NUTRITIONAL

ASSESSMENT
Nutritional Assessment: Defined
• Is the interpretation of
anthropometric, biochemical
(laboratory), clinical and dietary data
to determine whether a person or
groups of people are well nourished
or malnourished (over-nourished or
under-nourished).
 ABCD Method of Nutritional
Assessment
•A - Anthropometry
•B - Biochemical/biophysical
methods
•C - Clinical methods
•D - Dietary methods.
Anthropometric Measurement
• It is an essential feature of all nutritional
surveys
• Simplest and most practical
• Utilizes a number of physical signs
associated with malnutrition and
deficiency of vitamins and
micronutrients
Anthropometric Measurements
• Anthropometric Measurements used
to Assess Growth
• Length
• Height
• Weight
• Head Circumference
Anthropometric Measurements
• Anthropometric Measurements used
to Assess Body Composition
• Measurement of Fat-Mass
• BMI
• Measuring Fat-Free Mass
• Mid-Upper Arm Circumference
Anthropometric Measurements
• Weight
• The first step in anthropometric
measurement
• A pre-requisite for finding weight-for-
height z-score
• Unintentional weight loss can mean poor
health status and reduced ability to fight
infection
 Anthropometric Measurements
• Height
• This is measured with the child or adult in a
standing position (usually children who are two
years old or more). The head should be in
the Frankfurt position (a position where the line
passing from the external ear hole to the lower eye
lid is parallel to the floor) during measurement, and
the shoulders, buttocks and the heels should touch
the vertical stand. 
 Anthropometric Measurements
• Head Circumference
• The head circumference (HC) is the measurement of
the head along the supra orbital ridge (forehead)
anteriorly and occipital prominence (the prominent
area on the back part of the head) posteriorly.
• HC is useful in assessing chronic nutritional
problems in children under two years old as the
brain grows faster during the first two years of life.
But after two years the growth of the brain is more
sluggish and HC is not useful.
 Anthropometric Measurements
•Converting Measurements to Indices
• Weight-for-Age
• Height-forAge
• Weight-for-Height
• Body Mass Index
Nutritional Index Defined

•An index is a combination of two

measurements or one
measurement plus the person’s
age
Nutritional Index

• Weight-for-Age
• an index used in growth monitoring
for assessing children who may be
underweight.
 Nutritional Index
• Height-for-Age
• an index used for assessing stunting (chronic
malnutrition in children). 
• Stunted children have poor physical and intellectual
performance and lower work output leading to lower
productivity at individual level and poor
socioeconomic development at the community level.
• Stunting of children in a given population indicates
the fact that the children have suffered from chronic
malnutrition so much so that it has affected their
linear growth.
Nutritional Index
• Stunting 
• Defined as a low height for age of the
child compared to the standard child
of the same age. Stunted children
have decreased mental and physical
productivity capacity
Nutritional Index
• Weight-for-Height
• an index used for
assessing wasting (acute malnutrition).
• Wasting is defined as a low weight for the
height of the child compared to the
standard child of the same height. Wasted
children are vulnerable to infection and
stand a greater chance of dying.
Anthropometric Measurement
• Anthropometric Measurements used
to Assess Body Composition
• Measurement of Fat-Mass
•BMI
Anthropometric Measurement
• Measuring Fat-Free Mass
• Mid-Upper Arm Circumference
• the circumference of the upper arm at the
midway between the shoulder tip and the
elbow tip on the left arm. 
• The mid-arm point is determined by measuring
the distance from the shoulder tip to the elbow
and dividing it by two.
• A low reading indicates a loss of muscle mass.
• The only anthropometric measure for
assessing nutritional status among pregnant
women.
Mid-Upper Arm Circumference
Steps
• Ask the mother to remove any clothing that may
cover the child’s left arm. If possible, the child
should stand erect and sideways to the measurer.
• Estimate the midpoint of the left upper arm (arrow
6).
• Straighten the child’s arm and wrap the tape
around the arm at the midpoint. Make sure the
numbers are right side up. Make sure the tape is
flat around the skin (arrow 7).
• Inspect the tension of the tape on the child’s arm.
Make sure the tape has the proper tension (arrow
7) and is not too tight or too loose (arrows 8 and
9). Repeat any step as necessary.
• When the tape is in the correct position on the arm
with correct tension, read the measurement to the
nearest 0.1 cm (arrow 10).
• Immediately record the measurement.
TARGET GROUPS MUAC (in cm) MALNUTRITION

