Chapter 3. Nutritional Assessment part.pdf
- 1. Nutritional Assessment • A comprehensive evaluation of an individual's nutritional status to tell whether a person is well nourished or malnourished (Overnourishedor under nourished). • It involves gathering information by using theABCDmethods: 23-Jul-25 1 Muhumed Haji Abdi A)Anthropometricmethods B) Biochemical/ Laboratory methods C) Clinicalmethods D) Dietaryassessmentmethods
- 2. A) Anthropometricmethods • Anthropometryrefersto measurement of variationsof physical dimension (Height&Weight) and grosscomposition (body fat and fat freemass) of human body at different levelsand degreesof nutrition (Jelliff, 1966). • Anthropometricmeasurementsare usedto assess: 23-Jul-25 2 Muhumed Haji Abdi Physicalgrowthin children& Changesin bodycompositionin adults
- 3. A) Anthropometricmethods • Growth–Anthropometricmeasurementsforgrowthinclude: • Body composition–We considerthe bodyto madeup of twocompartments: 23-Jul-25 3 Muhumed Haji Abdi Headcircumference Length/height Weight BodyMassIndex(BMI) Skin foldthicknesses Hip circumference Waistcircumference Mid-upper armcircumference 1. Bodyfat 2. Fat-freemass
- 4. A) Anthropometricmethods • AnthropometricMeasurementsof Growth 23-Jul-25 4 Muhumed Haji Abdi Growthperformanceof childrenis an excellent reflectionof their underlyingnutritionalstatus. Childrenadaptto the chronicnutritionalinsultby eitherreducing their rateof growthor by totallyfailingto grow. Therefore, assessmentof growthperformanceof childrenis one very importantpurposeof anthropometricmeasurements.
- 5. A) Anthropometricmethods • AnthropometricMeasurementsfor Growth 23-Jul-25 5 Muhumed Haji Abdi Thefollowingbodymeasurementsaregoodindicatorsof growth performanceof children at different ageswhen combinedwiththe cut-offpoints. 1. Headcircumference(HC) 2. Heightor length 3. Bodyweight
- 6. A) Anthropometricmethods • AnthropometricMeasurementsfor Growth 23-Jul-25 6 Muhumed Haji Abdi
- 7. A) Anthropometricmethods • Headcircumference(HC) 23-Jul-25 7 Muhumed Haji Abdi Measuredusingflexiblemeasuringtapearound0.6cmwideto the nearest1mm. It is the circumference of the headalongthe supra-orbital ridge anteriorlyand occipital prominenceposteriorly. Usedin assessingchronicnutritionalproblemsin undertwochildren But after2 yearsas the growth of the brainis sluggishit is not useful.
- 8. A) Anthropometricmethods • Length: 23-Jul-25 8 Muhumed Haji Abdi Awoodenmeasuringboard(alsocalledslidingboard)is usedfor measuringlength. It is measuredin recumbent positionin children<2 yrs old to the nearest1mm. It is always> heightby 1-2cm An assistanceof twopeopleis needed in takingthe measurement. Measurementis readto the nearestmm.
- 9. A) Anthropometricmethods • Height: 23-Jul-25 9 Muhumed Haji Abdi Is measuredin children>2yrsandadultsin standingpositionto the nearest0.1 cm. Theheadshouldbe in the Frankfurt planeduringmeasurement,knees shouldbe straightand the heels, buttocksandshouldersblades, should touchthe verticalsurfaceof the stadiometer( anthropometer)or wall. Stadiometer or portableanthropometercan be used formeasuring. Thereis alsoa plastic instrument calledacustatStadiometerthat is cheaper thanthe conventionalStadiometer.
- 10. A) Anthropometricmethods • Weight: 23-Jul-25 10 Muhumed Haji Abdi Weighingsling(springbalance)alsocalledSalterscaleis usedfor measurementof weightin children< 2 years. In childrenthe measurement is performedto the nearest 10g. In adultsand children >2 years, beambalance is usedand the measurementis performed to the nearest0.1 kg.
- 11. A) Anthropometricmethods • IndicesDerived fromGrowthMeasurements • What is an index? 23-Jul-25 11 Muhumed Haji Abdi It is a combinationof twomeasurementsor a measurement plusage. Thefollowingarefewof them: Height-forage Weightfor height Weight-for-age Headcircumference-forage
- 12. A) Anthropometricmethods • Meaningsof the IndicesDerived from Growth Measurements 23-Jul-25 12 Muhumed Haji Abdi I. Height-for-Age(HFA) Index TheHFAindexreflectsa child’spast nutritionalstatus.It showshowa child’s heightcomparesto the heightof a child of the sameageand sex in theWHOstandards.Thisindex is usedto assessstunting. Stunting, or chronicundernutrition, is a formof undernutritionandpresentsas lowheight-for-age(HFA). It is defined by an HFAz-score belowtwoSDs of the median(WHOstandards). Stunting is a result of prolonged or repeatedepisodes of undernutritionwhichcanstartbeforebirth.
