PHYSIOLOGIC VALUE

OF FOOD
FOOD refers to the solid and liquid materials taken into
the digestive tract that are utilized to maintain and build
body tissues, regulate body processes and supply heat,
thereby sustaining life.

FOOD is composed of various compounds, both organic

and inorganic so that any food is either a chemical
compound or a mixture of chemical compounds. These
compounds and elements can be grouped as either
organic and inorganic.
ORGANIC COMPOUNDS
are proteins, lipids, carbohydrates and
vitamins.

INORGANIC COMPOUNDS or
ELEMENTS are water and minerals.
Three Major Nutrients
Carbohydrates, Proteins, Fats – stand quite apart
from the other requirements of the body such as
vitamins and minerals since the former are needed in
comparatively larger quantities.

Vitamins and minerals act as catalysts which

prompt the three major nutrients to interact.
METABOLISM
METABOLISM – is derived from the Greek word
Metabolismos which means to change or alter.
 Metabolism is the chemical proccess of transforming
food into complex tiisue element and of transforming
complex body substances into simple ones, along with
the production of heat.
 It is the the totality of the chemical proccess in the
body by which substances are changed into other
substances to sustain life, thus it is the dynamic
concept of change underlying all life.
Energy is the force or power that
enables the body to do its work. In
nutrition, however, energy pertains to
the chemical energy locked in foodstuffs
brought about by metabolism.
ENERGY FROM FOOD
The Calorie
The unit of energy commonly used in human
nutrition is the kilogram calorie(kcal) or
simply calorie. It is the unit of measurement
for the energy that the body gets from food.
1,000 small calories = 1 kilocalorie or calorie
Calories are not eaten. They are by-products of
carbohydrates, proteins, and fats that that are
oxidized in the body. One kilocalorie is the
amount of heat energy required to raise the
temperature of 1 kilogram of water by 1 ˚C.
1. Fuel factor of carbohydrate = 4 calories per
gram
2. Fuel factor of fat = 9 calories per gram
3. Fuel factor of protein = 4 calories per gram
The total calorie content(total energy)
available from food can be measured by a
device called a bomb calorimeter.
The Joule
The Joule is the measure of energy in the
metric system.
1 calorie(kilocalorie) = 4.184 joule(kilojoules)
Example:
1 cup of milk = 170kcal
170 kcal x 4.184 kjoules = 711.28 kjoules
 Calculation of Food Value
The energy value of one tablespoon of sugar (15 gram) is
approximately 60 calories (15 x 4). Most foods, however,
are complex and contain proteins, fats, and carbohydrates.
For example, one cup of milk contains approximately:
12gms carbohydrates x 4 cal/gm = 48 kcal
8 gms proteins x 4 cal/gm = 32 kcal
10 gms fats x 9 cal/gm = 90 kcal

Total = 170 kcal

From this information, the percentage of each
nutrient can be calculated. To calculate the percentage
of kcalories from fat, for examples, divide the 90 fat
kcal by the total 170 kcal.

Where: 90 kcal / 170 kcal = 0.529 or 0.53

0.53 x 100%
= 53%
 Body Women Men
Weight
kg kcal kjoules kcal kjoules
40 1,550 6,500
45 1,700 7,100
50 1,950 7,500 2,200 9,200
55 2,000 8,200 2,350 9,800
60 2,050 8,400 2,500 10,500
65 2,200 8,600 2,650 11,100
70 2,300 9,200 2,800 11,700
75 9,600 2,950 12,300
80 3,050 12,800
85 3,200 13,400
90 3,350 14,000
COMPONENTS OF ENERGY
EXPENDITURE
Basal Metabolism
Basal metabolism, also known as the required energy
expenditure (REE), is the measure of energy needed by
the body at rest for all its internal chemical activities
which is approximately 1 calorie per kilogram of body
weight per hour for an adult. It is the minimum amount of
energy needed by the body at rest I the fasting state.
It also indicates the amount of energy needed to suction
the life processes: respiration, cellular metabolism,
circulation, glandular activity, and the maintenance of
body temperature. It accounts for more than one-half f
calorie requirements for most people. The Basal
metabolic rate (BMR) is the rate of basal metabolism in
a given person at a given time and situation. It
constitutes one-half of the calorie requirements for an
individuals.
Conditions Necessary
To ensure accuracy:
for BMR Test
1. The subject must be in fasting or post-absorptive state, at
least 12 hours after the meal. (The test is usually taken in
the morning.)
2. The subject must be awake, lying quietly, and free from
physical fatigue, nervousness, or tension as this causes
an increase in heat production.
3. The environmental temperature should be between 20˚C
- 25˚C so that the subject can maintain his/her body
temperature.
Values obtained in this test which are within the plus or
minus 10% are still considered normal.
Calculation of BMR
1. A simple method for the calculation of the BMR is to use the
rule of thumb 1kcal per kg per hour for adult male and 0.9
kcal per kg per hour for adult female. Thus, an individual
whose ideal body weight (IBW) is 50 kg has a basal
metabolic energy need of 1,200 kcal per day (50 x 1 kcal x 24
hrs). This value, however, may not be applicable for obese or
lean individuals.
Example: Male, 75 kg
= 1 kcal x 75 x 24
= 1,800 kcal
Female, 65 kg
= 0.9 kcal x 65 x 24
= 1,404 kcal
2. Another method is the Harris-Benedict formula,
developed in 1909, which uses information on weight,
height, age, and sex.

