NUTRITION

ASSESSMENT AND
CLASSIFICATION
HELENITA ARLENE MENDONES – MOROS
NUTRITIONAL ASSESSMENT
• Nutritional assessment is the systematic process of
collecting and interpreting information in order to
make decisions about the nature and cause
of nutrition related health issues that affect an
individual 
• is the interpretation of anthropometric,
biochemical (laboratory), clinical and dietary data
to determine whether a person or groups of ...
PURPOSE OF NUTRITIONAL
SCREENING
• The purpose of nutritional screening is to rapidly
identify patients who are at high nutritional risk or
have poor nutritional status at hospital
admission. Nutritional screening should include
dynamic parameters rather than static ones—for
example, recent weight loss, current body mass
index (BMI), ...
APPROACHES TO N.
ASSESSMENT
• The simplest approach to assessment is serial
weight measurement. A comprehensive nutritional
assessment includes (1) anthropometric
measurements of body composition; (2)
biochemical measurements of serum protein,
micronutrients, and metabolic parameters; (3)
clinical assessment of altered nutritional
requirements and social or psychological issues that
may preclude adequate intake; and (4)
measurement of dietary intake.
• Techniques for measuring body composition of fat
and lean body mass include anthropometry and
bioelectric impedance analysis. Other techniques,
including dual X-ray absorptiometry (DXA), hydro
densitometry, total body potassium measurement,
and cross-sectional computed tomography or
magnetic resonance imaging are available in
research centers. Anthropometry, including waist-
hip ratios, regional DXA and cross –sectional
imaging is best for detecting morphologic changes
associated with fat distribution syndrome.
NACS USER’s GUIDE
MODULE
• WHAT IS NUTRITION ASSESSMENT?
• Nutrition assessment includes taking
anthropometric measurements and collecting
information about the client’s medical history,
clinical and biochemical characteristics, dietary
practices, current treatment, and food security
situation.
WHY IS NUTRITIONAL
ASSESSMENT IMPORTANT
• Optimal Nutritional Status- the state of the body
with respect to each nutrient and overall body
weight and condition- is a powerful factor in
promoting health and preventing and treating
diseases. Weight loss of more than 10 % is
associated with prolonged hospitalization, while 35
% has been associated with death.
• Other reasons:
• To identify people at risk of malnutrition for early
intervention and referral
• To identify malnourished clients for treatment- if
not treated early have longer hospital days, slower
recovery from infection, and complications and
higher morbidity and mortality.
• To track child growth
• To identify medical complications that affect the
body’s ability to digest food and utilize nutrients.
• To detect practices that can increase the risk of
malnutrition and infection.
• To inform nutrition education and counselling.
• To establish appropriate nutrition care plans.
WHAT IS NUTRITION
SCREENING
• Assessment can be preceded by rapid and simple
identification of people who may be malnourished
or at risk.
• Nutritionists and trained facility-based health care
providers or community service providers can do
nutrition screening in health care facilities, during
growth monitoring or home based care, during
support group meetings. Checking for bilateral
edema, weight, mid-upper arm circumference
(MUAC) and asking about recent illness and appetite.
• NEEDS:
• Standardized training in line with local and national
health policy
• Training materials by low literacy/ illiterate
populations
• Government approved recording and referral
materials
• Clear guidance on provider roles, whom to screen,
how & how often.
• Incentives to do accurate and consistent
community nutrition screening and make referrals.
PRIORITY SCREENING
TARGETS BY HCARE
PROVIDERS
• Children below 2 yrs. Old, esp. if not breastfed
• Pregnant women and up to 6 mos. Postpartum
• People who report unintentional weight loss
• People who have been prescribed food products to
treat malnutrition
• People with disease-related symptoms that can be
managed thru diet
• People with HIV, tuberculosis or other chronic
diseases
HOW OFTEN IS NUTRITION
DONE TO TARGETS
RECOMMENDED:
Pregnant/post partum women- every antenatal visit
0- 6 months Infants-at birth and on scheduled post natal
visit
6-59months Infants- during monthly growth monitoring
sessions for children under 2 and every three months for
older children.
Children 5 yrs. and over- every clinic visit
Adolescents and adults- every clinic visit
People with HIV- clinic visits and when initiating
antiretroviral therapy (ART)
TYPES OF NUTRITIONAL
ASSESSMENT
• ANTHROPOMETRIC MEASUREMENT
• Weight, Height, MUAC, Head circumference and skinfold
• BMI-body mass index
• Weight- pre requisite for finding weight-for-height z-
score for children and BMI for adults. Unintentional
weight loss can mean poor health and reduced ability to
fight infection. Accurate weight measurement is very
important.
• Low pregnancy weight and inadequate weight gain during
pregnancy are the most predictors of intrauterine growth
retardation and low birth weight.
• Recommended Pre pregnancy BMI
Pre- pregnancy nutritional Pre-pregnancy BMI
status
Underweight Less than 18.5
Normal weight 18.5- 24.9
Overweight 25.0-29.9
Obese 30 or more

