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3.4.3. Nutritional Assessment
3.4.3. Nutritional Assessment
I Wayan Weta, MS
School of Medicine
Udayana University/
RSUP Sanglah Denpasar
The purpose of Nutritional
Assessment
IDENTIFICATION OF NUTRITIONAL
DEFICIENCIES
CLASSIFICATION OF
MALNUTRITION
ESTIMATION OF NUTRITIONAL
REQUIRMENTS
Identification Nutrition-Related
Conditions
Nutritional Assessment
ABCD of nutritional
Assessment:
Anthropometric
Biochemical test
Clinical observation
Diet evaluation and
personal histories
Methods of Obtaining Intake
Data
Direct observation and nutrient analysis: can
be used only in controlled settings; doesnt
represent usual intake; calorie counts fall
into this category
Food record or diary: prospective tool; asks
client to record or weigh food intake for a
specific time period
Food frequency questionnaire: retrospective;
asks client to complete a survey about food
intake over a specific time period
24-hour recall: retrospective tool; asks client
about food intake during the previous 24
hours
Diet evaluation and
personal histories
Specific 24-Hour Food Record
Diet History
Periodic Food Record
Food Frequency Questionaire (FFQ),
Semi Quantitative FFQ (SM-FFQ)
method
Estimated food record
Strengths Weaknesses
Strengths Weaknesses
Greater precision than Eating behavior may
single 24-hour recall change
Not memory reliant Literate and numerate
dependent; requires
knowledge of portion
sizes
Considered actual High client burden
intake
Food Frequency
Questionnaire
Strengths Weaknesses
Low client burden Primarily provides qualitative
information
Quick and inexpensive Literate and numerate dependent
Strengths Weaknesses
Low client burden High staff burden
Client unaware of Intrusive
assessment
Not memory or literacy Difficult to attain and
dependent interpret
Does not represent usual
intake
Expensive
NCI Food
Frequency
Questionnair
e
Food Diary
10.00-12.00
Snack
12.00-13.00
Lunch
13.00-18.00
Snack
18.00-
Dinner
Addition questions:
Was intake unsual in any way? Yes/No
If yes, in what way?
Multi vitamin:_________________________________________
Other (list):
Qualitative Foods
Dietary Assessment
Food History
EXTRACELLULAR 20%
SKELETON 10%
Anthropometric
Measurement
Definition:
Measurement various dimension of the
human body, and its composition, in all
level of ages and nutritional status.
(Jelliffe, 1966).
Functions of
Anthropometrical Data
1. Measure the Growth Rate ( in Children)
Sex (m/f)
Height (H)(cm)
Weight (W)(kg)
Usual weight (UW)(kg)
W as (%) of UW
Ideal Body weight (IBW)(kg)
W as (%) of IBW
Anthropometrics
(cm)
MAC as (%) of standard
standar.
Fatfold Measurements
Courtesy Dorice Czajika-Narins, PhD
IDEAL BODY WEIGHT (IBW).
Hamwi Equetion
* H in cm
Anthropometrics
Height:
Body Mass Index (BMI)
BMI= Weight (kg)/Height2 (m2)
Body Measure:
Mid Arm Circumference (MAC)
Triceps skinfold (TSF)
MAMC = MAC - {3.14XTSF}
Nutritional status based on BMI
and IBW
BMI (kg/m2) Nutritional BW/IBW (%)
>30 state >120
25.1 29.9 Obese 111 -119
18,5 25.0 Overweight 90 110
17,0 -18,4 Normal 80 - 89
16.0 16.9 Mild PEM 70 -79
<16.0 Moderate PEM <70
Severe PEM
CALSSIFICATION OF OVERWEIGHT
AND OBESITY (WHO)
Obese 6 - -
(BMI >29)
Expected Weight Gain
Grafik pertambahan berat pada kehamilan
Trimaster I Trimaster II Trimaster III
10 kg 10 kg
5 kg 5 kg
0 0
Biochemical
Plasma Protein: Test
albumin,
hemoglobin,
hematocrit;
Additional:
prealbumin,
Thyroxin binding protein,
serum transferrin, or TIBC,
ferritin
Protein metabolism: 24 hour urine test
Urinary
Creatinin High Index (CHI)
CHI = Urinary Creatinine 24 hours X 100%
Expected Creatinin urine in IBW
Expected creatinin urine:
- men = 23 mg/kg IBW/24 hours
- women= 18 mg/kg IBW/24 hours
Interpretation:
- CHI > 80% : normal
-CHI 60-80% : moderate depletion skeletal muscle
-CHI 40-50% : Severe depletion of skeletal muscle
Urinary
N Balanced =
(protein intake:6.25) (urinary urea
Nitrogen+4)
Interpretation:
+ : Anabolic state
0 : Balanced state
- : catabolic state
Biochemical Test
(continued)
Immune System Integrity:
Anergy:
Lymphocyte count (TLC)
Skin testing
Delayed sensitivity (Mumps
or PPD tuberculin)
Biochemical Test
(continiud)
Laboratory Determinations:
Serum albumin (g/dL)
TIBC (g/dL)
Serum transferrin (TFN) (g/dL)
White blood cell count (No/mm3)
Total Lymphocyte count (No/mm3)
24-h urinary urea Nitrogen (g)
24-h urinary creatinine(mg)
CHI (%) standard
OBJECTIVE DATA
SOMATIC COMPARTMENT
MARKER Normal Mild Moderate Severe t 1/2
Nutrient deficiencies
Underlying disease requiring
modified nutrient or food plan
Personal culture and ethnic needs
Economic need
Drugs information that interact with
food and nutrient
Primary and Secondary
Nutritional Disease
Primary deficiency disease:
Lack of essential nutrient on the
diet
Secondary deficiency disease:
Results from one or more
barriers to use of the nutrient
after consumed food.
Nutrition-Related
Conditions
Two major Nutritional task:
1. Identify person at risk of
malnutrition because of their
disease, injury or life style.
Heart disease, hypertension, diabetes,
liver and renal disease.
Surgery, etc.
2. Analysis of intake to monitor
effectiveness of treatment
Problem List
Indicates:
Normal : >100
Mild malnutrition : 97.5-99.9
Moderat to severe malnutrition : <97.5
Hospital Prognostic
Index (HPI)
HPI=
(0.91*ALB)-(1.00*DCH)-(1.44*SEP)
+(0.98*DX)-1.09
ALB(g/dL), DCH: 1=+, 2= -, SEP: 1=+, 2= -, DX: 1=ca, 2=
others
Mortality Risk:
Low :<-1
Intermediate : -1 --+1
High :>+1
Summeries
Nutritional assessment:
The first step of medical nutrition Therapy
Begin with patient and family
The patient medical record: Communication
among health care team members
Porpuse , Identify:
Nutrient deficiency
Nutritional status
Nutrient requirement
Nutritional relative diseases
Evaluation and monitary medical nutrition
intervention
Refferences