Example:
Males
REE = 66 + [13.7 x wt(kg)] + [5 x ht(cm)] – [6.8 x
age(yr)]
Females
REE = 655 + [9.6 x wt(kg)] + [1.8 x ht(cm)] – [4.7 x
age(yr)]
3. One more method used in obtaining the metabolic or
fat-free body size is called the biologic body weight
raised to the ¾ power.
The metabolic body size for the different body weights is
given in Table 32.
Once the metabolic body size is known based on
weight in kilograms, the figure is multiplied by 70, a value
which applies to all animals.
A 50-kg man’s REE = 18.8 x 70 = 1,326 kcal
4. The last method is developed by WHO/FAO/UNU in
1985.
It uses the following equation:
1.6 x wt(kg) + 879 = REE
Thus, a 50-kg man has a REE of 1,459 kcal.
Body Weights in kilogram and Metabolic Body Size (kg)¾
Kilograms Metabolic Body Size (kg)¾
5 3.3
10 5.6
15 7.6
20 9.5
25 12.1
30 12.8
35 14.4
40 15.9
45 17.4
50 18.8
65 21.6
70 24.2
80 26.7
90 29.2
100 31.6
 Factors that Affect the Basal
Metabolic Rate (BMR)

1. Surface area – The greater the body

surface are or skin area, the greater the
amount of heat loss, and, in turn, the
greater necessary heat produced by the
body. Muscle tissue requires more oxygen
than adipose tissue.
2. Sex – Women, in general, have a metabolism
of about 5% to 10% less than that of men even
when they are of the same weight and height.
Women have a little more fat and less
muscular development than men.
3. Age – The metabolic rate is highest during the
periods of rapid growth, chiefly during the
first and second years, and reaches a lesser
peak through the ages of puberty and
adolescence in both sexes. The BMR declines
slowly with increasing age to lower muscle
tone from lessened activity.
Body composition – A large proportion of inactive
adipose tissue lowers the BMR. Athletes with great
muscular development show about 5% increase I basal
metabolism over non-athlete individuals.

5. State of nutrition - A decrease in the mass of active

tissue such as in the case of undernourishment or
starvation causes a lowered metabolism often as much
as 50% below normal.
6. Sleep – During sleep, the metabolic rate falls
approximately 10% to 15% below that of waking
levels. This decreased rate is due to muscular
relaxation and decreased activity of the
sympathetic nervous system.
7. Endocrine glands – The endocrine glands, which
secrete hormones into the blood stream, are the
principal regulators of the metabolic rate. The male
sex hormones increase the BMR about 20% to 15%
and the female sex hormones a little less.
8. Fever – It increases the BMR about 7% for each
degree rise in the body temperature above 98.6˚F.
Adjustment of Kcalorie Allowances for adult Individuals
of Various Body Weights and ages
Ideal Body Weight Kcalorie Allowance
Men Kg lb 22 years 45 years 65 years
50 110 2,200 2,000 1,850
55 121 2,350 2,100 1,950
60 132 2,500 2,300 2,100
65 143 2,650 2,400 2,200
70 154 2,800 2,600 2,400
75 165 2,950 2,700 2,500
80 176 3,050 2,800 2,600
85 187 3,200 2,950 2,700
90 198 3,750 3,100 2,800
95 209 3,200 2,900
100 220 3,400 3,100
 Ideal Body Kcalorie Allowance
Weight
Wome Kg lb 22 years 45 years 65 years
n
40 88 1,550 1,450 1,300

