Nutrition Assessment

• Nutrition care process: systematic problem-solving approach dietitians use to critically think and make decisions to address nutrition related problems and provide safe and effective quality nutrition care
• Nutrition care process components:

  Nutrition assessment, diagnosis, intervention, monitoring and evaluation
• Nutrition assessment: dietitians collect and documents information
• Nutrition diagnosis: data collected during nutrition assessment will guide the dietitian; selection of appropriate nutrition diagnosis
• Nutrition intervention: directed to the root cause or etiology of the nutrition problem; aimed in alleviating the signs and symptoms
• Nutrition monitoring and evaluation: final step in the process; determine if the patient is making progress
• Nutrition assessment: A systematic approach to collect, classify, and synthesize important and relevant data needed to identify nutrition-related problems and causes
• Nutrition assessment is a dynamic process that involved initial data collection and continual reassessment and analysis of the client's status and compare it to the standard recommendations and goals
• Nutrition monitoring and evaluation: Dietitians use the data collected and use it to determine changes in the client's behavior and nutritional status and efficacy of nutrition intervention
• For individuals, data will come from client through interview, observation, and documentation.

  For groups or populations, data will come from surveys, data sets, and research
• Anthropometric or body composition measurements includes height, weight, body mass index (BMI), growth pattern, percentile ranks, weight history
• Biochemical analysis uses laboratory data such as electrolytes, lipid panel, glucose HbA1c
• Clinical examination comprises the personal history, medical health family, and also includes physical examination
• Dietary analysis and assessment is used to determine the usual food intake with respect to nutritional recommendations that are specific to the patient
• Environmental assessment determines all aspects of an individual's environment or living conditions that may affect their ability to buy or make food
• Nutrition-focused physical examination is a systematic review of the entire individual, looking for signs of malnutrition with respect to macro and micronutrients
• Proteins are macronutrients and are made up of amino acids
• Protein: provides structure to the tissue; involved in metabolic, hormonal, and enzyme systems; maintain acid-base balance in our bodies
• There are 10 essential amino acids that must be ingested in our diet
• Proteins cannot be stored in the body that's why it needs to be taken daily. These are restricted in patient's with acute liver failure and end-stage renal disease
• Ideal protein biomarkers have short half-life and reflects changes in serum
• Protein biomarkers are affected by protein malnutrition from disease states
• Albumin is used in the assessment of hospitalized patients

  HALF-LIFE: 20 DAYS

  NORMAL LEVEL: >35 g/L
• Albumin is a predictor of mortality in patients that are in long-term healthcare facilities. It is an accurate marker for the catabolic stress during infection
• Albumin helps identify chronic protein deficiencies under conditions of Kwashiorkor and Marasmus
• Kwashiorkor is a chronic protein deficiency under conditions of adequate non-protein calories intake
• Marasmus is a severe manifestation of protein-energy malnutrition. It occurs as a result of total calorie insufficiency.
• Transferrin is a glycoprotein that transport ferric ions. It is used as an early indicator of iron deficiency and is decreased by protein or energy deficiency

  HALF-LIFE: 9 DAYS
• Transferrin is not a sensitive biomarker to detect changes in nutritional status in patients receiving two weeks of total parenteral nutrition
• Transthyretin effectively demonstrates an anabolic response to feeding due to its short half-life and small storage pool and correlates very well with nitrogen balance.
• Transthyretin is a good marker for visceral protein synthesis and patients receiving metabolic or nutritional supprot

  HALF-LIFE: 2 DAYS
• Transthyretin aka Thyroxine binding Prealbumin/Prealbumin
• Retinol-binding protein is used in monitoring short-term changes in nutritional status

  HALF-LIFE: 12 HOURS (has short half-life and small storage pool)
• There is a potential problem in using your retinol-binding protein as a biomarker or nutritional marker because it is excreted in the urine

  When patients have renal disease, this will cause an increase in the retinol binding protein giving a false increase in the nutritional status of the patient
• Insulin-like growth factor 1 (aka Somatomedin C) is important for the stimulation of growth. It is regulated by growth hormone and nutritional intake that's why it is used as a nutritional marker in adults and children
• Fibronectin is an opsonic glycoprotein which regulates phagocytosis.

  HALF-LIFE: 15 HOURS
• Fibronectin is an alpha 2 glycoprotein that serves important roles in cell-to-cell adherence, tissue differentiation, wound healing, microvascular integrity, and opsonization of particulate matter or bacteria.
• Levels of fibronectin as decrease after physiologic damage that iscaused by severe shock, burns, or infection. It is a good indicator for sepsis and burn patients.
• Nitrogen balance: difference between nitrogen intake and excretion. Most widely used indicators of protein change and adequacy of feeding in a controlled setting
• 90-95% of daily nitrogen losses is accounted by elimination throughthe kidneys. Determination of a 24-hour urinary urea and nitrogen is a method for estimating the amount of nitrogen excretion.