- 13. A) Anthropometricmethods • Meaningsof the IndicesDerived from Growth Measurements 23-Jul-25 13 Muhumed Haji Abdi II.Weightfor heightIndex TheWFH/WFLindexreflectsa child’scurrent nutritionalstatus. It showshowa child’sweightcomparesto the weightof a childof the same height/lengthandsexin theWHOstandards. Theindexis usedto assesswasting Wastingis a formof acutemalnutrition. It is definedby a MUAC< 12.5 cm or a WFH< -2 z-score(WHOstandards)in children6-59months.
- 14. A) Anthropometricmethods • Meaningsof the IndicesDerived from Growth Measurements 23-Jul-25 14 Muhumed Haji Abdi TheWFAindexreflectsa child’s combined currentand pastnutritional status. It showshowa child’sweightcomparesto the weightof a childof the sameageand sexin theWHOstandards. Theindexis usedto assessunderweight. Underweight is a compositeformof undernutritionincludingelementsof stunting andwastingandis definedby a weight-for-age(WFA) < -2 z-score(WHOstandards).
- 15. A) Anthropometricmethods • Indicators 23-Jul-25 15 Muhumed Haji Abdi An indicatoris an index+ a cut-offpoint. E.g. HFA<-3 z-score(WHOstandards) = is indicator of severeStunting WFH< -3 z-score(WHOstandards) = is indicatorof severWasting WFA< -3 z-score(WHOstandards) = is indicatorof severMalnutrition BMI < 18.5kg/m2 = indicatorchronicenergy deficiency
- 16. A) Anthropometricmethods • AnthropometricMeasurementsof Body composition 23-Jul-25 16 Muhumed Haji Abdi Linear growthceasesat aroundthe ageof 25-30years. Therefore, the main purposeof nutritionalassessment of adultsusing Anthropometryis determination of the changesof bodyweight and bodycomposition. We consider the bodyto madeup of twocompartments:the fat mass & the fat freemass. Thereforedifferent measurementsareused to assessthesetwo compartments: Totalbodymass=Fat mass+ fat freeMass.
- 17. A) Anthropometricmethods • AnthropometricMeasurementsof Body composition 23-Jul-25 17 Muhumed Haji Abdi Bodymass index(BMI) Waistto Hipcircumferenceratio Skin foldthickness Measurementsusedto assessfat mass:
- 18. A) Anthropometricmethods • AnthropometricMeasurementsof Body composition 23-Jul-25 18 Muhumed Haji Abdi Bodymass index(BMI): Bodymass indexis the bestmethod for assessing adultnutritional statusas the indexis not affected by the height of the person. Therefore,it is mostfrequentlyusedfor assessingadultnutritional status.
- 19. A) Anthropometricmethods • AnthropometricMeasurementsof Body composition 23-Jul-25 19 Muhumed Haji Abdi Bodymass index(BMI): Cut-off pointsfor BMI > 40kg/m2= veryobese 30-40kg/m2= obese 26-30kg/m2 =overweight 18.5-25kg/m2= Normal 17-17.9kg/m2= Mildchronicenergydeficiency 16-16.9kg/m2= Moderatechronicenergydeficiency < 16kg/m2= Severechronicenergydeficiency
- 20. A) Anthropometricmethods • AnthropometricMeasurementsof Body composition 23-Jul-25 20 Muhumed Haji Abdi Skin FoldThicknesses(SFT) Skin foldthicknessis doneat the followinganatomical sites: Bicepsskinfold Tricepsskinfold Subscapularskinfold Suprailliacskinfold Midaxillaryskinfold Thighskinfold Calfskinfold
- 21. A) Anthropometricmethods • AnthropometricMeasurementsof Body composition 23-Jul-25 21 Muhumed Haji Abdi Skin FoldThicknesses(SFT)
- 22. A) Anthropometricmethods • AnthropometricMeasurementsof Body composition 23-Jul-25 22 Muhumed Haji Abdi SkinFoldThicknesses(SFT) ThemeasurementshouldbeperformedusingprecisionSFTcalipers,which havea constantanddefinedpressureof 10g/sq.mmthroughouttherangeof measuredskinfolds. Skinfoldshouldbe readto thenearest0.5mmafter2-3secondsof caliper application. Measurementsare madein triplicateuntilreadingsagreewithin± 1.0mm. All themeasurementsshouldbemadeontheleftside???
- 23. A) Anthropometricmethods • AnthropometricMeasurementsof Body composition 23-Jul-25 23 Muhumed Haji Abdi WaistTo HipCircumferenceRatio It is thecircumferenceof thewaistmeasuredmid-waybetweenthelowestrib cageandanteriorsuperioriliacspinedividedbythecircumferenceof thehip measuredat thelevelof thegreater trochantorof thefumer(bothare measuredto thenearest0.5cm). If theratiois > 1 inmale,and> 0.87in femalethereis highriskof coronary heartdisease.