45 99 1,700 1,550 1,450

50 110 1,800 1,650 1,500

55 121 1,950 1,800 1,650

58 128 2,000 1,850 1,700

60 132 2,050 1,900 1,750

65 143 2,200 2,000 1,850

70 154 2,300 2,100 1,950

 Computation of DBW (Desirable Body Weight)
1. Ador Dionisio’s Method
Height – For every 5 feet, allow 100 lbs for female and 110 lbs for
male. Then multiply the additional inches by 2.
Age – Multiply any age between 25 and 50 by 2 then divide by 5.
Example:
Male, 45 years old, 5’4” tall
Height = 5 feet = 110 lbs
4 inches x 2 = 8 lbs
118 lbs
Age = (45 years)2 = 18 lbs
5
DBW = 118 lbs + 18 lbs = 136 lbs
2. Tannhauser’s Method
Measure height in cm and deduct 100. From the
difference, take of its 10%.
Example:
Male, 45 years old, 5’4” tall
Height = 5’4 = 162.56 cm
162.56 – 100 = 62.56 cm
10% of 62.56 cm = 6.256
62.56 – 6.256 = DBW (kg)
DBW (kg) = 56.7 kg or 126 lbs
Physical Activity
Calorie requirements depend on the type and amount
of exercise. The more vigorous the physical work, the
greater the calorie cost. The kind of physical activity and
the amount of time spent determine the amount of
energy the body uses.
 Calorie Expenditure for Various Types of
Activities
Types of Activities Calories
Sedentary Activities
reading, writing, eating, watching TV office work, 80-100
sitting at work
Light Activities
cooking, washing dishes, ironing, welding, standing 110-160
at work, rapid typing
Moderate Activities
mopping, scrubbing, sweeping, gardening, 170-240
carpentry, walking fast, standing at work with
moderate are movement, sitting at work with
vigorous arm movement

Heavy Activities
heavy scrubbing, hand washing, walking fast, 250-350
bowling, golfing, heavy gardening
Specific Dynamic Action of Food
Carbohydrates or fat increases the heat production
of about 5% of the total calories consumed. It is the
energy required to digest, transport, and utilize
food.
Estimation of Daily Energy
Requirement of an Adult
The daily energy requirement of an adult is commonly
estimated by adding together the requirements for basal
metabolism, physical or muscular activity, and the
Specific Dynamic Action (SDA) of food:
1. Determine the DBW in kg of the individual.
2. Determine the basal needs:
Male = 1.0 kcalorie/kilo of DBW/hr x 24
Female = 0.9 kcalorie/kilo of DBW/hr x 24
3. Subtract 0.1 kcalorie/kilo of DBW/hours of
sleep.
4. Add the activity increment.
5. Add the SDA (10% f basal needs + activity
increment).
6. Sum equals the approximate daily calorie
requirement.
 Activity Increment

Activity Kcalorie per day

Men Women
Sedentary or light 225 225
work 750 500
Moderate work 1,500 1,000
Heavy work 2,500
Very heavy work
Estimation of Total Energy Need
The total energy need of an individual is
the composite of energy necessary to
replace basal metabolic needs, energy
expenditure for physical activities,
thermogenic effect of food, and other
factors.
 The total energy need of an adult may be determines
using one of the methods on the following.
1. The most practical and rapid method of estimating
energy need is based on desirable body weight (DBW)
according to occupation. This method is often used in
clinics and hospitals.
DBW According to Occupation
Occupation or Female Male
Activity
Kcal/lb Kcal/kg Kcal/lb Kcal/kg

Bed patient 12 25 14 30
Light work 14 30 16 35
Moderate work 16 35 18 40
Heavy work 18 40 20 44
Table 37
Approximate Increase Above Basal Need for Selected Activities
Active Category Percent Above Basal
Sleeping, reclining 10%
Very Light 30%
Sitting and standing, painting, driving, laboratory
work, typing, playing musical instruments, sewing,
ironing
Light 50%
Walking on level 2.5-3 mph, tailoring, pressing,
garbage work, electrical trades, carpentry work,
washing clothes, golfing, sailing, laying tables tennis,
playing volleyball
Moderate 75%
Walking on 3.5-4 mph, plastering, weeding and
hoeing, loading and stacking bales, scrubbing floors,
shopping with heavy load, cycling, skiing, playing
tennis, dancing
Heavy 100%
Walking with load uphill, tree-felling, work with pick
and shovel, playing basketball, swimming, climbing,
playing football
3. The daily energy need can also be determined
by referring to the recommended dietary,
allowances for Filipinos
Recommended Daily Energy Intake for
Age
Adults
Men Women
20-31 2,580 1,920

40-49 2,450 1,820

50-59 2,320 1,730

60-69 2,060 1,540

70-79 1,810 1,340

4. The fourth method is recommended by
FAO/WHO/UNU (1985).
To get the energy need, multiply REE by the type
of activity.
Energy Need based on Type f Activity
Type Activity Men Women
Very Light 1.3 1.3
Light 1.6 1.5
Moderate 1.7 1.6
Heavy 2.1 1.9
Very Heavy 2.4 2.2

Example:
Basal metabolic needs of a 50-kg man is 1,459 kcal x
1.7(moderate)
= 2,480 kcal
Energy Balance
The amount of energy taken in by an individual should be
equal to the amount of energy expended during the day. If
this is so, then the individual is said to be in energy
balance and, thus, attains a desirable body weight. A
desirable or ideal body weight is still debatable since body
weight is made up of fats, muscles, organs, bones, and
fluid. Two individuals having the same weight because of
the aforementioned components.