Moderate
11 – 11.9CM Acute
Malnutrition
Children under 5

Severe Acute
<11cm
Malnutrition
Non-Pregnant / Non-
Pregnant / Postpartum Nutritional Status
Postpartum

<185mm <190mm SAM

>185mm to >190mm to
MAM
<220mm <230mm

>220mm >230mm Normal

• Search for a sample menu for a given
situation.
• Analyze the caloric content of each item in
the menu.
• Using the Filipino Food Exchange List,
replace the items with its equivalent food
product.
• Submit your output using Legal-sized Bond
paper, Arial Narrow font 11 on September
23, 2019 at 8am.
Nutritional Assessment
• Biochemical Method
• Measurement of individual nutrient in
body fluids
• Used to detect abnormal amount of
metabolites in the urine
• It is useful in detecting early changes in
body metabolism and nutrition before the
appearance of overt clinical symptoms
 Nutritional Assessment
•Biochemical Method
• Limitations
• Time consuming
• Expensive
• Cannot be applied on large scale
• Needs trained personnel and facilities
Biochemical Method
•Serum Proteins
•Albumin
•Transferrin
•Prealbumin
•Retinol Binding Protein
Protein Function Significance

Allbumin Maintenance • Levels Increase With Dehydration, Blood And Albumin Transfusion, And
of plasma Anabolic Steroids
oncotic • Levels Decrease In Liver Failure, Inflammation, Volume Overload States
pressure; (Cirrhosis, Congestive Heart Failure, Renal Failure), Zinc Deficiency,
carrier protein Protein-losing States (Nephrotic Syndrome, Enteropathy), Corticosteroid
Use, And Bedrest

Transferrin Iron transport • Levels Increase During Dehydration, Iron Deficiency, Pregnancy, Estrogen
Therapy, And Acute Hepatitis
• Levels Decrease In Liver And Renal Failure, Inflammation, Anemia Due To
Chronic Disease And Vitamin B12 And Folate Deficiency, Corticosteroids,
Zinc Deficiency, And Protein-losing States (Nephrotic Syndrome,
Enteropathy)
Prealbumin Binds • Levels Increase In Renal Failure (Degraded By The Kidney) And
thyroxine; Corticosteroid And Oral Contraceptive Use
carrier for • Levels Decrease In Liver Failure, Inflammation, And Hyperthyroidism
retinol-binding
protein

Retinol- Vitamin A levels increase in renal failure (degraded by the kidney)

