Nutriti
Nutrition Assessment ## Defining Nutritional Status
Nutritional status: Refers to the degree of balance between nutrient intake and nutrient requirements.
Affected by numerous factors: physiologic, psychosocial, developmental, cultural, and economic.
Optimal nutritional status: Achieved when sufficient nutrients are consumed to support day-to-day body needs and any increased metabolic demands (e.g., due to growth, pregnancy, or illness).
Under nutritional status: Occurs when nutritional reserves are depleted or when nutrient intake is inadequate to meet day-to-day needs or added metabolic demands.
Over nutritional status: Caused by the consumption of nutrients, especially calories, sodium, and fat, in excess of body needs.
Obesity Statistics
Estimated 16\% of children and adolescents, ages 2 to 19, are overweight or obese.
Over 70\% of adults in the United States are either overweight or obese.
Definitions:
For children (2 to 19 years): Overweight is defined as a Body Mass Index (BMI) equal to or greater than the 85^{th} percentile based on age- and gender-specific BMI charts.
For adults:
Overweight is defined as a BMI of 25 or greater.
Obesity is defined as a BMI of 30 or greater.
Being overweight during childhood and adolescence is associated with an increased risk for becoming overweight during adulthood.
Obesogenic Environment
Description: An environment that encourages large portions of high-fat, energy-dense foods and fails to encourage healthy behaviors such as physical activity (Endalifer & Diress, 2020).
Impact of television & technology: Ads focusing on fast foods; playing video games/smartphone activities.
Promoting a positive environment of change:
Removing soda/candy machines from school areas.
Placing grocery stores in food deserts.
Creating safe places to exercise and play outdoors.
Developmental Competence: Infants and Children
Rapid growth period:
Birth to 4 months of age is the most rapid period of growth in the life cycle.
Infants typically double their birth weight by 4 months and triple it by 1 year of age.
They increase length by 50\% during the 1^{st} year and double it by 4 years of age.
Brain size increases to 50\% of adult size by 2 years of age, 75\% by age 4, and 100\% by age 8 .
Breastfeeding recommendations:
Ideally formulated to promote normal infant growth and development.
Provides natural immunity through IgA antibodies.
Other advantages: Fewer food allergies and intolerances, reduced likelihood of increased feeding, less cost than commercial formulas, increased maternal-baby interactions.
Nutrient requirements: Fat, calories, and essential fatty acids are crucial for proper growth and central nervous system development.
Milk recommendation: Whole milk is recommended until 2 years of age.
Developmental Competence: Adolescence
Characterized by: Rapid physical growth and endocrine and hormonal changes.
Increased nutrient needs: Caloric and protein requirements increase to meet the demands of rapid growth, bone growth, and increasing muscle mass.
Specific mineral needs: Calcium and iron requirements also increase, especially in girls due to the onset of menarche.
Dietary patterns: Increased requirements often cannot be met by three meals per day; therefore, nutritious snacks play an important role in achieving adequate nutrient intake.
Activity levels: Childhood is the most active period in the life span, with levels of activity decreasing during adolescence.
Developmental Competence: Pregnancy and Lactation
Nutrient needs: To support the synthesis of maternal and fetal tissues, sufficient calories, protein, vitamins, and minerals must be consumed.
CDC recommended weight gain based on BMI:
25 to 35 lbs for women of normal weight.
28 to 40 lbs for underweight women.
15 to 25 lbs for overweight women.
11 to 20 lbs for obese women.
Developmental Competence: Adulthood
Nutrient needs: Growth and nutrient needs stabilize during adulthood.
Health status: Most adults are in relatively good health, but lifestyle factors can lead to the development of disease.
Lifestyle factors impacting health: Cigarette smoking, stress, lack of exercise, excessive alcohol intake, and diets high in saturated fat, cholesterol, salt, and sugar and low in fiber.
Importance of education: Adult years are a crucial time for health education to preserve health and to prevent or delay the onset of chronic disease.
Metabolic Syndrome (MetS) emergence: A concern leading to increased cardiac risk.
