Group 1 (Alfeche, Bag-ao, Cagatan, and Dela Cruz) Metric System

Nutrition Care Process (ADIME Process) WT ( KG)

Assessment of Nutritional Status BMI = 2
1. Physical Assessment HT (m)
Anthropometric Measurements
Height and Weight
- BMI Imperial English System
- Body Composition
- Mid-arm Circumference (MAC) WT (lbs)
- Desirable Body Weight (DBW) Determinations BMI = ( )(703)
- Total Energy Requirement (TER) & distribution of TER
HT 2(¿)
- Application of Food Exchange List Asian (filipino) (FEL) &
sample menu
Other Sources of Data Body Composition - refers to everything in your body, split up into
- Malnutrition Universal Screening Tool (MUST) different compartments.
- Subjective Global Assessment (MNA)
- Geriartic Nutrional Risk Index (GNRI) Two compartments are commonly used:
a. Fat mass - refers to all fat tissue in body
b. Fat-free mass - everything else, including muscle, organs,
bone and fluid
Height & Weight – Components of BMI
If both change at once, you might not see any changes in body weight. For
Body Mass Index (BMI) - A calculation based on height and weight. Used example, if you start exercising, you may gain two pounds of muscle in the
to determine if you are underweight, average weight, overweight, or obese first month. At the same time, you may lose two pounds of fat due to
(but it has its flaws). It is not always a reliable indicator of body fat. burning more calories through exercise or changes in your diet. Since your
However it is a useful screening tool since people who are overweight or fat-free mass increased by the same amount as your fat mass decreased,
obese generally have an increased risk for: your body weight won’t change. If you focus on the number on the scale,
• Coronary heart disease you may become discouraged or frustrated because your program “isn’t
• Hypertension working.” This is one example of why knowing your body composition is
• Osteoarthritis much more useful than knowing your body weight.
• Sleep apnea & respiratory problems
• Some cancers
• Stroke Desirable Body Weight (DBW)
• Type 2 diabetes  Ideal body weight is a range that tells you whether your weight is in
proportion to your height and gender. It's important to evaluate if
your goals are in a healthy range and safe to achieve.
  Keeping your weight in the normal range is an important part of 7. Fat list
healthy aging. 8. Fast-food list
 Elevated body mass index (BMI) in older adults can increase the 9. Combination food list
likelihood of developing health problems. These include heart 10. Free food list
disease, high blood pressure, stroke, and diabetes. 11. Alchohol list

Formula Other Sources of Data

(Height (cm) - 100)(0.9) = Desirable body weight Malnutrition Universal Status (MUST)
 is a five- step nationally recognized and validated screening tool to
Total Energy Requirement identify ADULTS who are malnourished or at risk of malnutritio.
Energy requirement is the amount of food energy needed to balance  developed by the multidisciplinary British Association for Parenteral
energy expenditure in order to maintain body size, body composition and a and Enteral Nutrition (BAPEN), is considered the most scientifically
level of necessary and desirable physical activity consistent with long-term robust, practical, and versatile nutrition screening tool for adults. It
good health. has been designed to detect under nutrition (malnutrition) and over-
Note: The average allowance for men of reference size (77 kg) is nutrition (overweight/obesity).
2,300 kcal/day; for women, it is 1,900 kcal/day.
In different care settings including
1. Hospital inpatients and outpatients
Food Exchange List 2. Care homes
 The basis of a meal planning system designed by the American 3. GP surgeries and health centers
Dietetic Association and the American Diabetes Association. They 4. Community
are based upon principles of good nutrition for everyone.
 For some lists, each contributes an appropriate level of nutrients of With different groups of adult patients, including but not exclusively
each food (calories, carbohydrates, proteins, and fats). For other, the 1. Elderly
contribution of nutrients varies within or between lists. 2. Surgical
 This tool is used by Health practitioners because it is an easy tool to 3. Medical
work with and teaches food selection in a practical way. 4. Orthopaedic
5. Those requiring intensive care
The 11 Food Exchange Lists 6. Mental health care
1. Starch Lists 7. Pregnancy and lactation (with adaptation)
2. Sweets, desserts, and other carbohydrates list
3. Fruit list By different healthcare professionals
4. Vegetable (nonstarchy) list 1. Nurses
5. Meat and meat subsitutes list 2. Doctors
6. Milk list 3. Dieticians
 4. Health-care assistants  SGA requires no additional laboratory testing or capital outlay. In
5. Students addition, SGA has been found to correlate strongly with other
Steps subjective and objective measures of nutrition
1. Calculate BMI from weight and height  Clinicians place the patient into one of these categories based upon
2. Determine unplanned weight loss ( % ) in past 3–6 months. their subjective rating of the patient in two broad areas: 1. Medical
3. Consider the effect of acute disease History, 2. Physical Examination. In general, 60% of the clinician's
4. Add scores from 1, 2, and 3 together to give overall risk of rating of the patient is based on the results of the medical history,
malnutrition. Total score and 40% on the physical examination (see SGA evaluation form in
0 indicates low risk figure 1)
1 indicates medium risk
2 indicates high risk SGA classifies the patient as:
5. Initiate appropriate nutritional management. Using local a. Well-nourished
management guidelines. prepare appropriate care plan. b. Mildly malnourished or suspected of malnutrition
c. Severely malnourished

Medical History Section

The first SGA component, the medical history, involves asking questions
and evaluating the patient's answers about the following four parameters:
 Weight change
 Dietary intake
 Gastrointestinal symptoms
 Functional impairment
The patient is rated as either nourished, mildly, moderately malnourished,
or severely malnourished for each of the four parameters.

Physical Examination Section

Physical evidence of malnutrition is rated differently. There are four
categories to select from: normal nutrition, mild malnutrition, moderate
malnutrition, or severe malnutrition.
Physical signs to examine include:
 Loss of subcutaneous fat
Subjective Global Assessment (SGA)  Muscle wasting
 A clinical method of assessing nutritional status based on findings in a  Edema
health history and physical examination.  Ascites (in hemodialysis patients only)
There are several body locations to examine for each parameter.
Geriatric nutritional risk index (GNRI)
 an index calculated based on serum albumin and the ratio
between the present weight and the ideal body weight of the
patient; GNRI is used to predict nutrition-related complications in
elderly patients
 Structured as a dichotomous index, based on serum albumin
values and the discrepancy between real and ideal weight, the
GNRI seems to account for both acute and chronic reasons of
nutrition-related complications. It allows us to face the frequent
difficulties in obtaining a profitable participation of the old patient to
nutritional assessment. Its application appears feasible in all
healthcare settings in which it shows adequacy to discriminate
different profiles of nutritional risk. A GNRI less than 92 might be
suggested as clinical trigger for routine nutritional support
 Structured as a dichotomous index, based on serum albumin
values and the discrepancy between real and ideal weight, the
GNRI seems to account for both acute and chronic reasons of
nutrition-related complications. It allows us to face the frequent
difficulties in obtaining a profitable participation of the old patient to
nutritional assessment. Its application appears feasible in all
healthcare settings in which it shows adequacy to discriminate
different profiles of nutritional risk. A GNRI less than 92 might be
suggested as clinical trigger for routine nutritional support