Nutritional Status Assessment

ASSESSMENT OF NUTRITIONAL
STATUS
INTRODUCTION
The nutritional status of an individual is
often the result of many inter-related
factors.
It is influenced by food intake, quantity &

quality, & physical health.
The spectrum of nutritional status spread

from obesity to severe malnutrition
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 reflects nutritional influences.
Direct Methods of Nutritional
Assessment
These are summarized as ABCD
• Anthropometric methods
• Biochemical, laboratory methods
• Clinical methods
• Dietary evaluation methods
CLINICAL ASSESSMENT
It is the simplest & most practical method of

assessing the nutritional status of a patient.
Also called ‘Subjective Global Assessment’
It involves:
Detailed history, examination.
CLINICAL ASSESSMENT/2
Good nutritional history should be obtained
General clinical examination, with special
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
Clinical signs of nutritional deficiency
HAIR
Sparse & thin Protein, zinc, biotin
deficiency
Easy to pull out Protein deficiency
Corkscrew Vit C & Vit A

Coiled hair deficiency
MOUTH
Glossitis Riboflavin, niacin, folic acid,
B12
Bleeding & spongy gums Vit. C,A, K, folic acid & niacin
Angular stomatitis & B 2, 6, niacin
fissured tongue
leukoplakia Vit.A,B12, B-complex, folic acid
Sore mouth & tongue Vit B12, B complex & iron

EYES
Night blindness, Vitamin A deficiency

exophthalmia
Photophobia-blurring, Vit B2 & vit A

conjunctival inflammation deficiencies
NAILS
Spooning Iron deficiency
Transverse lines Protein deficiency

SKIN
Pallor Folic acid, iron, B12
Hyperkeratosis Vitamin A & Vitamin C
Flaking dermatitis PEM, Vit B2, Vitamin A, Zinc

& Niacin
Pigmentation, Niacin & PEM
desquamation
Bruising, purpura Vit K ,Vit C & folic acid
Anthropometric Methods
Anthropometry is the measurement of body
height, weight & proportions.
It is an essential component of clinical
examination of infants, children & pregnant
women.
It is used to evaluate both under & over
nutrition.
The measured values reflects the current
nutritional status & don’t differentiate
between acute & chronic changes .
Anthropometric Measurements
Height
Weight - IBW, ABW, BMI
Mid-arm circumference
Tricep Skin fold thickness
Creatinine height index
Head/chest ratio
Hip/waist ratio
Anthropometry for children
 Accurate measurement of height and weight
is essential. The results can then be used to
evaluate the physical growth of the child.
 For growth monitoring the data is plotted

on growth charts over a period of time to
calculate growth velocity, which can then be
compared to international standards
Percentile chart
Growth Monitoring Chart

Measurements for adults
Height:
The subject stands erect & bare footed
on a stadiometer with a movable head
piece. The head piece is leveled with
skull vault & height is recorded to the
nearest 0.5 cm.
WEIGHT MEASUREMENT
Use a regularly calibrated electronic or

balanced-beam scale.
Weigh in light clothes, no shoes
Read to the nearest 100 gm (0.1kg)

Ideal body weight
• Males: 106 lbs + 6 lbs per inch over 5 ft
• Females: 100 lbs + 5 lbs per inch over 5 ft
• Add 10% for large-framed and subtract 10%

for small framed
Average Body Weight
• %IBW = (current wt/IBW) X 100
– >200% IBW – Morbid obese
– >150% IBW - Obese
– >120% IBW – Overweight
– 100%±10% IBW - Normal
– 80-90% IBW - Mild malnutrition
– 70-79% IBW - Moderate malnutrition
– 60-69% IBW - Severe malnutrition
– <60% IBW - non-survival
Body Mass Index
• The international standard for assessing body size in
adults is the body mass index (BMI).
• BMI is calculated using the following formula:
– BMI = Weight (kg)/ Height (m²)
• High BMI is associated with type 2 diabetes & high

risk of cardiovascular morbidity & mortality
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)
Waist circumference
Waist circumference predicts mortality better than
any other anthropometric measurement.
Waist measurement can be used to assess obesity, and

two levels of risk have been identified
MALES FEMALE
LEVEL 1 > 94cm > 80cm
LEVEL2 > 102cm > 88cm
Waist circumference
Level 1 is the maximum acceptable waist
circumference irrespective of the adult age
and there should be no further weight gain.
Level 2 denotes obesity and requires weight

management to reduce the risk of type 2
diabetes & CVS complications.
DIETARY ASSESSMENT
• Nutritional intake is assessed by five
different methods. These are:
– 24 hours dietary recall

– Food frequency questionnaire
– Dietary history since early life
– Food diary technique
– Observed food consumption
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 person’s usual intake
Food Frequency Questionnaire
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.
FOOD DIARY
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.