Diagnosed by the presence of 3 of the following 5 biomarkers:
Increases in Blood Pressure (BP).
Increases in fasting plasma glucose.
Increases in triglycerides.
Increased waist circumference.
Low HDL cholesterol.
Developmental Competence: The Aging Adult
Malnutrition risk: As people age, they are at increased risk to develop undernutrition or overnutrition.
Major risk factors for malnutrition in older adults: Poor physical or mental health, social isolation, alcoholism, limited functional ability, poverty, and polypharmacy.
Normal physiologic changes affecting nutritional status: Poor dentition, decreased visual acuity, decreased saliva production, slowed gastrointestinal motility, decreased gastrointestinal absorption, and diminished olfactory and taste sensitivity.
Energy requirements: Decrease in energy requirements due to loss of lean body mass and increase in fat mass.
Sarcopenia: Age-related loss of muscle mass.
Sarcopenic obesity: Low muscle mass with excess fat.
Genetics and Environment
Obesity epidemic: Continues to grow exponentially; estimated 1 in 5 adults worldwide to have obesity by the year 2025.
Types of obesity:
Monogenic: Early-onset severe obesity.
Polygenic or common: A combination of genetic and environmental factors.
Genetic contribution: Ranges from 40\% to 70\% of obesity risk.
Culture and Nutrition
Cultural heritage: Each person has a unique cultural heritage that can significantly affect nutritional status.
Immigrant patterns: Immigrants commonly maintain traditional eating customs long after adopting the language and dress of their new country.
Factors impacting eating customs: Occupation, socioeconomic level, religion, gender, and health awareness.
Newly arriving immigrants: May arrive malnourished due to limited food supplies in their country of origin, unfamiliarity with new foods, and disruption of food habits. Commonly occurring nutritional problems are observed.
Cultural factors and dietary practices to consider:
Cultural definition of food.
Frequency and number of meals eaten away from home.
Form and content of ceremonial meals.
Amounts and types of foods eaten and regularity of food consumption.
Cultural food preferences are interrelated with religious dietary beliefs and practices, which helps in suggesting improvements or modifications that do not conflict with dietary laws.
Fasting and other religious observations may limit a person's food or liquid intake during specified times; knowing these practices is essential.
Types of Nutritional Assessment
Nutrition Screening
The 1^{st} step in nutritional assessment.
Parameters include: Weight and weight history, conditions associated with increased nutritional risk, diet information, and routine laboratory data.
A variety of valid tools are available for screening different populations:
Malnutrition Screening Tool (MST): Validated for use in adult acute-care patients.
Mini Nutritional Assessment (MNA): Validated for use in older adults in long-term care and community settings.
Individuals identified at nutritional risk during screening should undergo a comprehensive nutritional assessment.
Comprehensive Nutritional Assessment
Components:
Dietary history and clinical information.
Physical examination for clinical signs and anthropometric measures.
Laboratory tests.
Methods for Collecting Dietary Intake Information
24-hour recall: The individual or family member provides a detailed account of everything eaten within the past 24 hours.
Advantage: Specific dietary intake information can be collected over a defined period.
Disadvantages: Individuals may not accurately recall type or amount of food; intake may be atypical; individuals may alter the truth; snack items and use of gravies, sauces, and condiments may be underreported.
Food frequency questionnaire: Collects information on how many times per day, week, or month an individual eats particular foods, providing an estimate of usual intake.
Advantage: Obtains information about multiple time frames.
Disadvantages: Does not always quantify intake; relies on memory for frequency.
Food diaries or records: Individuals or family members write down everything consumed for a certain period (e.g., 3 days, typically two weekdays and one weekend day).
Advantage: Most complete and accurate if information is recorded immediately after eating.
Disadvantages: Noncompliance, inaccurate recording, atypical intake on recording days, conscious alteration of diet during the recording period.
Direct observation of feeding with documentation: Can detect problems not readily identified through standard interviews.
Mobile apps: Increasingly used to assess and monitor intake, including taking photos of meals and tracking weight changes and dietary adherence.
Standardized dietary guidelines: Can help determine the adequacy of a diet.
