Biochemical Assessment of Nutritional Status: by Dr. MDA Bashar, MD, DNB

BIOCHEMICAL
ASSESSMENT OF
NUTRITIONAL STATUS
by
Dr. MDA Bashar, MD,DNB
“Biochemical tests provide the most objective and
quantitative data on nutritional status”
• Two types of Tests
• Static
• Functional
Stati
c
measure of a nutrient or its metabolite in blood, urine, or body
tissue (an actual measure of the nutrient
Examples: Iron or vitamin A
Limitations: may fail to reflect the overall nutrient status

(serum may not reflect level of nutrient in tissues)
Functional
reflects the failure of function or physiologic process of the body

as a result of nutritional deficiency (somewhat indirect measure)
Examples: Immune response will be compromised by protein

deficiency; visual adaption to dark will be compromised by
vitamin A deficiency
Limitations: May be nonspecific; indicates a general nutritional

status,
but may not allow id of specific nutrients
Protein Status Evaluation
Types of Proteins:
1) Somatic or skeletal muscle (about 75% of
body’s protein)
2) Visceral in organs or viscera, erythrocytes,
lymphocytes (about 25% of body’s protein)
Evaluation of “protein status” is challenging; no one test or
indicator is perfect or without limitation. It is best to evaluate in
addition to other nutrition status indicators (anthropometric,
clinical, dietary)
Methods to evaluate
protein:
Creatinine Height Index (CHI)
The body excretes creatinine in the urine as a by-product of
skeletal muscle. The amount that is produced is relative
to stature (height). This amount can be looked up in
references. So. . .
CHI = creatinine (mg) excreted in urine for 24 hours x 100----then

divide by the expected 24 hr urine creatinine. It is expressed by a
percentage value.
3-methylhistidine is excreted by muscle as well, but this test is

not routinely used
Nitrogen Balance
Nitrogen is a byproduct of protein breakdown from food we ingest
or from our body’s own turnover/breakdown of protein
A person is said to be in “positive nitrogen balance” (a good
thing!) when nitrogen intake (from dietary protein intake) exceeds
(or is >) than nitrogen loss.
A person is said to be in “negative nitrogen balance” (a serious

concern!) when nitrogen losses (from losses of the body’s protein
breakdown) exceed nitrogen intake (dietary protein intake).
N2 testing requires collection of urine for 24 hours and knowledge

of protein intake for 24 hours. This test is typically completed in
very controlled environment.
Methods to evaluate protein in the
blood
Albumin (Alb) used in clinical settings to “evaluate” protein
status; has half life of 14-20 days (it takes longer to determine
if the patient’s diet is adequate in protein). Albumin may
“drop” during infection, and can appear low during over
hydration. Albumin may appear high during dehydration.
Transferrin binds iron and transports to bone marrow; may

drop during infection, wounds, kidney disease.
Prealbumin transports protein that has a half life of 2-3
days. Because of this, it is considered a better indicator of
protein status and provides more “up to date response” to
nutrition therapy. There are some limitations with
interpretation.
Retinol-Binding Protein (RBP) transports protein for

vitamin A; similar to prealbumin; has a half life of 12 hours.
Levels can decrease with vitamin A deficiency.
IGF (Insulin-like Growth Factor) is a growth promoting

peptide produced in response to growth hormone.
Immunocompetence (indirect measure)
1)Nonspecific (skin, mucous membranes, phagocytes, etc) &

Antigen Specific Immunity (b-lymphocytes and t-lymphocytes)
possibly drop during protein malnutrition
2) TLC – total lymphocyte count (decreases)
3) Delayed cutaneous (skin) hypersensitivity

Evaluating Iron (Fe)
Status:
Serum Ferritin combines w/ Fe and is stored in liver, spleen &
bone marrow. **Most sensitive and best test to detect early
iron deficiency!
Transferrin carries Fe in blood. Associated and used to calculate

TIBC (total iron binding capacity). When TIBC goes up, iron
level is low. When TIBC goes down, iron level is high.
Hemoglobin (Hgb) is the molecule in RBC (red blood cells) that

holds iron, and allows the cells to carry oxygen to the body
tissues. (Stage III indicator)
Hematocrit (Hct) expressed as a percentage of RBCs

as compared to entire volume of blood
Dietary sources of
iron
Heme iron may be found in meat, poultry, fish
Non-heme iron may be found in cereal, greens, peas/beans,
eggs, dried fruits;
Vitamin C improves iron absorption
Stages of Iron Deficiency:
I. Depletion present with decreased serum ferritin
II. Iron deficiency present with decreased transferrin saturated
II Fe deficiency anemia present with decreased hemoglobin

