nutritional assessment and ABCD ASSESSMENTppt
- 1. Unit: I Introduction to Nutrition and Food Science, Food Groups and Food Pyramid Balanced diet for different age groups, Recommended dietary Allowances Assessment of Nutritional Status. Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0)
- 2. Unit: I Assessment of Nutritional Status Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0)
- 3. What is Food nutritional assessment ? Nutritional assessment is the interpretation of anthropometric, biochemical (laboratory), clinical and dietary data to determine whether a person or groups of people are well nourished or malnourished (over-nourished or under-nourished).
- 4. The ABCD methods Nutritional assessment can be done using the ABCD methods. These refer to the following: A. Anthropometry B. Biochemical/biophysical methods C. Clinical methods D. Dietary methods.
- 5. A: Anthropometry • anthropometry - Anthropo means ‘human’ and metry means ‘measurement’. • uses several different measurements including length, height, weight and head circumference.
- 6. A: Anthropometry Length • A wooden measuring board (also called sliding board) is used for measuring the length of children under 2 yrs old to the nearest millimetre • Measuring the child lying down always gives readings greater than the child’s actual height by 1-2 cm.
- 7. A: Anthropometry Measuring length. (Source: UNICEF, 1986, How to weigh and measure children: assessing the nutrition status of young children)
- 8. A: Anthropometry Height • measured with the child or adult in a standing position (usually children who are two years old or more). • head should be in the Frankfurt position (a position where the line passing from the external ear hole to the lower eye lid is parallel to the floor) • the shoulders, buttocks and the heels should touch the vertical stand. • Either a stadiometer or a portable anthropometer can be used for measuring. Measurements are recorded to the nearest millimetre.
- 9. A: Anthropometry Measuring height. (Source: UNICEF, 1986, How to weigh and measure children: assessing the nutrition status of young children)
- 10. A: Anthropometry Weight • A weighing sling (spring balance), also called the ‘Salter Scale’ is used for measuring the weight of children under two years old, to the nearest 0.1 kg. • In adults and children over two years a beam balance is used and the measurement is also to the nearest 0.1 kg. • In both cases a digital electronic scale can be used if you have one available. • Do not forget to re-adjust the scale to zero before each weighing. You also need to check whether your scale is measuring correctly by weighing an object of known weight.
- 11. A: Anthropometry (Source: UNICEF, 1986, How to weigh and measure children: assessing the nutrition status of young children)
- 12. A: Anthropometry (Source: Ethiopian Federal Ministry of Health, 2010, Training course of the out patient treatment programme of severe acute malnutrition)
- 13. A: Anthropometry The head circumference (HC) • measurement of the head along the supra orbital ridge (forehead) anteriorly and occipital prominence (the prominent area on the back part of the head) posteriorly. • measured using flexible, non-stretchable measuring tape around 0.6cm wide. • HC is useful in assessing chronic nutritional problems in children under two years old as the brain grows faster during the first two years of life. • But after two years the growth of the brain is more sluggish and HC is not useful.
- 14. A: Anthropometry
- 15. Converting measurements to indices • Weight-for-age is an index used in growth monitoring for assessing children who may be underweight. You assess weight-for-age of all children under two years old when you carry out your community-based nutrition (CBN) activities every month • Height-for age is an index used for assessing stunting (chronic malnutrition in children). Stunted children have poor physical and intellectual performance and lower work output leading to lower productivity at individual level and poor socioeconomic development at the community level An index is a combination of two measurements or one measurement plus the person’s age.
- 16. Converting measurements to indices • Body mass index is the weight of a child or adult in kg divided by their height in metres squared: BMI = Weight (kg) (Height in metres)2 •Birth weight is weight of the child at birth and is classified as follows: more than 2500 grams = normal birth weight 1500–2499 grams = low birth weight less than 1500 grams = very low birth weight
- 17. Converting measurements to indices
- 18. Indicator • An indicator is an index (for example, a scale showing weight for age, or weight for height) combined with specific cut-off values that help you determine whether a child is underweight or malnourished
- 19. Indicator Index Cut off value base on SD or percentage Indications Weight-for-age Less than 2 and more than 3 Moderate underweight Weight-for-age Less than 3 Severe underweight Height-for-age Less than 2 and more than 3 (i.e. 70-79.99% of the norm) Moderate acute malnutrition Height-for-age Less than 3 (i.e. 70% of norm) and bilateral pitting oedema Severe acute malnutrition (Source: Ethiopian Federal Ministry of Health, 2010, Training course of the out patient treatment programme of severe acute malnutrition)
- 20. Measurements of fat-mass (fatness) • Body Mass Index (BMI) is the weight of a person in kilograms divided by their height in metres squared. • A non-pregnant adult – BMI is 18.5 and 25 kg/m2 • If an adult person has a BMI of less than 16 kg/m2 they will not be able to do much physical work because they will have very poor energy stores. • In addition they will be at increased risk of infection due to impaired immunity.
