Assessment of Nutrition Status and Nutrition

Requirements

Luciana
 Introduction

 Nutrition care is a vital component of quality patient

care
 Patients with undernutrition increase risks of morbidity
and mortality
 Nutrient deficiencies involving micronutrients ( vitamin or
trace elements ) or macronutrients ( fat, protein, or
carbohydrate )
Assessment of Nutrition Status

 Nutrition assessment has 4 major goals :

1. Identification of the presence of factors associated with
an increased risk of developing malnutrition
2. Determination of risk of malnutrition – associated
complications
3. Establisment of estimated nutrition needs
4. Establisment of parameters against which to measure
nutrition therapy outcome
 Nutrition Screening

 Nutrition screening is to identify individuals who are

overweight, obese, malnourished, or at risk for malnutrition
 Risk factors for undernutrition include :
• Disease state
• Complicating condition
• Treatment
• Socioeconomic condition
 Nutrition screening using simple tool in the community or
outpatient setting, especially in young children and the
elderly
 For inpatients, a nutrition screening process should be
conducted within 24 to 72 hours admission
 Nutrition screening can be a cost effective to decrease
complications and length of hospital stay
 Assesment of Nutrition status
Physical Examination Suggestive of Malnutrition
Laboratory Assessment Clinical Findings Acute/Chronic Disease
Anthropometric Measurements

 Are used to evaluate LBM and fat stores

 The most common measurements are :
• Weight
• Stature ( height or length, depending on age )
• Head circumference
• Wrist circumference, and
• Waist circumference
 The best indicator of adequate nutrition in a child is
appropriate rate of growth
 At each medical encounter, weight, statue, and head
circumference should be plotted on the appropriate
NCHS gender and age-based growth curve.
 In newborn, average weight gain is 10 to 20 g/kg per
day ( 24 to 35 g/day in term infants and 10 to 25 g/day
in preterm infants )
 Weight gain declines after 2 to 3 months of age
 Head growth, which is usually 0,5 cm/week
 Failure to thrive is defined as weight for age or weight-
for-height ( or length ) below the 5th percentile
 Short stature is associated with many chronic diseases
Body Mass Index

 BMI is defined as body weight in kilograms divided by

the square of the height in meters ( kg/m2 )
 It can be used to categorize both obesity and
undernutrition in adults and children
 A healthy weight is one associated with a reduction risk
 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 )
Skinfold Thickness and Midarm Muscle
Circumference

 Skinfold thickness measurement estimate of subcutaneous fat,

midarm muscle circumference
 Triceps skinfold thickness is commonly used skinfold
measurement
 Midarm muscle circumference is a calculated value based on
the measurement of the midarm circumference and triceps
skinfold thickness
Waist circumference

Waist circumference is used to assess abdominal

fat content
Excess abdominal fat is a predictor –related
complicationf risk for obesity
Waist-to-Hip ratio

 The waist-to-hip ratio is associated with undesirable

health consequences
Specific Nutrient Deficiencies

 Nutrition assessment must include an evaluation of

trace element, vitamin, and essential fatty acid
deficiencies.
 A deficiency of any of these nutrients may result in
altered metabolism and cell dysfunction and may
interfere with metabolic process necessary for nutritional
repletion
 Assessment of Trace Element Status
Trace Elements

 Trace elements are include :

• Zinc, copper, manganese, selenium, chromium, iodine,
fluoride, molybdenum, and iron
• Zinc :
 Involved in the regulation of gene expression
 Deficiency of zinc can cause abnormal GI losses :
malabsorptive state
 Plasma zinc concentrations decrease in acute stress
state such as : trauma, surgery, burns, or sepsis
 Copper :
 Involved in iron metabolism
 Copper deficiency include hypercholesterolemia,
anemia, skeletal demineralization
 In severe cases, copper deficiency is further manifested
as hypothermia, hair and skin depigmentation,
progressive mental deterioration, and growth
retardation
 Iodine :
 A component thyroid hormone, may result in goiter
formation
 Iron :
 It is an important component of hemoglobin, myoglobin,
and cytochrome enzymes
 It is important in oxygen transport, muscle iron storage,
and cellular energy production
 Patients with iron deficiency anemia generally present
with fatigue, weakness, and pallor
 Iron deficiency or overload is confirm by assessment of
body iron stores, as reflected indirectly by measurement
of hemoglobin, serum iron, total iron- binding capacity,
and serum ferritin
 Directly methods : liver biopsy
Vitamins