In the absence of tables, any of the two methods shown

here may be used.
1. Tannhauser’s Method
Height in centimeter = 157 cm
(factor) = 100
= 57 kg
(10% of answer obtained
to adjust weight to suit
Filipino standard) = 5.7
= 51.3 or 51 kg
2. For 5 feet, allow 100-105 lbs (females); 105-110 lbs (male).
For each additional inch, add 5 lbs.
5’2” = 105
+10
=115 lbs
The values above apply to adults with small frame. Add 5 lbs
for medium frame and 10 lbs for large frame.
Body Mass Index
The body mass index (BMI) is the ratio of weight to
height.
BMI = weight in kg
(height in meters)²
Example:
An individual who weighs 92 kg and is 175 cm
tall would have a BMI of 92 kg/(1.75 )² = 30.

(Note: Body weight and height should be measured

without shoes.)
Nutritional Screening and Assessment
Calculation
a. Determine the BMI – (1) Use monogram
– (2) Compute for the BMI using the
formula
– wt in kg/ht in m²
b. Determine the ideal body weight
Nutritionist-Dietitians’ Association of the Philippines formula
Formula: (1) Female 5’0” – 106 lbs
add 4 lbs for every inch thereafter
(2) Male 5’0” – 112 lbs
add 4 lbs for every inch thereafter
WATER AND ELECTROLYTE
BALANCE
 Water
> Water constitutes about 60% to 70% of the total
body weight so that a deprivation of water by as much as
10% will already result in illness and a 20% loss of body
water may cause death. It is next to oxygen in
importance for the maintenance of life.
> Water found in a normal adult human body total 45
liters. Two third of this (30 liters) is found inside or
within the cell while one third (15 liters) is outside the
cell.
 Functions
1. Water is the universal solvent.
2. Many chemical reactions require water. It serves as a
catalyst in many biological reactions especially those
that involve digestion, absorption, and circulation.
3. It is a vital component of tissues, muscles, glycogen,
and other and is essential growth.
4. Water acts as a lubricant of the joints and the viscera
in the abdominal cavity.
5. It is also a regulator of body temperature through its
ability to conduct heat.
 Water Intake
 The amount of water needed by the body may be met by
a direct intake of water, water ingested as such, or from
water bound with foods, and from metabolic water,
which is a result of oxidation of foodstuff in the body.
 Water produced as an end product of metabolism
amounts to approximately 14 g/11 cal. For example, 100 g
of fats, carbohydrates, and proteins when oxidized will
yield 107 mL, 60 mL, and 41 mL of water, respectively.
 Water Output
> Water leaves the body via several channels such as
through the skin as an insensible perspiration; through the
lungs as water vapor in the expired air; through the
gastrointestinal tract as feces; and through kidneys as urine.
> Water may also be lost together with electrolytes through
tears; stomach suction; breathing; vomiting; bleeding;
perspiration; drainage from burns; and discharge from
ulcer, skin diseases, and injured or burned areas.
Fluid Requirement Based on Caloric Expenditure
Using the Holliday-Segar Method
Weight Daily Requirement

3-10 100mL/kg
10-20 1000 mL + 50mL/kg for each kg in excess of 10
> 20 1500 mL + 20 mL/kg for each kg in excess of 20