Laboratory Assessment
Hemoglobin estimation
Serum Proteins:
Serum albumin has long half life 14 – 21 days
Serum albumin level < 3g/dl is important
Serum pre-albumin – half life 3-5 days
Serum transferrin – 7 days
Stool examination for the presence of ova
and/or intestinal parasites
Urine dipstick & microscopy for albumin,
sugar and blood cells
Specific Lab Tests
Measurement of individual nutrient in
body fluids (e.g. serum retinol, serum iron,
urinary iodine, vitamin D)
Detection of abnormal amount of
metabolites in the urine
Analysis of hair, nails & skin for micro-
nutrients
Nitrogen Balance
• 1 gram nitrogen = 6.25grams of protein
• Nitrogen output is estimated in 24 hrs urine,
skin, stool, additional loss
• Nitogen balance = Nitrogen intake – loss
(urine 90% +stool 5% + integument 5%)
• Nitrogen Turnover is checked by Urinary 3
methyl histidine excretion
Other Tests
• Immunologic tests
• Functional assessment of muscle strength
• Body composition analysis
• Estimation of energy need
Energy Substrate
25 – 35 kcal/kg/day
55% from carbohydrates
20-30% from lipids
15% from proteins
Carbohydrates
 Glucose is the main source.
 At least 100 grams of glucose /day is required
daily to prevent protein use for energy
 I gram of glucose provides 4 kcal of energy
Lipids
• Long chain triglycerides
• Medium chain triglycerides
• Fatty acids
– Essential fatty acids – linoleic acid, α linoleic acid,
oleic acid
Proteins
 Maintenance requirement: 0.8g/kg/day
 5.5 -6.5 grams/day
 Nitrogen requirement: 0.2g/kg/day
 Major stress - protein requirement: 1.5 – 2.5 g/kg/day

Fluid Requirement
• 25 – 35 ml/kg/day
• 4ml/kg/hr for first 10 kg body wt
• 2ml/kg/hr for next 10 kg body wt
• 1ml/kg/hr for every kg above 20 kg
• 100ml/kg (for first 10 kg wt), 50ml/kg (for

next 10 kg), 20ml/kg (for each kg above 20
kg)
Electrolyte Requirement
 Sodium – 0.5 mmole/kg/day
 Potassium – 1 mmole/kg/day
 Calcium – 0.2 – 0.3 meq/kg
 Magnesium – 0.35 – 0.45 meq/kg
 Phosphorus – 30 – 40 mmole/day
Indications for Nutritional Support
• General indications
• Selected indications
General Indications
o Serum albumin< 3 g/dl with no gut
inflammation
o Starvation for > 7 days
o Surgical /accidental trauma – moderate/severe
o Inadequate oral intake (<50% caloric need)
o Weight loss >10% of actual body weight
Routes of Nutrition Administration
• Oral route
• Enteral route
• Parenteral route

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ASSESSMENT OF NUTRITIONAL

It is influenced by food intake, quantity &

The spectrum of nutritional status spread

Nutrition is assessed by two types of

It is the simplest & most practical method of

Easy to pull out Protein deficiency

Corkscrew Vit C & Vit A

leukoplakia Vit.A,B12, B-complex, folic acid

Sore mouth & tongue Vit B12, B complex & iron

Night blindness, Vitamin A deficiency

Photophobia-blurring, Vit B2 & vit A

Spooning Iron deficiency

Transverse lines Protein deficiency

Hyperkeratosis Vitamin A & Vitamin C

Flaking dermatitis PEM, Vit B2, Vitamin A, Zinc

Tricep Skin fold thickness

Creatinine height index

 For growth monitoring the data is plotted

Growth Monitoring Chart

Use a regularly calibrated electronic or

Weigh in light clothes, no shoes

Read to the nearest 100 gm (0.1kg)

• Females: 100 lbs + 5 lbs per inch over 5 ft

• Add 10% for large-framed and subtract 10%

• High BMI is associated with type 2 diabetes & high

Waist measurement can be used to assess obesity, and

Level 2 denotes obesity and requires weight

– 24 hours dietary recall

A trained interviewer asks the subject to

inexpensive, more representative & easy to

The length of the collection period range

Reliable but difficult to maintain.

 5.5 -6.5 grams/day

 Nitrogen requirement: 0.2g/kg/day

 Major stress - protein requirement: 1.5 – 2.5 g/kg/day

• 100ml/kg (for first 10 kg wt), 50ml/kg (for

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