Nutritional assessment

The definition of Nutritional Assessment is: A structured way to

establish nutritional status and energy-requirements by objective
measurements, completed with objective parameters and in
relation to specific disease-indications, an adequate (nutritional-
) treatment can be developed for the patient.

Nutritional status

The definition of nutritional status is: the condition of the

body as a result of the intake, absorption and use of
nutrition and the influence of disease-related factors.

Nutritional Assessment: -is the process of determining

nutritional status which may reveal nutritional deficiencies
or excess.
- Primary deficiency caused by inadequate intake of
nutrient.
- - secondary def. caused by body insufficient use of
the nutrients.
- There are 2 level of nutritional assessment

1-To evaluate the dietary intake or the food we eat to

determine the quantities of nutrient consumed as
compared to the RDA/DRI.
2-To evaluate dietary intake but also consider how
the body use the nutrient for growth & maintenance.

To determine the nutritional status of individuals or population,

estimates of food consumption are used.

-if the dietary intake is out of balance, under, over, or

malnutrition may be diagnosed.

Under nutrition:-is the under consumption of energy or

nutrients based on RDA/RDI values.
This mean either not eating enough food for energy but take all
the essential nutrient or eating enough food for energy but
choosing that lacking certain nutrients.

Over nutrition: - is consumption too many nutrients & / or

energy intake compared to RDA/DRI levels.

Mal nutrition: -is a condition result from an imbalanced

nutrients & or energy intake. It is an umbrella term that include
the under nutrition of too few nutrients or energy intake &
over nutrition of excess nutrients or energy consumption.

Aims and Objectives

Aims
To understand the methods commonly used to assess nutritional
status in children and adults and to explore the methods
available to assess dietary intake.

Objectives
• Describe patterns of child growth and identify critical
periods
• Explain the indicators used to describe nutritional status in
terms of growth and micronutrient status
• Compare different methods of dietary assessment and
discuss the advantages and disadvantages of each
• List and locate the main sources of diet and nutrition-
related information on a country/regional level
Introduction
Understanding measures of nutritional status is critical
for the interpretation of nutrition-related development
outcomes.
Standards, reference values and indicators have been
constructed for nutrition outcomes against which the
nutritional status of individuals and populations can be
compared.
Nutritional assessment is often viewed according to the
ABCD scheme:
A.Anthropometry, i.e. physical growth and body size
B. Biochemistry, used mostly for micronutrients
C. Clinical evaluation
D.Dietary intake assessment
Anthropometry
Anthropometric measurements and indices
The most common anthropometric measurements in
children are:

• Height (or length in children <2 years of age)

• Weight
• Mid upper arm circumference (MUAC, most
commonly in children under 5 years of age)
These measurements are then used to construct the
following indices in children:
• Weight-for-height/length (weight in relation to the
normal weight for a given height)
• Length/height-for-age (height in relation to the
normal height at a given age)
• Weight-for-age (weight in relation to the normal
weight at a given age.
 WHO cut-offs for under nutrition in children
The WHO recommends the use of the WHO child
growth standards for under nutrition based on z-
scores.

WHO recommended cut-off for

• weight-for-height,
• height-for-age,
• weight-for-age
Indicator z-score
<-3 -3 to -2 <-2
Weight-for-height Severely wasted Moderately Wasted
wasted
Height-for-age Severely stunted Moderately Stunted
stunted
Weight-for-age Severely Moderately Underweight
underweight underweight

• Anthropometry in adults
• In adults, the most common anthropometric
measures taken are weight and height, and
these are normally combined in the calculation
of the Body Mass Index (BMI). The same
formula is used for both genders.

•
•Calculate your BMI now:
Insert weight: kg
• Biochemical and Clinical Measures
of Deficiency
• In this topic we will be looking at methods of
assessing vitamin A, iron, iodine and zinc status.
• For each nutrient we will identify clinical signs and
biochemical measures of deficiency

• Dietary Assessment
• The assessment of dietary intake is the final method
we will discuss that is commonly used to assess
nutritional status in individuals and populations.
Note that it does not actually measure 'status' since
status depends on nutrient use and losses, not only
on intake.

• Measuring past intake

• There are two main methods used to measure the
past intake.
Method Description Advantages Disadvantages
24-hour dietary Individuals are asked by trained Inexpensive, quick A single 24 hour recall
recall interviewers using a standardised and easy with a is likely to omit
protocol to recall the exact food low burden for the infrequently eaten
intake during the previous 24 respondent, foods. Recall bias likely
hours or previous day. Detailed therefore large as heavily reliant on
descriptions of foodstuffs coverage is memory.
including the estimation of possible.
quantities are recorded. This is
repeated over several days and
analysed using food composition
tables.
Food frequency This provides qualitative Easy, cheap, and a Poor accuracy.
questionnaire information about food low burden on the
consumption patterns and has two subject.
components: a list of foods
(which may focus on specific
groups of foods/nutrients) and a
set of frequency-of-use
categories. Information on
quantity can be taken if questions
on portion size are included. The
results usually represent usual
intakes over time and are useful
for ranking subjects into low,
medium or high intake groups.