Note : This method is not suitable for

neonates < 14 days old or for
conditions associated with abnormal
losses.
ABNORMALITIES OF WATER BALANCE
Over-hydration of Water Intoxication
When large amounts of water are lost in the body
usually caused by high environmental temperature,
sodium is also lost.
Dehydration
> This condition becomes serious if the loss is about 10%
of the total body water and fatal loss is from 20% to 22%.
It is especially critical in babies.
> Electrolytes are also lost with the water in this
condition, and the skin becomes loose and inelastic.
Nutritional Assessment
RECOMMENDED DIETARY ALLOWANCES
AND ADEQUATE DIET
An adequate diet is composed of various nutrients which
the body needs for maintenance, repair, living processes,
and growth or development. It is a diet which meets in
full all the nutritional needs of a person
> The dietary standard is changed from Recommended
Dietary Allowances (RDA) to Recommended Energy and
Nutrient Intakes (RENI) to emphasize that the standard
is in terms of nutrients and not foods or diets.
> RENIs are levels of intakes of energy and nutrients
which, on the basis of current scientific knowledge, are
considered adequate for the maintenance of health and
well-being of nearly all healthy persons in the
population.
ESSENTIALS OF AN ADEQUATE DIET
> Proteins, carbohydrates, fats, vitamins, minerals,
cellulose, and water should be provided in sufficient
quantity through the daily meals to meet the needs of
the body.
> The milk group is counted on to provide most of the
calcium requirements. It provides riboflavin, high-
quality protein, other vitamins and minerals,
carbohydrates, and fats. The milk allowance is used in
the form of fluid, whole or skim milk, buttermilk,
evaporated milk, dry milk, and cheese. A portion may be
used in cooking.
The meat groups provides a generous amounts of high-
quality protein. Iron, thiamine, riboflavin, niacin,
phosphorus, and zinc are supplied. At least once a week,
liver, kidney, and salt water fish such as salmon, oysters,
and mackerel should be included in the animal protein
allowance.
The bread and cereal group furnishes thiamine,
protein, iron, niacin, carbohydrate, and cellulose at a
relatively low cost. The enrichment of bread and cereals
with iron, thiamine, riboflavin, and niacin substantially
contributes additional amounts of these nutrients to the
diet.
The vegetable-fruit group is an important supplier or
fiber, minerals, and vitamins particularly vitamins A and
C.
 ASSESSMENT OF NUTRITIONAL STATUS
> Nutritional status or nutriture is the degree to which the
individual’s psychological need for nutrients is being met
by the food the person eats. It is the state of balance in the
individual between the nutrient intake and the nutrient
expenditure or need.
> The evaluation of the nutritional status involves
examination of the individual’s physical condition, growth
and development, behavior, blood and tissue levels of
nutrients, and the quality and the quantity of the nutrient
intake.
In a thorough nutritional status assessment,
all of the following aspects are considered:
1. Dietary history and intake data
2. Biochemical data
3. Clinical examination
4. Anthropometric data
5. Psychosocial data
METHODS OF ASSESSING DIETARY INTAKE
1. 24-hour Recall
The individual completes a questionnaire or is
interviewed by a dietitian/nutritionist or a nurse
experienced in dietary interviewing and is asked to recall
everything that he/she ate within the last 24 hours or the
previous day.
Example:
2. When was the first time you had anything to eat or
drink?
3. What did you have and how much?
4. When did you eat again?
5. Where?
6. What and how much
 SAMPLE 24-HOUR RECALL FORM
Name
Date / /
Day of Week(encircle): Sun Mon Tue Wed Thu Fri Sat
Time of Meal Food or Beverage Type of Preparation Amount

Was this intake unusual? Yes No

If so, how?

Do you take any vitamin or mineral supplement?

Yes No
If yes, describe:
Name or Type Dose(if known) How often
2. Food Frequency Questionnaire
It should be modified based on the information from the
24-hour recall. For instance, if a patient said he/she had
a glass of milk yesterday, he/she should not be asked,
“Do you drink milk?” but rather “How much milk do you
drink?” Answer should be recorded as 1/day, 1/wk, 3/mo,
for example, or as accurately as possible. It may just have
to be noted as “occasionally or rarely”.
3. Dietary History
The dietary history is more complete than either the
24-hour recall or food frequency questionnaire,
although it usually includes both of these sources. The
dietary history contains additional information about
the following:
1. Economics
a. Income
b. Amount of money for food each week
or month and individual perception of
its adequacy for meeting food needs
2. Physical Activity
a. Occupation
b. Exercise
c. Sleep – hours/day

3. Ethnic Cultural Background

a. Influence on eating habits
b. Religion
c. Education
4. Home Life and Meal Patterns
a. Number of household members
b. Person who does shopping
c. Person who does cooking and relationship with
this person
d. Food storage and cooking facilities
e. Type of housing
f. Ability to shop and prepare food
5. Appetite
a. Good, poor, any changes
b. Factors that affect appetite
c. Taste and smell perception
6. Allergies, Intolerances, and Food Avoidance
a. Foods avoided and reason
b. Length of time of avoidance
7. Dental and Oral Health
a. Problems with eating
b. Foods that cannot be eaten
c. Problems with swallowing, salivation, and food
sticking
8. Gastrointestinal Concerns
a. Problems with heartburn, bloating, gas,
diarrhea, constipation, distention
b. Frequency of problems
c. Home remedies
d. Antacid, laxative, and other drugs used
9. Chronic Diseases
a. Treatment
b. Length of time of treatment
c. Dietary modification
10. Medication
a. Vitamin and/or mineral supplement
b. Medications
4. Food Diary or Record
This method involves time, understanding, and
motivation on the part of the patient or client. The
subject is asked to write down everything he/she eats or
drinks for a certain time period. Three days, particularly
two weekdays and one weekend day, have been found to
be a representative time period for most people.
5. Observation of Food Intake
Observation of food intake is the most accurate method
of dietary intake assessment but also the most time-
consuming, expensive, and difficult. It requires knowing
the amount and kind of food presented to the person
and the record of the amount actually eaten.
EVALUATION OF THE FOOD INTAKE
DATA
Evaluation by Food Group Method
The simplest, fastest, yet crudest way to evaluate food
intake data is to determine how many servings from
each of the four food groups were consumed during the
recorded day. The number of servings is suggested in the
basic four or seven food plans.
General Rules for Menu Planning
1. Use the whole day as a unit rather than the
individual meal. Make breakfast relatively simple
and standardized, then plan dinner. Lastly, plan
lunch and snacks to supplement the other two
meals.
2. Use some food from each of the food groups
daily(energy-giving foods, body-building foods, and
body-regulating foods).
3. Use some raw fruits or vegetables at least once a day.
4. Plan to have each meal at least one food with
staying power or high in satiety value, one which
contains roughage, and generally some hot food
or drink.
5. Combine or alternate foods of bland from with
those of a more pronounced flavor.
6. Combine and alternate soft and crisp foods.
7. Have a variety of color, food, and food
arrangement.
8. When more foods are served at one meal,
decrease the size of portions and use fewer rich
foods.
Some Don’ts for Menu Planning
1. Avoid using the same kind food twice a day without
varying the form in which it is served except staples
like rice, bread, and milk.
2. Do not use the same food twice in the same meal
even in different forms.
3. Do not use the same food too often from day to day.
Other Considerations