(Hgb) and decreased mean corpuscular volume (MCV)
Mean Corpuscular Hemoglobin (MCH) is the amount of
hemoglobin in RBCs
Mean Corpuscular Volume (MCV) is the volume of the average

RBC; Cell size may go up or down
Low MCV (microcytic anemia or “small red blood cells) is a sign

of iron deficiency or even lead poisoning
High MCV (macrocytic anemia or “large red blood cells) is a

sign
of folate or vitamin B12 deficiency
Types of Blood work or Lab
Panels:
CBC (Complete Blood Count) includes RBC, Hgb, Hct, MCH, MCV and
can give some idea of anemias
Metabolic Panels or Chem profile/panels (liver profile or

comprehensive) includes minerals Na, K, P, Cl, Ca, Alb, total
proteins, globulins and liver enzymes (alkaline phosphatase, ALT,
AST), byproducts of metabolism (BUN, creatinine, CO2), blood
glucose
Lipid Panels include total cholesterol, triglycerides, LDLs, HDLs,

VLDLs.
We will study more next semester!
Metabolic
Panel
ALT (alanine aminotransferase) is a liver enzyme; when elevated
may signal a liver problem or disease
Alkaline Phosphatase (ALP) enzyme indicating a problem in liver,

bone, placenta, intestine
AST (aspartate aminotransferase) indicates MI, liver disease,

drug exposure, musculoskeletal injuries
Bilirubin is the pigment in bile, produced from the breakdown of
hemoglobin; when elevated may indicate liver problem and
results in jaundice
BUN (blood urea nitrogen) is the byproduct of protein
metabolism; when elevated can signal renal disease or
dehydration
Creatinine becomes elevated with renal disease
Calcium stays very tightly controlled; if low may indicate

hypoparathyroidism, renal disease, or pancreatitis; high levels
can indicate excessive vitamin D intake. When out of normal
range indicates a metabolic problem rather than a true
deficiency of dietary calcium.
Carbon Dioxide (CO2) indicates acid/base balance in body. Too

high indicates alkalosis; too low indicates acidosis
Chloride (Cl) works with Na to help with acid-base balance and
fluid pressure. Low level may indicate alkalosis and low K;
High level may indicate kidney disease or heart disease
Glucose (Normal is 70-100 mg/dl) is considered the normal

range for a fasting blood glucose level.
If a fasting blood glucose level determines 100-125

mg/dL, the person is considered to have impaired
fasting glucose, a type of prediabetes
A random blood glucose test usually will be below 125

mg/dL; when elevated, may signal diabetes.
• A1C test is a common blood test used to diagnose type 1 and
type 2 diabetes. The A1C test may be referred to as
hemoglobin A1C, HbA1C, glycated hemoglobin, glycosylated
hemoglobin.
• The test reflects the average blood sugar level for the past two
to three months and measures the percentage of your
hemoglobin (protein in RBC that carries oxygen) is coated with
sugar (glycated).
• Normal A1C 4.5-6% (5% = 97 mg/dL as estimated average blood glucose level)
• Prediabetes A1C 5.7-6.4% (6% = 126 mg/dL as estimated average BG level)
• Diabetes A1C >6.5% (7%= 154 mg/dL as estimated average BG level)
Phosphorus (P) closely relates to Ca; when high may indicate
renal failure; when low may indicate a bone disease (rickets
or osteomalacia)
Sodium (Na) maintains acid-base and fluid balance. Low level

may be from vomiting, diarrhea, or diuretics, or
overhydration; High level may be seen with dehydration.
Terms: hypernatremia, hyponatremia
Potassium (K) plays a key role in acid-base and fluid balance;

nerve impulses. High level may be seen with renal disease.
Low levels may be caused by diuretics, vomiting, diarrhea,
eating disorders. Terms:hyperkalemia, hypokalemia
Biochemical Tests of
Nutrients:
Zinc (Zn) is involved in enzymes; immune function and wound
healing. If depleted can result in growth retardation; if
severe may cause dwarfism. Possible tests: metallothionen,
hair zinc, urinary zinc
Vitamin C, in reduced form, is ascorbic acid; used in formation of

collage, promotion of Fe absorption. Tests: serum, leukocyte
levels
Vitamin B6 serves as a coenzyme in reactions; of most concern
in elderly and alcoholism; Tests-PLP, plasma PL, total B6
using microbiological assay, Tryptophan Load test (most
widely used), Methionine Load test
Folate serves as a coenzyme that transports carbon groups in

amino acid metabolism and nucleic acid synthesis.
There are 4 stages of folate deficiency;

