not detect early cases
Clinical Signs of Nutritional Deficiency
Mouth
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