1. Meal Patterns. Meal or menu patterns are

helpful in planning but they must take into
account the family’s habits and needs. For
example, the traditional pattern for
breakfast recommended by nutritionists
are:
Fruit bread or rice
Egg or substitute hot beverage
The following is a good menu guide for lunch
and dinner:
Meat, fish, or poultry rice
Vegetable fruit or dessert

2. Planning for the Week. It is best to have a

weekly menu plan. In hospitals, the practice
of dietitians is to prepare a so-called “cycle
menu.”
NUTRITION SURVEY
Nutrition Survey is an epidemiological
investigation of the status of the
population by various methods together
with an evaluation of the ecological
factors of the community.
Significance of Nutritional Assessment
1. It is the first essential in nutritional planning.
2. It provides data and information for planning and
evaluation.
3. It helps define priorities and responsibilities of
public health system at the national, regional,
provincial, city, municipal, and barangay levels.
Methods of Nutritional Assessment
A. Methods that provide direct information
1. Clinical examination
2. Biochemical examination
3. Anthropometric measurement
4. Biophysical technique
B. Methods that provide indirect information
1. Studies on food consumption
2. Studies on health conditions and vital statistics
3. Studies on food supply situation
4. Studies on socio-economic conditions
5. Studies on cultural and anthropological
influences
Factors Considered in the Selection of
Nutrition Survey Method
1. Unit to be surveyed
Example: household, individual, at-risk
group, etc.
2. Types of information required
Example: food intake, height and weight
measurement, hemoglobin level, socio-
economic conditions, etc.
3. Degree of reliability and accuracy acquired
4. Facilities and equipment available
Example: reasonable number, type, practically
5. Human resources
Example: nutritionist, medical technologist,
medical nutritionist, biochemist, local
extension worker, auxiliary worker; training
required
6. Time reference
Example: season of the year, day(weekend or
weekday), number of days of food record
collection (1 day, 3 days, 1 week)
7. Funding or financial support
Features of Methods and Reference
Standards Used
1. Clinical Assessment
a. Description
It deals with the examination of changes that can
be seen or felt in superficial tissues such as skin,
hair, eyes.
b. Advantages
b.1 More coverage in a short time
b.2 Inexpensive; no need for sophisticated
equipment
c. Disadvantages
c.1 Non-specificity of signs (signs may be due to non-
nutritional causes)
c.2 Overlapping of deficiency states (dietary
deficiencies are not restricted to an isolated
nutrient)
c.3 Bias of the observer (observations of two
examiners are most often not consistent with
each other)
c.4 Clinical signs known to be of value in nutrition
surveys and their interpretations
d. Clinical signs known to be of value in nutrition
surveys and their interpretations
d. Clinical symptoms of common nutritional problems
e.1 Protein-Energy Malnutrition
Classification
 Mild to moderate
 Severe
Marasmus (dry form)
Kwashiorkor (edematous form)
Marasmic kwashiorkor
Clinical Signs and Their Interpretations
Area Signs Associated Disorder or
Nutrient
1. Hair Lack of luster; thinness and Kwashiorkor; less commonly
sparseness; straightness, marasmus
dyspigmentation, flag sign; easy-
pluck ability
2. Face Nasolabial dyssebacea Riboflavin
Moon face Kwashiorkor
3. Eyes Pale conjunctiva Anemia (iron etc.)
Bitot’s spot Vitamin A
Conjunctival xerosis
Corneal xerosis
Keratomalacia
Angular palpebritis Riboflavin; pyridoxine
4. Lips Angular stomatitis Riboflavin
Angular scars
cheilosis
5. Teeth Mottled enamel Fluorosis
 Area Signs Associated Disorder or
Nutrient
6. Gums Spongy bleeding gums Ascorbic acid
7. Glands Thyroid enlargement Iodine
Parotid enlargement Starvation
8. Tongue Scarlet and raw tongue Nicotinic acid
Magenta tongue riboflavin
9. Skin Xerosis Vitamin A
Perifollicular hyperkeratosis Ascorbic acid
Petechiae Nicotinic acid
Pellagrous Dermatosis Kwashiorkor
Flaky paint dermatosis Riboflavin
Scrotal and vulval
dermatosis
10. Nails Koilonychia Iron
 Area Signs Associated Disorder or
Nutrient
11.Subcutaneous Edema Kwashiorkor
tissue Fat: Decreased Starvation; marasmus: obesity
Increased
12. Muscular Muscle wasting Starvation; marasmus; and kwashiorkor
and skeletal Frontal and parietal bossing Vitamin D
systems Ephyseal enlargement
Beading of ribs
Persistently open anterior fontanella
Knock-knees or bow legs
Thoracic rosary
Musculoskeletal hemorrhages
13. Internal Hepatomegaly Kwashiorkor
systems Psychomotor changes Kwashiorkor
a. Gastro -
intestina Mental confusion Thiamine; nicotinic acid
l Sensory loss Thiamine
b. Nervous Motor weakness
Loss of position sense
Loss of vibration
Loss of ankle and knee jerks
Calf tenderness Thiamine
Cardiac enlargement Tachycardia
c. Cardiac
e.2 Xerophthalmia –

