Assessment: Dietary and Clinical Data

1. Chapter 14 Assessment: Dietary and Clinical Data

2. Nutritional Status A measurement of the degree to which the individual’s physiologic need for nutrients is being met Nutrient intake Nutrient requirements

3. Nutrition Imbalance Nutrition is an important factor in the etiology and management of several major causes of death and disability Homeostasis within safe ranges of intake Deficiencies and excesses Undernutrition and overnutrition Nutritional risk

4. Development of Deficiency

5. Nutrition Screening Purpose: To quickly identify individuals who are malnourished or at nutritional risk and to determine if a more detailed assessment is warranted Usually completed by DTR, nurse, physician, or other qualified health care professional At-risk patients referred to RD

6. Characteristics of a Nutrition Screening Simple and easy to complete Routine data Cost effective Effective in identifying nutritional problems Reliable and valid

7. Nutrition Questionnaire

8. Nutrition Screening Tools Acute-care hospital or residential setting Perinatal service Pediatric practice Malnutrition Universal Screening Tool (MUST) Nutrition Screening Initiative (NSI)

9. Nutrition Assessment A comprehensive evaluation, completed by a registered dietitian, for defining nutritional status using medical, social, nutritional, and medication histories, physical examination, anthropometric measurements, and laboratory data Gather adequate data to make professional judgment about nutritional status

10. Nutrition Assessment Goals Identify individuals who require aggressive nutritional support Restore or maintain nutritional status Identify appropriate MNTs Monitor efficacy of interventions

11. Nutrition Histories Medical and social histories Medication history Nutrition or diet history

12. Nutrient Intake Analysis At least 72 hours Daily food record or food diary Food frequency questionnaire 24-hour recall Advantages and disadvantages

13. Food Diary

14. Anthropometry Involves obtaining physical measurements of an individual and relating them to standards that reflect the growth and development of the individual Evaluate overnutrition and undernutrition Important to use proper technique Serial measurements most valuable

15. Interpretation of Height and Weight Children’s growth charts Length and height Weight: ideal weight for height, actual body weight, % weight loss BMI

16. Using Height and Weight to Assess Nutritional Status

17. Calculating BMI BMI = Weight (kg) divided by (height [m]2) Appropriate BMI between 18.5 and 24.9

18. Body Composition Subcutaneous fat (skin-fold thickness) Circumference measurements Waist circumference Midarm circumference Head circumference Calf circumference

19. Skinfold Calipers Measure the Thickness of Subcutaneous Fat Tissue in Millimeters Courtesy Dorice Czajika-Narins, PhD

20. Other Methods of Body Composition Underwater weighing Total body potassium Neutron activation analysis BIA CT Ultrasound and MRI DEXA Air displacement plethysmogram

21. Nutrition-Focused Physical Examination Physical signs Equipment Examination techniques Findings Immune function Handgrip dynamometry Biochemical analysis

22. Classifying Malnutrition Body weight Body fat Somatic and visceral protein stores Laboratory values

23. Focal Points Nutrition screening is needed to identify those individuals who would benefit from more in-depth nutrition assessment, intervention and follow-up. Careful and meticulous nutritional assessment is an important tool in patient management. Adaptations of the exact content of the screening and assessment will vary according to the patient’s medical diagnosis and clinical setting. A skilled registered dietitian uses the screening and assessment process to make the best possible decisions about the specific nutritional diagnoses, interventions, desired outcomes and evaluation.