binding transport; levels decrease in cirrhosis, inflammation, vitamin A and zinc deficiency, and
protein binds to hyperthyroidism
(RBP) prealbumin
CLINICAL FINDINGS
 CLINICAL FINDINGS
M – inus amount of protein and calories
A – bsent edema
R – eally hungry (voracious eater)
A – lert and irritable
S- evere muscle wasting
M – more amount of protein, fats and carbohydrates
U – sually common in 1 year under
S – ubcutaneous fats not preserved
CLINICAL FINDINGS
• Features of KWASHIORKOR
K- (c) aloric protein malnutrition
W – asting
A – norexia
S – kin changes ( flaky paint dermatosis)
H – air changes (flag sign) and
H – ypoalbuminemia
I – nfection and Irritability
O – edema
R – etardation of growth
K – eratomalacia
O – rganomegaly
R – etention of subcutaneous fat
NUTRITIONAL SCREENING AND
ASSESSMENT TOOLS
• Malnutrition Universal Screening
Tool (MUST)
• Nutrition Screening Initiative
• Minimum Data Set
• Mini-Nutrition Assessment
Malnutrition Universal Screening Tool
(MUST)
• A nutritional assessment tool for
adults
• Parameters:
• BMI
• Weight History
• Effect of the Disease on Ability to
take Oral Nutrition
Nutrition Screening Initiative
•A nutritional tool aimed at
improving the routine nutrition
screening and assessment of
older adults in the community
•Uses the mnemonics
DETERMINE
Nutrition Screening Initiative
• DISEASE
• Any disease, illness or chronic condition which causes to
change the way an elderly eat, or makes it hard to eat.
• Four out of five adults have chronic diseases that are
affected by diet.
• Confusion or memory loss that keeps getting worse is
estimated to affect one out of five or more of older adults.
• Feeling sad or depressed, which happens to about one in
eight older adults, can cause big changes in appetite,
digestion, energy level, weight and well-being
Nutrition Screening Initiative
• EATING POORLY
• Eating too little and eating too much both lead to poor
health. Eating the same foods day after day or not
eating fruit, vegetables, and milk products daily will
also cause poor nutritional health.
• One in five adults skip meals daily. Only 13% of adults
eat the minimum amount of fruit and vegetables
needed.
• One in four older adults drink too much alcohol. Many
health problems become worse if you drink more than
one or two alcoholic beverages per day.
Nutrition Screening Initiative
• TOOTH LOSS/MOUTH PA I N
• A healthy mouth, teeth and gums are
needed to eat.
• Missing, loose or rotten teeth or
dentures which d o n ’t fit well, or cause
mouth sores, make it hard to eat
Nutrition Screening Initiative
• ECONOMIC HARDSHIP
• As many as 40% of older adults have
incomes of less than 20,000Php (PSA,
2016).
Nutrition Screening Initiative
• REDUCED SOCIAL CONTACT
• One-third of all older people live alone.
Being with people daily has a positive
effect on morale, well-being and eating.
 Nutrition Screening Initiative
• MULTIPLE MEDICINES
• Many older adults must take medicines for health
problems.
• Growing old may change the way we respond to
drugs. The more medicines you take, the greater
the chance for side effects such as increased or
decreased appetite, change in taste,
constipation, weakness, drowsiness, diarrhea,
nausea, and others.
Nutrition Screening Initiative
• INVOLUNTARY WEIGHT LOSS/GAIN
• Losing or gaining a lot of weight when you
are not trying to do so is an important
warning sign that must not be ignored.
• Being overweight or underweight also
increases your chance of poor health
 Nutrition Screening Initiative

• NEEDS ASSISTANCE IN SELF-CARE

• Although most older people are able to eat,
one of every five have trouble walking,
shopping, buying and cooking food,
especially as they get older
Nutrition Screening Initiative

• ELDER YEARS ABOVE AGE 80

• Most older people lead full and
productive lives. But as age increases,
risk of frailty and health problems
increase. Checking nutritional health
regularly makes good sense.
 QUESTIONS FROM THE NUTRITION SCREENING INITIATIVE
Determine Your Nutritional Health
QUESTION YES

I have an illness or condition that made me change the kind and /or 2
amount of food I eat
I eat a fewer than 2 meals per day 3

I eat few fruits or vegetables or milk products 2

I have 3 or more drinks of beer, liquor, or wine almost every day 2

I have tooth or mouth problems that make it hard for me to eat 2

I don’t always have enough money to buy the food I need 4

I eat alone most of the time 1

I take 3 or more different prescribed or over the counter drugs a day 1

Without wanting to, I have lost or gained 10lbs in the past 6 months 2

I am not always physically able to shop, cook and/or feed myself 2

 Nutrition Screening Initiative
• Interpretation
Total Score
0–2 Good
3–5 Moderate Nutritional Risk
6 – more High Nutritional Risk