Low serum folate indicates early depletion; last the tissues
begin to deplete. By the time there is full blown
deficiency, MCV levels go up (macrocytic anemia) and Hgb
goes down.
Vitamin B12 is involved and active in human metabolism. Sources
include animal products and fortified grain, soy and plant based
meat substitutes.
In order to be absorbed for B12 to be absorbed by the body, it

requires an INTRINSIC FACTOR to be secreted by the stomach.
When B12 and IF bond, this complex can be absorbed by the
ileum.
B12 deficiency is called pernicious anemia. It can result in serious

neurological damage. The initial lab indicators for Vit B12
deficiency present the same way as with folic acid deficiency (high
MCV and low Hgb). Unless a serum B12 is checked, the true
deficiency can be missed.
The Schilling test is used to determine if low B12 level is a result

of IF production problem or ileal dysfunction!
Source for slide
information
Lee, Robert and Nieman, David. Nutritional Assessment 5th

edition. McGraw Hill 2010.
http://www.mayoclinic.org/tests-procedures/a1c-
test/basics/results/prc-20012585

Biochemical Assessment of Nutritional Status: by Dr. MDA Bashar, MD, DNB

Uploaded by

Copyright:

Available Formats

Biochemical Assessment of Nutritional Status: by Dr. MDA Bashar, MD, DNB

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Biochemical Assessment of Nutritional Status: by Dr. MDA Bashar, MD, DNB

Uploaded by

Copyright:

Available Formats

BIOCHEMICAL

• Two types of Tests

Examples: Iron or vitamin A

Limitations: may fail to reflect the overall nutrient status

reflects the failure of function or physiologic process of the body

Examples: Immune response will be compromised by protein

Limitations: May be nonspecific; indicates a general nutritional

CHI = creatinine (mg) excreted in urine for 24 hours x 100----then

3-methylhistidine is excreted by muscle as well, but this test is

A person is said to be in “negative nitrogen balance” (a serious

N2 testing requires collection of urine for 24 hours and knowledge

Transferrin binds iron and transports to bone marrow; may

Retinol-Binding Protein (RBP) transports protein for

IGF (Insulin-like Growth Factor) is a growth promoting

1)Nonspecific (skin, mucous membranes, phagocytes, etc) &

2) TLC – total lymphocyte count (decreases)

3) Delayed cutaneous (skin) hypersensitivity

Transferrin carries Fe in blood. Associated and used to calculate

Hemoglobin (Hgb) is the molecule in RBC (red blood cells) that

Hematocrit (Hct) expressed as a percentage of RBCs

Vitamin C improves iron absorption

Stages of Iron Deficiency:

I. Depletion present with decreased serum ferritin

II. Iron deficiency present with decreased transferrin saturated

II Fe deficiency anemia present with decreased hemoglobin

Mean Corpuscular Volume (MCV) is the volume of the average

Low MCV (microcytic anemia or “small red blood cells) is a sign

High MCV (macrocytic anemia or “large red blood cells) is a

Metabolic Panels or Chem profile/panels (liver profile or

Lipid Panels include total cholesterol, triglycerides, LDLs, HDLs,

Alkaline Phosphatase (ALP) enzyme indicating a problem in liver,

AST (aspartate aminotransferase) indicates MI, liver disease,

Creatinine becomes elevated with renal disease

Calcium stays very tightly controlled; if low may indicate

Carbon Dioxide (CO2) indicates acid/base balance in body. Too

Glucose (Normal is 70-100 mg/dl) is considered the normal

If a fasting blood glucose level determines 100-125

A random blood glucose test usually will be below 125

Sodium (Na) maintains acid-base and fluid balance. Low level

Potassium (K) plays a key role in acid-base and fluid balance;

Vitamin C, in reduced form, is ascorbic acid; used in formation of

Folate serves as a coenzyme that transports carbon groups in

There are 4 stages of folate deficiency;

In order to be absorbed for B12 to be absorbed by the body, it

B12 deficiency is called pernicious anemia. It can result in serious

The Schilling test is used to determine if low B12 level is a result

Lee, Robert and Nieman, David. Nutritional Assessment 5th

You might also like