It affects the eyes, gradually beginning with an

impairment of night vision. Initial stages may be
treated by supplementation of the daily diet with
Vitamin A. Severe cases need large supplements
and simultaneous treatment of the eye problem
with antibiotics.
Symptoms
Impaired night vision
Smokey conjunctiva
Dry eyes
Cornea softening and ulcers
e.3 Anemia –
Sole reliance on breast milk for children beyond six
months leads to anemia. Since blood cells require
both protein and iron for their formation, treatment
should concentrate on supplementing these nutrients
in the diet.
Symptoms
Tiredness
Paleness under the eyelid
Breathlessness
Heart palpitations
Paleness under the nails
Edema
e.4 Goiter –
The enlargement of the thyroid glands is due to its need for
iodine. If iodine is in short supply, the gland grows to try
and offset the deficit. The obvious neck swelling makes
the disease easy to diagnose.
It is more common in females, especially in puberty and
during pregnancy. The simple lack of iodine in the diet may
not be the cause of goiter if considerable quantities of
“goitrogenic” agents (kale, turnips, and some varieties of
cabbage) are also consumed.
 These food prevent the absorption of iodine in an
otherwise adequate diet. Goiter may be treated either
by the supplementation of normal diet with iodine,
usually added to salt; surgically; or by administering
thyroid extract with the help of a medical personnel.
Symptoms:
Swelling of the neck
Difficulty in swallowing
Difficulty in breathing
Tight feeling in throat
 Classification of Goiter by
Palpation
Grade Characteristics

0 > No palpable or visible goiter

1 A goiter that is palpable but not visible when the

neck is in the normal position (i.e., the thyroid
gland is not visibly enlarged). Nodules in a thyroid
that is otherwise not enlarged fall into this
category.
2 A swelling in the neck that is clearly visible when
the neck is in a normal position and is consistent
with an enlarged thyroid gland when the neck is
palpated.
e.5 Vitamin B2 or Riboflavin
Deficiency

Symptoms
 Magenta red tongue
 Sores at the angle of the mouth and folds of the
nose
 Itching and scaling of skin around nose, mouth,
scrotum, forehead, ear, scalp
2. Biochemical Assessment
a. Description
Estimation of time desaturation, enzyme activity, or
blood composition
a.1 Test are confined to two fairly easily obtainable
fluids: blood and urine.
a.2 Results are generally compared to standards, i.e.,
normal levels for age and sex.
b. Advantages
b.1 Objectivity, independent of the emotional and
subjective factors that usually affect the
investigator
b.2 Can detect early subclinical states of nutritional
deficiency
c. Disadvantages
c.1 Costly, usually requiring expensive equipment
c.2 Time-consuming
d. Factors affecting accuracy of results
d.1 Standards of collection
d.2 Methods of transport and storage of samples
d.3 Techniques employed
e. Common biochemical parameters/tests
f. Biochemical tests applicable and
interpretation

f.1 Protein
Methods
 Urea N/creatinine N ratio
Index of dietary adequacy
From over two – to 24-hour urine sample
 Index of 30 or lower in a random sample
indicative of malnutrition
 Amino acid imbalance test

 Ratio of four dispensable amino acids and

four indispensable amino acids in serum by
paper chromatography
 High (5-10) in kwashiorkor and low (less
than 2) in well-fed children
Hydroxyproline excretion in random urine
 Low (0.5-1.5) in clinically malnourished children;
normal: 2.0 to 5.0
Serum albumin
 Lowered in severe protein depletion
 Guide to interpretation (g/100 mL):
High 4.25
Acceptable 3.52-4.24
Low 2.80-3.51
Deficient less than 2.80
f.2 IRON

Hemoglobin determination
Cyanmethemoglobin method by
spectrophotometry
A.O. hemoglobinometer – simple
technique, handy equipment
Others: Sahli’s method; Tallquist methods;
copper sulfate specific gravity method
Hematocrit – Obtained from a finger prick
 A measure of red cell volume
 Values below which anemia is said to exist

