NUTRITIONAL ASSESSMENT
MEASUREMENTS
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’s 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 quantity of the nutrient intake.
IN THE 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 interviewed by a
dietitian/nutritionist or nurse experienced in dietary
interviewing and is asked to recall everything that he/she ate
within the last 24 hr. or the previous day.
2. FOOD FREQUENCY QUESTIONNAIRE
Questions, however, should be modified based on the
information from the 24-hour recall.
3. DIETARY HISTORY
The dietary history is more complete than either the 24-hour
recall or food frequency intake questionnaire, although it
usually both of these sources. The dietary history contains
additional information about the ff:
1. Economics
2. Physical Activity
3. Ethic and Cultural Background
4. Home Life and Meal Pattern
5. Appetite
6. Allergies, Intolerance and Food Avoidances
7. Dental and Oral Health
8. Gastrointestinal Concerns
9. Chronic Diseases
10. Medication
4. FOOD DIARY RECORD
This method involves time, understanding, and motivation on
the part of the patient/client. The subject is asked to write
down everything he/she eats or drinks for a certain time
period. 3days, particularly 2 weekdays and 1 weekend day
have been found to be a representative time period for most
people.
5. OBSERVATION AND FOOD INTAKE
This method is the most accurate 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 usually eaten.
ANTHROPOMETRIC
This method is the most accurate 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 usually eaten.
COMMON ANTHROPOMETRIC MEASUREMENT
WEIGHT [FOR AGE]
ü Uses weighing scales such as beam balance scales
or clinical scales which are ideal or a bar scale in
absence of scales initially mentioned.
ü Assess body mass
ü A sensitive indicator of current nutritional status
ü Uses reference values for age or height or both of
population.
ü Key anthropometric measurement.
MEASURING TOOLS:
ADVANTAGE
• It is a simple as it is commonly used
• Weight can be determined fairly accurately by personnel
with minimum training.
DISADVANTAGE
• 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.
HEIGHT [FOR AGE]
ü Assess linear dimensions of the following:
• Legs
• Pelvis
• Spine
• Skull
ü Less sensitive and generally an indicator of past
nutritional status (chronicity of malnutrition)
ü Uses statiometer, anthropometric steel rods fixed
accurately and vertically to the wall; for infants (below
2 years), an infatometer is used.
TO MEASURE:

ADVANTAGE:
• 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.
WEIGHT FOR HEIGHT/LENGTH
ü Most accurate indicator of present or accurate state
of nutrition
ü An expression of leanness or wasting
ADVANTAGE
• It is nearly independent of age from 1 to 10 years.
• An expression of leanness or wasting.
DISADVANTAGE
• Height for age (mentioned above) is disadvantage.
SKINFOLD THICKNESS
ü Assess body composition, fat distribution and
hence reserve of calories.
ü Must be compared against standards for age and
sex at all ages.
ü Uses a reliable caliper (Harpenden, Lange or
USAMRNL)
BODY CIRCUMFERENCE
ü The head/chest circumference ratio is of value in
detecting PEM in early childhood. The head and
chest circumference are the same at six months of
age. After this age , the skull grows slowly and the
chest grows more rapidly.
ü The mid-upper arm circumference (MUAC) has
been mainly used on children from 1-6 years old
Between 1 and 4 years, the reference values
change a little, and the age need not be accurately
known.
BIRTH WEIGHT
ü It is related to maternal nutrition and socio-
economic status.
ü Usually taken as cut-off point for “low-birth weight
babies” is 2,500 grams.
MUAC
ADVANTAGE
• The advantage is the same as that in weight for age.
DISADVANTAGE
• Births are often unattended by health personnel.
• Other factor play role (gestational age, infectious and
toxemic episodes during pregnancy, etc).
BIRTH WEIGHT [WEIGHT-FOR-AGE]
Philippines classification of undernutrition (FNRI)
(based on Gomez’ classification)
• Depending on how far a 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% his/her ideal weight;
and
• Third degree or severely underweight, when the child’s
weight is only 60% or less of his/her ideal weight.
CLASSIFICATION OF NUTRITIONAL STATUS BY
MCLAREN AND READ (1972)
a. Overweight: 110% of standard weight
b. Normal weight: 90-109% of standard
c. underweight, mild: 85-89% of standard weight
d. undernourished, moderate: 75-84% of standard weight
e. undernourished, severe: 75% of standard weight
• The weight-for-height and height-for-age-combination
of these anthropometric measurements permits further
distinction bet. 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 stunning.
MALNUTRITION
• A common clinical and public health problem, affecting all
ages and all care settings
Definition:
A state in which a deficiency of nutrients such as energy,
protein, vitamins and minerals causes measurable adverse
effects on body composition, function or clinical outcome
THOSE AT RISK OF MALNUTRITION
• Sick, frail and elderly
• Cancer, Stroke
• Acute/chronic pain
• Chronic respiratory disorders, i.e. COPD
• Poor dentition
CLINICAL CONSEQUENCES INCLUDE
• Reduced muscle strength
• Impaired wound healing
• Longer recovery from illness/surgery
• Poorer clinical outcomes
• More frequent GP visits and hospital admissions
FACTS
• In 2010, 34% of hospital in-patients on admission were
medium/high risk of malnutrition
• 93% of those at risk from malnutrition, live in the community
• Malnutrition costs £13b per year and affects at least 2 million
people in the UK
• Effective and regular screening to identify malnutrition or risk
of malnutrition is essential
•Tackling malnutrition can improve
•nutritional status, clinical outcomes
•and reduce health care us
MALNUTRITION UNIVERSAL SCREENING TOOL
(“MUST”)
What is ‘MUST’?
• A five-step malnutrition screening tool for adults in hospital
and the community, including care homes, outpatient clinics
and general practice.
What does ‘MUST’ do?
• Identify those who may be malnourished or at risk of
malnutrition
• MUST Score of:
0 – low risk
1 – medium risk
2 or above – high risk

HOW OFTEN SHOULD PATIENTS BE SCREENED?

• All Hospital in-patients to be screened within 24hours of
admission, then weekly
• All outpatients at their first appointment
• All people in care homes on admission, then monthly
• All people on registration at GP surgeries
• And for all, upon clinical concern, including: • unintentional
weight loss, loose fitting clothes, wasted muscles
• fragile skin, poor wound healing
• poor appetite, altered taste sensation, impaired
swallowing
• altered bowel habit; or prolonged illness

MEDIUM AND HIGH RISK OF MALNUTRITION (MUST

SCORE greater 1)
• Should not automatically be prescribed Oral Nutritional
Supplements (ONS)
• Instead think “Food First!”
• Many already doing this, but everyone needs to put this into
practice.

TOOLS FOR ASSESSMENT OF NUTRITIONAL STATUS

SUBJECTIVE GLOBAL ASSESSMENT (SGA)

validated nutrition assessment tool that correlates well with
nutrition risk indices and other assessment data in
hospitalized patients.

MINI NUTRITIONAL ASSESSMENT (MNA) GERIATRIC NUTRITIONAL RISK INDEX (GNRI)

reliable and quick method for evaluating nutritional status in
older adults, >65 years old – Evaluates independence,
medication therapy, pressure ulcers, number of full meals
consumed per day, protein intake, fruit and vegetable intake,
fluid intake, mode of feeding, self-view of nutritional status,
comparison with peers, mid-arm and calf circumferences.
1. Is a widely used, simple and well-established tool to assess
nutritional risk. The purpose of this study was to assess the
association between GNRI and all-cause mortality in diabetic
foot ulcers patients undergoing minor or major amputations.
2. It has been used as a simple and valuable tool to predict
outcomes calculated from only serum albumin and the ratio
between actual and ideal body weight.

- GNRI is useful for predicting mortality even at the time of

dialysis initiation. Among the causes of death, GNRI was
strongly associated with infection associated death.

METHOD FOR CALCULATING GNRI

• Ideal Body Weight (IBW) was calculated from height and
GNRI was calculated using IBW, albumin (ALB) level, and
body weight (BW).
• IBW = Height x Height x 22
• GNRI =1.487 x ALB (g/dL) + 41.7 ( If BW IBW, we set BW/
IBW)ss