 Vitamins act as both catalysts ( cofactors ) and in

essential metabolic reactions in the body
 Vitamin toxicity can occur, especially with the fat-
soluble vitamins ( A, D, E, and K ), which are stored in the
body
 Excessive dietary intake of vitamin A ( hypervitaminosis A
) is increased risk of hip fracture
Assessment of Vitamin Status
Essential Fatty Acids

 The body can synthesize all fatty acids except £-linoleic

acid ) and linolenic acid.
 Essential fatty acid deficiency include : dermatitis,
alopecia, impaired wound healing, growth failure,
thrombocytopenia and anemia
Carnitine

 Carnitinine is required for transport of long-chain

fatty acids into the mitochondria and energy
production
 Other predisposing factors for carnitine deficiency
include : chronic kidney or liver disease, vitamin C
deficiency, chronic use of valproic acid and
zidovudine, and a vegetarian diet
The clinical presentation of carnitine deficiency
includes :
• Skeletal muscle weakness, fatty liver, and fasting
hypoglycemia,coma
 Carnitine is available from a wide variety of
dietary sources
Assessment of Nutrient Requirements

 Nutrition requirements depend on an individual ‘s clinical

condition
 For obese patients, usual nutrition requirements may be
altered because of the need for weight loss
 Organ function ( intestine, kidney, liver, and pancreas )
may affect nutrient utilization
Energy Requirements
 The Dietary Reference Intakes for macronutrients recommend that
adults consume :
• Carbohydrates : 45%-65%
• Fat : 20%-35%
• Protein : 10%-35%

• The recommendations for children :

• Carbohydrate : 45%-65%
• Fat : 30%-40%
• Protein : 10%-30%
 Estimating Energy Expenditure
 The most commonly used methods to determine energy
requirements use population estimates of calories per kilogram
of body weight ( kcal/kg )
 Daily adult requirements determined by using ABW or adjusted
IBW in kilograms :
• Healthy, normal nutrition status : 20-25 kcal/kg/day
• Malnourished or metabolically stressed : 25-30 kcal/kg/day
• Major burn injury ( > 50% TBSA ) : 30 kcal/kg/day
 Caloric requirements increase with fever, sepsis, major surgery,
trauma, burns, and long term growth failure
 The Harris-Benedict equations are a popular means for
assessing energy requirements in adults
Protein
 Daily protein requirements are based on age, nutrition
status, disease state, and clinical condition
 Protein metabolism depends on both kidney and liver
function, protein requirements are altered with kidney or
liver dysfunction
 RDA of protein :
• > 18 years : 0,8/kg/day
• Adults older than 60 years : 1,5 g/kg/day ( to reduce the
loss of LBM )
• Metabolic states such as : infection, sepsis, trauma, and
surgery : 1,5-2 g/kg/day
• Burned patients : 2,5-3 g/kg/day
• Pregnancy and lactating women : 1,1 g/kg/hari
Fat

 Total daily intake of fat should represent no more than

10%-35% of total calories

 Fiber
• Maintenance of normal bowel habits, lower blood
pressure, and lower cholesterol serum concentration
• Men and women > 50 years of age : 30 g/day and 21 g/
day of total fiber
Fluid
 The daily fluid requirement for an adult is 30-35 ml/kg.
 Micronutrients
 Requirements for micronutrients ( electrolytes, trace elements and
vitamins )
 Factors that affect micronutrient requirements include GI losses
through diarrhea, vomiting, hypermetabolism/catabolism
 Sodium, potassium, magnesium, and phosphorus- dependent
on kidney function. Calcium needs may be increased in these
patients
 Patients with malnourished will have increased electrolytes
requirements
Drug-Nutrient Interactions
Drug-Nutrient Interaction