Hemoglobin (grams %)

6 mos. to 6 years 11
6 years to 14 years 12
Adult males 13
Adult females – non pregnant 12
Adult females – pregnant 11
f.3 Vitamin A
Methods
 Serum vitamin A and serum carotene level by
spectrophotometry using micro and macro
methods.
 Low serum vitamin A reflects prolonged severe,
dietary deficiency probably up to 1 year in adults
and up to 4 months in young children.
 Serum carotene level is not indicative of vitamin
A status per se but it is useful because it reflects
recent ingestion of carotene-containing foods.
Anthropometric Measurements
a. Definition

Anthropometry is the measurement of

variations of the physical dimensions and gross
composition of the human body at different
age levels and degrees of nutrition.
b. Common anthropometric measurements
b.1 Weight (for age)
Uses weighing scales such as beam balance scales
or clinical scales which are ideal or a bar scale in
absence of the scale initially mentioned
Assesses body mass
A sensitive indicator of current nutritional status
Uses reference values for age or height or both of
population
Key anthropometric measurement
Advantages
It is a simple as it is commonly used.
Weight can be determined fairly accurately by
personnel with minimum training.
Disadvantages
It depends on accurate age determination (which is
sometimes difficult)
Interpretation on individual basis may be
complicated by edema.
It does not distinguish between acute and chronic
malnutrition but useful when serial measurements
are taken; useful also in children less than 1 year
old.
b.2 Height (for age)

Assesses linear dimensions of the following: legs,

pelvis, spine, and the skull
Less sensitive generally an indicator of past nutritional
status (chronicity of malnutrition)
Uses statiometer, anthropometric steel rods fixed
accurately and vertically to the wall; for infants (below
2 years), an infantometer is used.
Advantages
Inexpensive tools may be used.
It is simple to do in the field.

Disadvantage
It is less sensitive to changes in growth rate.
Errors in measurement are easily made.
Other factors play a role.
b.3 Weight for height/length
Most accurate indicator of present or current
state of nutrition
 An expression of leanness or wasting
Advantages
It is nearly independent of age from 1 to 10
years.
It is also probably independent of ethnic
groups especially in ages of 1 to 5 years.
Disadvantage
Height for age (mentioned above) is a
disadvantaged.
b.4 Skinfold thickness

Assesses body composition, fat distribution, and,

hence reserve of calories
Must be compared against standards for age and
sex at all ages
Uses a reliable caliper (Harpenden, Lange, )
b.5 Body circumferences
> The head/chest circumference ratio is of value in
detecting PEM in early childhood. The head and
chest circumferences are the same at six months
of age. After this age, the skull grows slowly and
the chest grows more rapidly.
> The mid-upper arm circumference (MUAC) has
been mainly used on children from 1 to 6 years
old. Between 1 to 4 years, the reference values
change a little, and the age need not to be
accurately known.
b.6 Birth weight
It is related to maternal nutrition and socio-
economic status
Usually taken as cut-off point for “low-birth
weight babies” is 2,500 grams.
Advantage
The ad vantage is the same as that in weight for
age.
Disadvantage
Births are often unattended by health personnel.
Other factors play a role (gestational age,
Infectious and toxemic episodes during
pregnancy)
Reference/Standards used

c.1 Weight-for-age – Philippine classification of

undernutrition (FNRI) (based on Gomez’
classification)
Depending on how far a child’s weight compares with
his/her standard weight, a child is classified as:
Normal, when the child’s weight is between 91% and
110% of his/her ideal weight:
First degree or moderately underweight, when the
child’s weight is only 76% to 90% of his/her ideal
weight.

Second degree or moderately underweight, when the

child’s weight is only 61% to 75% of his/her ideal
weight.

Third degree or severely underweight, when the

child’s weight is only 60% or less of his/her ideal
weight.
c.2 Weight-for-height –
Classification of nutritional status by McLaren and Read
(1972)
Overweight 110% of standard weight
Normal 90-109% of standard weight
Underweight, mild 85-89% of standard weight
Undernourished, moderate 75-84% standard weight
Undernourished, severe 75% of standard weight
c.3 The weight-for-height and height-for-age-

> combination of these anthropometric measurements

permits further distinction between acute malnutrition
(low weight-for-height, normal height-for-age) and
chronic malnutrition (low weight-for-height, low
height-for-age) as well as simple stunting.
> Thus, the diagram below shows the classification of
nutritional status using cut-off points for use in the
Philippines.
 Nutritional Status for Philippines
Use
Weight for height (wasting) 85% of reference
standards

85% and above Below 85%

90% and Normal Acute or recent malnutrition

Above (wasted)

Below Nutrition dwarfism Severe chronic malnutrition

90% (stunted) (stunted and wasted)
THANK YOU