- 24. A) Anthropometricmethods • AnthropometricMeasurementsof Body composition 23-Jul-25 24 Muhumed Haji Abdi WaistTo HipCircumferenceRatio
- 25. A) Anthropometricmethods • Advantageof anthropometricassessment • Pitfallsof anthropometric assessment 23-Jul-25 25 Muhumed Haji Abdi Simple Inexpensive Accurate(objective) It cannot identifyspecificnutritionaldeficiencies Provide gradableresult Non-invasive
- 26. B) Biochemical / Laboratory methods • Measuresthe total amount or concentrationof nutrientsin the body fluids(blood, serum, urine)and storagesites • Thetestreflectrecent nutritionalstatus • It alsodetectssub-clinicaldeficiencies • Exampleof BiochemicalTests(laboratory) 23-Jul-25 26 Muhumed Haji Abdi Hemoglobin, VitaminA, Thiaminin urine, etc. Serumferritinlevel SerumHDL ErythrocyteFolate TissuestoresofVit. A,Vit D,
- 27. B) Biochemical / Laboratory methods • Advantages • Disadvantages 23-Jul-25 27 Muhumed Haji Abdi Detectsub-clinical malnutrition GivegradablenutritionalInformation Are more objective Needhighly trainedstaff Involveinvasiveprocedures Manyqualitycontrolproblemsduringsampletaking, carrying out the test,analysis. Etc Needsophisticatedinstruments
- 28. C) Clinical methods of assessment • It is the use of signs& symptoms to assessthe nutritional statusof children/adults. • It is cheap, noninvasive and quickmethod • Basedon the examinationof changesin the skin,Hair, buccalmucosaetc. • Drawbacks • Clinicalsignsof nutrition thatare usedfor nutritionass’t 23-Jul-25 28 Muhumed Haji Abdi PEM - Edema, easilypluckable & grayhair, flakypaint dermatosis, muscle wastingetc. Anemia- paleconjunctivaeandpalms VAD - Corneal xerosis, bitot spot, keratomalacia Verysubjective Lessspecific(otherdisease mayhavesimilarfeatures)
- 29. C) Clinical methods of assessment 23-Jul-25 29 Muhumed Haji Abdi Sign/ symptom Nutritional abnormality • Inability to see during the evening or dim light (Night blindness also called nyctalopia) • Bitot’s spots Vitamin A deficiency: • Easy bruising of skin • Spongy bleeding gums Scurvy (vitamin C deficiency) • Pale: palms, conjunctiva, tongue • Easy fatigability, loss of appetite shortness of breath Anemia: Which may herald, deficiency of: Iron, Vitamin B12, Folic acid, copper, protein (main causes of nutritional anemia)
- 30. C) Clinical methods of assessment 23-Jul-25 30 July 23, 2025
- 31. D) Dietary assessment methods 23-Jul-25 31 Muhumed Haji Abdi • Thismethodsincludeassessmentof pastor currentintakesof nutrientsfromfood by individualsor a groupin orderto knowtheir nutritionalstatus. • It assessthroughrecording foodintakeand translating it into nutrient consumed • Identifiesthe firststageof nutritionaldeficiency • Thenutritionaldeficiencycould be: Primary(lowlevelsin the diet) or Secondary(interferencewith absorption, transport, utilization, or excretion of nutrients becauseof somedrugs, dietarycomponents, or diseasestates) Or both
- 32. D) Dietary assessment methods Methods Used to assess current intake 1. Weighed record method Individuals weigh and record all foods and beverages consumed over a specific period. The emphasis is on the precise measurement of food portions using a scale. 2. Observed weighed method → Observation and weighing of all foods and beverages consumed by individuals by trained personnel. 3. Food Diary method ▪ Relies on individuals to self-report their food intake by recording details in a diary without the need for constant weighing or observation.
- 33. D) Dietary assessment methods Methods Used to assess past intake 1. Twenty-four-hour Recall → Subject recalls food intake of previous 24hr in an interview. →This involves all beverages, snacks deserts etc that have been ingested from x time yesterday to x time today. 2. Dietary History used to assess the nutrient intake of an individual or a group from food over a longer period of time, usually to see the association between diet and disease. 3. Food Frequency Questionnaire ▪ Uses comprehensive list of specific food items to determine the frequency of consumption of a particular nutrient over a given period (day, week, month, year).
- 34. Other Methods 23-Jul-25 34 Muhumed Haji Abdi • Nutritionalassessmentmay alsoinvolvecollectionon variablesknownto affect nutritionalstatusof a population. These mayinclude: Economicand socio-demographicdata (birthorder, marriagebreakdown, deathof either parent…) Cultural practices, foodhabits Foodprices Infoon marketing, distribution, & storageof food Healthandvital statistics: Coverageof safe water Immunizationcoverage Lowbirthweight rate Exclusivebreast feedingrate Ageandcause-specificmortality rates, etc