- 21. Measurements of fat-mass (fatness) (Source: Ethiopian Federal Ministry of Health, 2010, Training course of the out patient treatment programme of severe acute malnutrition)
- 22. Measurements of fat-mass (fatness) (Source: Ethiopian Federal Ministry of Health, 2010, Training course of the out patient treatment programme of severe acute malnutrition)
- 23. Measuring fat-free mass (muscle mass) • An accurate way to measure fat-free mass is to measure the Mid Upper Arm Circumference (MUAC). • The MUAC is the circumference of the upper arm at the midway between the shoulder tip and the elbow tip on the left arm. • The mid-arm point is determined by measuring the distance from the shoulder tip to the elbow and dividing it by two. • A low reading indicates a loss of muscle mass.
- 24. MUAC (Source:Ethiopian Federal Ministry of Health, 2010, Training course of the out patient treatment programme of severe acute malnutrition)
- 25. Measuring fat-free mass (muscle mass) Target Group MUAC Malnutrition Children under five 11-11.9 Moderate acute malnutrition <11 cm Severe acute malnutrition Pregnant women/ Adults 17-21 cm Moderate malnutrition 18-21 cm with recent weight loss Moderate malnutrition <17 cm Severe Malnutrition <18 cm with recent weight loss Severe malnutrition
- 26. Clinical methods of assessing nutritional status Clinical methods of assessing nutritional status involve • checking signs of deficiency at specific places on the body • asking the patient whether they have any symptoms that might suggest nutrient deficiency from the patient. Clinical signs of nutrient deficiency include: • pallor (on the palm of the hand or the conjunctiva of the eye) • Bitot’s spots on the eyes • pitting oedema • goitre and severe visible wasting
- 27. Checking for bilateral pitting oedema in a child In order to determine the presence of oedema, • you should apply normal thumb pressure on both feet for three seconds (count the numbers 101, 102, 103 in order to estimate three seconds without using a watch). • If a shallow print persists on both feet, then the child has nutritional oedema (pitting oedema). • You must test for oedema with finger pressure because you cannot tell by just looking.
- 28. Checking for bilateral pitting oedema in a child (Source: Ethiopian Federal Ministry of Health, 2010, Training course of the out patient treatment programme of severe acute malnutrition)
- 29. Other Clinical Symptoms Bitot’s spots These are a sign of vitamin A deficiency. Look at the figure; as you can see, these spots are a creamy colour and appear on the white of the eye. Goitre is a swelling on the neck and is the only visible sign of iodine deficiency (Source: Ethiopian Federal Ministry of Health, 2010, Training course of the out patient treatment programme of severe acute malnutrition)
- 30. Other Clinical Symptoms Visible severe wasting • In order to determine the presence of visible severe wasting for children younger than six months, you will need to ask the mother to remove all of the child’s clothing so you can look at the arms, thighs and buttocks for loss of muscle bulk. Sagging skin and buttocks indicates visible severe wasting
- 31. Other Clinical Symptoms A child with severe visible wasting. (Source: Ethiopian Federal Ministry of Health, 2010, Training course of the out patient treatment programme of severe acute malnutrition)
- 32. Other Clinical Symptoms (Source: Ethiopian Federal Ministry of Health, 2010, Training course of the out patient treatment programme of severe acute malnutrition)
- 33. Other Clinical Symptoms Sign/Symptom Nutritional anormality Pale: palms, conjunctiva, tongue Gets tired easily, loss of appetite shortness of breath Anemia: may be due to deficiency of iron, folic, vitamin B12, acid, copper, protein or vitamin B16 Bitot’s spots Vit A deficiency Goitre Iodine deficiency disorder
- 34. Dietary methods of assessing nutritional status • Dietary methods of assessment include looking at past or current intakes of nutrients from food by individuals or a group to determine their nutritional status. • You can ask what the family or the mother and the child have eaten over the past 24 hours and use this data to calculate the dietary diversity score. • Dietary diversity score is an indicator of both the balance of nutrient consumption and the level of food security (or insecurity) in the household. • The higher the dietary diversity score in a family, the more diversified and balanced the diet is and the more food-secure the household.
- 35. Dietary methods of assessing nutritional status
- 36. Dietary methods of assessing nutritional status • As part of the dietary assessment you should also check the salt iodine level of households using the single solution kit (SSK). • This enables you to determine whether the salt iodine level is 0, more than 15 parts per million (PPM) or less than 15 PPM. • Normally, an iodized salt should have iodine level of more than 15 PPM to be effective in preventing iodine deficiency and its consequences.
- 37. Dietary methods of assessing nutritional status Testing salt iodine level using an SSK. (Photo: UNICEF Ethiopia / Dr Tewoldeberhan Daniel)