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Nutritional Assessment in Hospitalized Patients: Tools and Methods

This article discusses the process of nutritional assessment in hospitalized patients, including anthropometric measurements, clinical evaluation, biochemical assessment, and dietary evaluation. It also explores the use of ESPEN guidelines and provides insights into clinical assessment for detecting malnutrition.

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Nutritional Assessment in Hospitalized Patients: Tools and Methods

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  1. بسم الله الرحمن الرحيم

  2. Nutritional assessment in hospitalized patients M. Safarian, MD PhD.

  3. Nutrition Care Process Steps • Nutrition Assessment • Nutrition Diagnosis • Nutrition Intervention • Nutrition Monitoring and Evaluation

  4. Nutritional care process Anthropometrics Nutritional assessment tools

  5. Nutritional Assessment • Anthropometric assessment • Clinical evaluation • Biochemical, laboratory assessment • Dietary evaluation

  6. ESPEN guidelines Questions to be answered: • What is the condition now? • Is the condition stable? • Will the condition get worse? • Will the disease process accelerate nutritional deterioration?

  7. Anthropometric methods in ICU • Weight • Height estimation • Mid-arm circumference • Skin fold thickness • Head circumference

  8. Weight

  9. Ideal Body Weight (kg) • Men=48+ 2.3 for each inch over 152 m • Women=45.3+2.3 for each inch over 152 cm • Correction for skeletal size:

  10. Ideal Body Weight (kg) • Add 10% if SS is large • Subtract 10% if SS is small

  11. Adjusted body weight • Used when actual body weight is more than 120% of IBW: • ABW=IBW+ 25% of (actual body weight - IBW)

  12. Height in ICU patients

  13. Alternative measurementsEstimating Height from ulna length

  14. Estimations of height

  15. Body composition (BIA) Very popular Safe Noninvasive Portable Rapid

  16. معرف ميزان چربي زير پوستي و درنتيجه ميزان چاقي خواهد بود. محلهاي اندازه گيري: تريسپس، بايسپس،زير کتف و بالاي تيغه ايلياک . مشکلات عملي: خطاي در اندازه گيري. مشکلات اندازه گيري. وارياسيون توزيع چربي در افراد مختلف (فردي وجمعيتي). حساسيت کم. Skin Fold Thickness

  17. Skin Fold Thickness

  18. Mid arm circumference • measured with a nonstretch measuring tape • midway between the acromion and olecranon of the nondominant arm • ≤ 15 cm: severe depletion of muscle mass • 16–19 cm: moderate depletion • 20–22 cm: mild depletion

  19. Mid arm circumference

  20. BMI estimation If MUAC is <23.5 cm, BMI is likely to be <20 kg/m2 If MUAC is >32.0 cm, BMI is likely to be >30 kg/m2

  21. Clinical assessment

  22. CLINICAL ASSESSMENT • Detectiong of physical signs, (specific & non specific), that may be associated with malnutrition. • Nutritional history • General clinical examination, with special attention to organs like hair, angles of the mouth, gums, nails, skin, eyes, tongue, muscles, bones, & thyroid gland. • Detection of relevant signs helps in establishing the nutritional diagnosis

  23. CLINICAL ASSESSMENT

  24. General: muscle wasting

  25. Flaky paint dermatosis: protein deficiency

  26. Essential fatty acid deficiency syndromes (EFADs)

  27. Zinc deficiency

  28. Zinc deficiency

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