ChooseMyPlate.
Dietary Guidelines.
Dietary Reference Intakes (DRIs).
Subjective Data: Nutritional History
Eating Pattern Questions
Number of meals/snacks per day?
Type and amount of food eaten?
Fad, special, or alternative diets?
Where is food eaten?
Food preferences and dislikes?
Religious or cultural restrictions?
Ability to feed self?
Usual Weight Questions
What is your usual weight?
Is your weight 20\% below or above desirable weight?
Have you had a recent weight change? How much lost/gained? Over what time period?
Reason for loss or gain?
General Nutritional History
Changes in appetite, taste, smell, chewing, swallowing.
Recent surgery, trauma, burns, infection.
Chronic illnesses.
Nausea, vomiting, diarrhea, constipation.
Food allergies or intolerances.
Medications and/or nutritional supplements.
Patient-centered care.
Alcohol or illegal drug use.
Exercise and activity patterns.
Family history.
Additional History for Specific Populations
Infants and Children (obtained from responsible person/caregiver):
Relevant questions related to gestational nutrition.
Whether infant was breastfed or bottle-fed.
Child's willingness to eat what is prepared.
Overweight and obesity risk factors.
Adolescents:
Present weight.
Use of anabolic steroids or other agents to increase muscle size and physical performance.
Overweight and obesity risk factors.
Age of first menstruation (menarche).
Pregnant Women:
Number of pregnancies and pregnancy history.
Food preferences during pregnancy.
Aging Adult:
Prior dietary history in ages 40s and 50s.
Factors affecting present dietary intake.
Vitamin D and calcium intake.
Objective Data: Clinical Signs and Anthropomorphic Measures
Clinical Signs
General appearance observation: Can provide clues to overall nutritional status (e.g., obese, cachectic—fat and muscle wasting, or edematous).
Specific clinical signs of nutritional deficiencies: late manifestations, only readily detectable in areas with rapid turnover of epithelial tissue (skin, hair, mouth, lips, and eyes).
Note: Signs may also be non-nutritional in origin; laboratory testing is necessary to make a clinical diagnosis.
Anthropometric Measures
Derived weight measures:
Percent usual body weight: \text{Percent usual body weight} = \frac{\text{current weight}}{\text{usual weight}} \times 100
Recent weight change: (As presented in the source, this formula is identical to Percent usual body weight; typically, recent weight change is calculated as \frac{\text{current weight} - \text{usual weight}}{\text{usual weight}} \times 100 ).
Body Mass Index (BMI): A practical marker of optimal weight for height and an indicator of obesity or protein-calorie malnutrition.
\text{BMI} = \frac{\text{weight(kg)}}{\text{height (meters}^2)} or \text{BMI} = \frac{\text{weight (lbs.)}}{\text{height (inches)}^2} \times 703
Waist-to-hip ratio: Assesses body fat distribution as an indicator of health risk.
\text{Waist to hip ratio} = \frac{\text{Waist circumference}}{\text{hip circumference}}
Waist circumference (WC): Alone predicts health risk.
Arm span or total arm length: Useful when height is difficult to measure.
Measure distance from the sternal notch to the tip of the middle finger and multiply the number by 2 . (Arm span is nearly equivalent to height).
Serial assessment: Made at routine intervals (weekly, biweekly, or monthly) dependent on the patient population.
Cardinal Features of Long-Term Weight Loss
Individualized and based on realistic patient goals.
Culturally sensitive.
Regular physical exercise: 4 to 5 times a week for 30 minutes.
Eating a low-calorie, low-fat diet:
Caloric intake: 1400 to 1500 kcal/day.
Fat intake: 20\% to 25\% of total calories.
Monitoring daily food intake: Food diary, portion size, weight.
Classification of Malnutrition
Obesity: Obese appearance.
Marasmus (protein-calorie malnutrition): Starved appearance.
Kwashiorkor (protein malnutrition): Swollen abdomen and extremities (edema), often with a distended belly, due to severe protein deficiency despite adequate caloric intake. Hair changes, skin lesions, and impaired immune function are also common.