• BMI is not so accurate indicator during pregnancy,

MUAC should also be used.
• The main anthropometric measurement for
newborns is birth weight, which is not a measure of
acute malnutrition. Infants with low birth weight
(less than 2.5 kg.) are at higher risk of physical and
cognitive impairments and nutrition-related chronic
disease in later life. All infants lose weight
immediately after birth. Unless he loses 10% of his
weight is not a problem, if he regains his weight
after a week. Most double their weight at the end
of 5 months.
• Length and Height- measuring requires a height
board or measuring tape marked in (cm.)
centimeters. Measure length for children under
2yrs of age less than 87 cm long. Measure height
for 2 yrs. & older who are more than 87 cm tall and
for adults.
• WEIGHT-FOR- HEIGHT –WHZ is an index that is used
to assess the nutritional status of children from
birth to 59 months of age.
• The Monitoring and Assessment of Relief
Transmissions (SMART) Emergency Nutrition
Assessment(ENA) tool , available from the
Nutrisurvey website, calculates WHZ automatically.
• The SMART Training package is available online.
• MUAC- is the circumference of the left upper arm
measured at the mid-point between the tip of the
shoulder and the tip of the elbow, using a tape
measure. In mm. or cm. Measure pregnant and up
to 6 moths postpartum. Also for children instead of
WHZ, adolescents and non pregnant /post partum
adult. Not recommended for infants below 6
months.
• MUAC cutoffs , children 6 mo. To 14 yrs. of age
Severe Acute Moderate Acute NORMAL
Malnutrition Malnutrition Nutritional Status
6-59 months < 115 mm > 115 to < 125 mm > 125 mm
5-9 years < 135 mm > 135 to < 145 mm > 145 mm
10-14 years < 160 mm >160 to < 185 mm > 185 mm
adults

• MUAC cutoffs to classify nutritional status of adults

Non-pregnant/Non- Pregnant/ Postpartum Nutritional Status
Postpartum
< 185 mm < 190 mm SAM
> 185 to < 220 mm < 190 to < 230 mm Moderate Malnutrition
> 220 mm > 230 mm Normal Nut Status

• BMI- an indicator based on weight on height ratio.

• It is used to classify malnutrition in non-pregnant/
no post partum adults. Not used for clients with
edema. Use MUAC instead.
• Calculate BMI by dividing a person’s weight in kg.
by the square of the person’s height in meters.
Convert measurements in cm to m (100cm= 1 m)
Formula for BMI
weight in (kg)
• BMI = ___________
height x2(m)
BMI can also be found using look-up tables or BMI
nutrition intervention wheel
BMI values below or above the WHO range for
normal nutritional status indicate a need for nutrition
intervention to slow or reverse weight loss or to
reduce overweight.
BMI NUTRITIONAL STATUS
< 16.0 Severe Malnutrition
> 16.0 to < 17.0 Moderate Malnutrition
> 17.0 to < 18.5 Mild Malnutrition
> 18.5 to < 25.0 Normal Nut Status
> 25.0 to < 30.0 Overweight
> 30.0 Obesity
• BMI-for age- z- score
• BMI can be used to measure the nutritional status
of adults 18 yrs. of age because they have
completed their physical development.
• WHO BMI table 5-18 years of age:
BMI-for Age Nutritional Status

< -3 z- score Severe malnutrition

> - 3 z- score and < 2 z-score Moderate malnutrition

> - 2 z-score and < + 1 z- score Normal Nutritional Status

> + 1 z – score and < + 2 z - score Overweight

> + 2 z- score Obesity

Biochemical Assessment
• Means checking levels of nutrients in a person’s
blood, urine, stool. Lab test results can give
information about medical problems that may
affect appetite or nutritional status.
Clinical Assessment
1. Pitting Edema
2. Emaciation
3. Hair loss, changes in hair color
Clinical Assessment
• 4. Medical History- determine comorbidities with
nutritional implications, opportunistic infections, other
medical complications, use of medications with
nutrition-related side effects, food and drug
interactions and risk factors (smoking, alcohol use,
overweight) for disease.
Visible wasting, bilateral pitting edema in infants,
inability to suckle, ineffective breastfeeding, recent
weight loss or failure to gain weight, as well as risk
factors such as insufficient breast milk or absence of the
mother.
Assess infant feeding practices and access to breastmilk.
Dietary Assessment
• Assess food and fluid intake, quality, quantity,
appetite, changes in food preferences, food
allergies, intolerance, and reasons for inadequate
food intake before and after illness.
• The results are compared with RDA and counsel
clients on how to improve their diet.
• 24 hour recall- to quantify the average the dietary
intake for a group of people. Can be repeated to
recall the day to day, week after week variation in
food intake.
• Food Frequency questionnaire – examines how
often an individual eats certain foods and the size
of the portions. This method is inexpensive and
quick but under- reporting is common.
• Food Group questionnaire- to ask wether they ate
or drank any of those foods previously.
Food Security Assessment
• Having at all times both physical and economic access to
sufficient food to meet dietary needs to a productive,
healthy life.
• Food Availability-sufficient quantities of food available
consistently to all groups in a country, region or
household through domestic production, import or
assistance.
• Food access- adequate resource to obtain sufficient
quality and quantity of food.
• Food utilization/ consumption- proper biological use of
food by the body.
• Thank you so much!!!