Clinical Nutrition in Practice

C and D of Nutrition Assessment

Clinical Assessment 2

Macronutrient • Kwashiorkor
Deficiencies • Protein Energy Malnutrition (PEM)

Micronutrient • Fat and water soluble deficiencies

Deficiencies • Mineral Deficiencies
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1.
Macronutrient Deficiencies
Macronutrient Deficiencies 4

Protein Energy Malnutrition (PEM)

» It is the cellular imbalance between the supply of nutrients

and energy and the body's demand for them to ensure growth,
maintenance, and specific functions.
Macronutrient Deficiencies 5

» Kwashiorkor:
It is the most common malnutrition caused
by deficiency of protein in diet.
» Marasmus:
It is due to the deficiency of Proteins along
with carbohydrates and fats.
2.
Micronutrient Deficiencies
Micronutrient Deficiencies 7

» Fat Soluble Vitamins Vitamin C

Vitamin A » Minerals
Vitamin D Calcium
Vitamin E Iron
Vitamin K Iodine
» Water Soluble Vitamins
B Vitamins
Vitamin A deficiency 8

» Vitamin A deficiency can result from a diet low in vitamin A or an

absorption or liver disorder. 
» Night blindness is an early symptom. Blindness can eventually
develop. The eyes, skin, and other tissues become dry and
damaged, and infections develop more often.
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Vitamin A deficiency- Bitot’s spot in a child

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Vitamin A deficiency – Bitot’s Spot in

Conjectiva
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Vitamin D 12

Vitamin D – precursor is cholesterol, converted by UV from sunlight

exposure, therefore is a “non-essential” vitamin

» Rickets (children)
» Osteomalacia (adults)
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Rickets

Bowed legs – characteristic of rickets

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Characteristic of Rickets

Beaded ribs – Characteristic of Rickets

Vitamin E 15

Vitamin E is a rare inherited disorder of fat metabolism that results

in poor absorption of dietary fat and Vitamin E. 
» Vitamin E deficiency is very rare in healthy people. It is almost
always linked to certain diseases in which fat is not properly
digested or absorbed. Examples include Crohn's disease, cystic
fibrosis, and certain rare genetic diseases.
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Vitamin E

Eczema characteristic of Vitamin E deficiency

Vitamin K 17

» Vitamin K plays a key role in helping the blood clot, preventing

excessive bleeding. Unlike many other vitamins, vitamin K is not
typically used as a dietary supplement.
» Low levels of vitamin K can raise the risk of uncontrolled bleeding.
While vitamin K deficiencies are rare in adults, they are very
common in newborn infants.
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Vitamin K
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Vitamin B1
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Vitamin B2
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» Sore lips/throat » Angular Cheilitis

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» Dermatitis » Seborrheic dermatitis

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Vitamin B3
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Pellagra
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Dermatitis
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Vitamin B5 (Pantothenic Acid)
Deficiency can result in acne, paresthesia, although it is uncommon
Vitamin B6 Deficiency 28

» Depression » Dermatitis
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Vitamin B7 deficiency

Hairloss due to Biotin Deficiency

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Vitamin B9 (Folate Deficiency)
Macrocystic Anemia
Vitamin B12 Deficiency 31

» Neurological degeneration of the » Demratitis caused by Vitamin B12

peripheral nerves
deficiency
Vitamin C Deficiency 32

» Petechiae are typical of blood » Type of gum disease

dyscrasias, vitamins
Mineral Deficiencies 33

» Iron
Koilonychia Pale Eyes
Calcium Deficiency 34
Iodine Deficiency 35

» Iodine is an element that is needed for the

production of thyroid hormone. The body
does not make iodine, so it is an essential
part of your diet. Iodine deficiency can
lead to hypothyroidism and enlargement
of the thyroid (goiter)
» Infants born to mothers who were iodine
deficient during pregnancy may result in
mental and physical disabilities in infants
Cretinism).
Dietary Assessment 36

Dietary Assessment can be carried out

utilizing various diet related questionnaires
including:

24-Hour Recall Method

Food Frequency Questionnaire
Food Record
Food Diary
Tools of Dietary Assessment 37

24 hour Dietary recall

Purpose:
To obtain detailed information about all the food and beverages consumed by the respondent in past 24 hours.
Data from 24 hour recall can include:
» Total amount consumed of each specific food and beverages.
» Total amount of each group of similar foods or beverages.
» The nutrient intake of food and beverages.
» Meal and snack pattern, consumption of food either home or away from home and other contextual
information.
» Population’s mean usual intake .
24 hour dietary recall 38
Tools of Dietary Assessment 39

Food Frequency Questionnaire

Purpose:
To obtain frequency and, in some cases, portion size information about food and beverage consumption over a
specified period of time, typically the past month or year.
Data from food frequency questionnaire can include:
» Depending on the breadth of items queried, data can be used to assess total dietary intake and/or
particular aspects of diet.
» Depending on whether portion size is determined, information may represent either usual frequency of
consumption only or total amount usually consumed.
» FFQs may be better than  (e.g., 24 hour dietary recall) at assessing intake of because they attempt to
directly capture usual intake over a period of time.
Food Frequency Questionnaire 40
Tools of Dietary Assessment 41

Food Record
Purpose:
To obtain detailed information about all foods and beverages consumed over a period of one or more days.
Data from food record can include:
» The record yields detailed information on foods and beverages (and if included, supplements) consumed
on a given day or over a period of days. The total amount of each specific food and beverage consumed is
captured.
» Similar types of food and beverage items reported, such as soups or sugar-sweetened beverages, can be
grouped. Totals for each group can then be summed.
» If information, including names of eating occasions, timing and locations of meals and snacks, sources of
food and beverages, and other activities such as TV and computer use during meals, is collected, records
can yield contextual information, such as meal and snack patterns, foods and beverages consumed at
home and away from home, and activities during meals.
Food Record 42
Tools of Dietary Assessment 43

Food Diary
A food diary is a daily log of what you eat and drink each day. The diary helps you and your
doctor understand your eating habits. It can help you realize what you consume.
The biggest problem with taking a food diary is under-reporting.
» Recording less than is actually consumed is very common - it can be on purpose, as people
don't want to be known to be eating certain foods, or most likely people are just trying to
recall what they have eaten and forgetting all the details. As the subject is recording food
intake as it is consumed, there is a risk of them changing their eating habits in response.
This method is also challenging to some people as they are required to accurately describe
their food and estimate portion sizes.
Food Diary 44