Tools of nutritional assessment

I- Direct tools

A- Anthropometry C- Clinical
B- Biological
- The most frequent used Non-specific as clinical
Laboratory method used signs may be also
- Easy, no labs
to determine deficiencies: caused by:
Ex:
- Serum ptn: (albumin) environmental factors
1. Growth chart
- Blood lipid: as: dryness of skin in
(weight, height for age)
(cholesterol, TAG) hot dry weather
2. Arm circumference
- blood forming nutrient:
(B6, B12blood glucose)
- Water soluble vit:
(Riboflavin thiamine,
niacin, vit C D- Diet
- Lipid soluble vit:
1. Food balance sheet
II- Indirect tools III- Ecological a. Supply (production, input)
b. Utilization
1.Morbidity rats -Agriculture
c. Per capita value
2.Mortality rates -Infection (B,V,P)
2. Family survey
-Socioeconomic state
- Disadvantage: failure in recoil,
-Health services
exaggeration
3. Individual survey
a. Quantitative = (24 hr. recall)
b. Qualitative = (food frequency)
= (food diary)
For each type of food eaten
‫مثال اكلت كم كيلو لحم في االسبوع‬
4. Specific group
➔ Need ↑ nutrient (infants, pre. school,
school, child, pregnancy, lactating
female, elderly)
 Breast feeding
Terms “short essay”
1) Exclusive → “only” breast feed + medicine.
2) Predominant → Breast feed + water, drinks.
3) Full → Exclusive, predominant.
4) Partial → Breast feed + artificial feed.
5) Artificial → “only” artificial feed.
6) Bottle → Feed by bottle artificial, expressed breast milk
7) Complimentary → {6m. → 2y} Breast feed + other food

Time of expressed milk storage 686

6 h → Room temperature
8 d → Fridge
6 m. → Freezer
Importance
‫ االم‬1. Maintain mother’s milk supply
‫ الطفل‬2. Sick baby unable to breast feed, can feed expressed milk through nasogastric tube
‫ اللبن‬3. If baby tried artificial milk once, he may no longer want breast milk
Weaning
- Add food to breast feed at 6 months because brain, body development requires increase
nutrient needs
- It represent (comprementory feeding period) 6m. → 2 y
- Complementary food should be: smashed, semi solid, diverse (4 groups/day)
Challenges of breast feeding “essay”
1. Lack of awareness of importance of breast feeding ‫أُم معندهاش وعي‬
2. Lack of support to working mothers who are breast feed ‫وقت‬
3. Poverty, people can’t pay nutrients-rich food ‫مال‬
4. In emergencies, feeding babies become difficult to find safe place"‫مكان "الطوارئ‬
5. Unethical marketing of formula & unhealthy food by companies ‫بتسمع اعالنات‬
6. Storage of health care workers trained to counsel mothers by importance of breast feeding

Global efforts to promote breast, complementary feed“essay”

‫ نقط اللي فوق‬6 ‫(هعكس) هصلح ال‬
 WHO recommendations for baby friendly hospital
1. Make a written breast-feeding policy ‫اعمل الئحة‬
2. Train all health care workers on this policy ‫ادرب الدكاترة عليها‬
3. Inform all pregnant females about benefits of breast feeding ‫األم وهي لسه حامل‬
4. Help mothers initiate breast feeding immediately within 1/2 hours from birth ‫اول ماتولد‬
5. Show mothers how to breast feed (hold, attachment) & lactation in separation ‫ترضّع ازاى‬

Hold
The whole body should be
1- Straight
2- Supported
3- Close to the mother
4- Towards the mother
Attachment
1- Mouth widely opened
2- Areola’s lower portion not visible
3- Lower lip curled outwards
4- Chin touches the breast

6. Breast feed on demand ‫كل ما يعيط ترضعه‬

7. Rooming in (mothers stay with infants 24/day) ‫تفضل مع ابنها‬
8. NO food or drinks other than breast milk ‫ال لالكل مع الرضاعة‬
9. NO artificial teats or pacifiers ‫ال لل؟؟؟‬
Advantage of breast feeding “essay”
1. For child
a. Provide baby all vitamins, minerals, Antibodies, enzyme needed
b. Support high brain development, functions, decrease obesity
c. Less susceptible to infection: ↓ diarrhea, ↓ pneumonia
2. For mother
a. ↓ PPH so ↓ MMR, ↓ anemia
b. ↓ Breast & ovarian cancers
3. For community
a. Each 1$ invested in breast feeding generate 35$ in economic return
 Nutritional content in breast milk
(vit. A, vit. B, Ca, vit. D, Iron) ABCDI
1. Vit. A:
a. If ↑ maternal supplementation → ↑ content of milk
b. If ↓ : - early delivery (as vit. A transferred late in gestation)
- early weaning
2. Vit. B
3. Ca: Constant through lactation, Not affected by maternal diet
4. Vit. D:
a. Deficient (insufficient) in milk so baby need → (sunlight exposure, intake of vit. D)
b. If ↑ maternal supplementation → ↑ content of milk
5. Iron:
a. Insufficient (poor) in milk
b. If ↑ maternal supplementation → NOT affect content of milk
‫ مش بكتفي بلبن االم‬vit. D & iron
National requirements of pregnant women “2013 essay”

1. Before pregnancy 2. During pregnancy 3. During lactation

‫ حتى قبل الحمل يفيد الطفل‬The extra energy need Energy requirement ↑ by
vit. B12 for pregnancy (24.-300 - 550 kcal/day (in 1st 6m.)
B kcal/day) - 400 kcal/day (6-12 m.
Polyunsaturated FA for
after delivery)
fetal development Folate, Iron: are the only - ↑ vit B1, B2, B3
F → Folic acid → prevent nutrients whose Thiamine, Riboflavin,
requirement doubles in Nicotinic acid
spina bifida & other neural
pregnancy - ↑ water intake as milk is
tubeIron
defects
I ‫الحاجتين اللي بضاعفهم في فتره‬ made of 88% H2O
Iodine → for normal ‫الحمل‬
thyroid function, mental + Zn, I, Ca
development so prevent Zinc: phytate, soya, iron
D →cretinism
vit. D → vary → ↓ Zn absorption
according to sun exposure Iodine: in sea food
Ca