NUTRITIONAL

ASSESSMENT
Rizky S. Prawiradilaga, dr., M.Kes
Nutrition Department
NUTRITIONAL ASSESSMENT

 A structured way to establish nutritional status

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

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Nutritional Status
 the condition of the body as a result of the
intake, absorption and use of nutrition and
the influence of disease-related factors.
• Equilibrium of energy intake and energy
expenditure determine the energy status /
nutritional status
• Energy st. assessment for children  weight
for age.(W/Age)
• Energy st. assessment for adults  weight
for height (W/H) : Body Mass Index (BMI).
NUTRITIONAL STATUS
 Normal if : intake = expenditure
 Malnutrition
 Poor nutrition ( PEM)  intake <
expenditure
 Over nutrition (over weight and
obesity)  intake > expenditure
DEVELOPMENT OF
NUTRITIONAL DEFICIENCY
Continued..

A physician should know how to

determine the nutritional status of the
patients.

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Clinical implications
Malnutrition:
 Increases the risk of complications
 Reduces effectiveness of medical
treatment
 Lengthens hospital stay
 Increases mortality rate
 DETERMINATION OF
NUTRITIONAL STATUS

• Historical Information (food

intake)
• Anthropometric measurement
• Physical examination
• Laboratory examination
(Biochemical Analyses)

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Historical Information
 Health history
 Sosio economic history
 Drug history
 Diet history :
- Qualitative method
- Quantitave daily consumtion method
ANTHROPOMETRIC
DETERMINATION OF NUTRITIONAL
STATUS

Physical and body part measurements and

rough determination of body composition

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Continued..

Use of Anthropometric
Measurement:
 Growth monitoring
 Finding out amount, composition, size and
change of tissues
 Determining the extent of tissue depletion,
making prognosis and nutritional therapy
evaluation
 As an additional information of nutrient
intake history
 May detect moderate and advanced
malnutrition
Disadvantages of Anthropometric
Measurement:
 Can not detect NUTRITIONAL status
within a short period
 Can not detect specific nutrient deficiency,
e.g. Zn, Se deficiencies
 Less sensitive
 Less accurate/poor validity
 Less precise if the examiner is not
experienced
ANTHROPOMETRIC
MEASUREMENT
Measurement of Growth and Development:
Body weight (BW)
Body height (BH)
Circumferences of skull, chest, thigh, calf, ankle,
waist, mid arm
Measures of Body Fat and lean Tissue
Skin fold thickness (usually 4 location : triceps,
biceps, sub scapula, suprailiaca, calf, thigh)
Waist Circumference
BODY HEIGHT
Body height is measured with microtoise
 Must be calibrated
 Accuracy up to 0.1 cm
 Standing bare footed
 Standing relaxed, backwards towards the
meter
 Back of head, back, behind touch the meter
and forming a straight line
 Straight sight, chin parallel to the ground
 Lower microtoise until it touches the head
 Read (up to 0.1 cm)
 Take note Continue..
Continued..

If BH is lower than standard, energy/protein

deficiency has happened for a prolonged
period during growth (especially protein)
BODY WEIGHT
Instrument : balance scale, max. 140 kg
 Must be calibrated
 Minimally dressed
 At the same time and condition every day
 Standing relaxed
 Straight position
 Chin parallel to the ground
 Weight noted up to 0.1 kg
BODY WEIGHT/BODY HEIGHT

 Is a sensitive index of nutritional status

 Hurdle : the presence of edema prevents
the use of BW as a determining parameter
SF and circumference measurements are
needed

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BMI
(Body Mass Index = Quetelet index )
The ratio of BW/BH is termed Body Mass Index
= Quetelet Index

 BW / BH(m2)
 for most adult
 indirect measures of obesity
 easy, quick and more precise than skin
fold (SF)
 A definition of the level of adiposity
How to use
Nomogram
Continued..

Classification of BMI (kg/m2)

 Underweight < 18,5
 Normal 18,5 – 22,9
 Overweight > 23
at risk 23 – 24,9
Obese I 25 – 29,9
Obese II > 30
Waist Circumference
 Normal Female < 0,8 m
Male < 0,9 m
Asses abdominal fat content
Measuring the distance around the
smallest area below the rib cage and
above the umbilicus with the use of a
nonstretchable tape measure
♀ WHR >0.80
♂ WHR >0.90

Greater have a high

risk of problem
Measurement of Skin folds Thickness
(SF)
Used skin fold caliper Lange

 must be calibrated
 usually at 4 locations :
 Triceps skinfold
 Biceps
 Subscapular
 Suprailiaca
Triceps Skin fold

 Taken at the midpoint between the acromial

and olecranon
 The arm should hang relaxed at the patient’s
side
 Non stretch tape made of fiber glass or steel
 Triceps fatfold measures:

15mm in ♂

25mm in ♀

Suggest excessive body fat

 LABORATORY EXAMINATION
(BIOCHEMICAL)
 to estimate avaibilability in biological fluids
and tissues
 allow assessment of clinical, subclinical
nutrient deficiencies
 objectives data used in assessing
nutritional status
 to eliminate the inevitable inconsitency
associated subjective judgment
Determine the Blood Cholesterol