Part 1

• Nutritional Status or Nutriture


  The degree to which an individual's physiological need for nutrients is being met by the food they are eating. The degree of balance between nutrient intake and nutrient requirement.
• Methods of Nutritional Assessment

  • Anthropometric Measurement
  • Biochemical Assessment or Examination
  • Biophysical Technique or Radiological Measurements
  • Clinical Assessment/Examination
  • Dietary Evaluation/Assessment
• Methods that Provide INDIRECT Information

  • Food Consumption Studies
  • Studies on health conditions and vital statistics
  • Studies on food supply situation
  • Studies on socio-economic conditions
  • Studies on cultural and anthropological influences
• Methods of Assessing Dietary Intake

  • 24-Hour Recall
  • Food Frequency Questionnaire
  • Dietary History (since early life)
  • Food Diary
  • Observation of Food Intake
• 24-Hour Recall


  • First essential in nutritional planning
  • Provides data and information for planning and evaluation
  • Helps define priorities and responsibilities of public health system at the national, regional, provincial, city, municipal, & barangay levels
• Clinical Assessment


  • Deals with the examination of changes that can be seen or felt in superficial tissues such as skin, hair, eyes, etc.
  • More coverage in a short time
  • Inexpensive, no need for sophisticated equipment
  • Non-specificity of signs (signs may be due to non-nutritional causes)
  • Overlapping of deficiency states (dietary deficiencies are not restricted to an isolated nutrient)
  • Bias of the observer (observations of two examiners are most often not consistent with each other)
• Clinical Symptoms of Common Nutritional Problems

  • Protein – Energy Malnutrition (Marasmus, Kwashiorkor, Marasmic kwashiorkor)
  • Xerophthalmia
  • Anemia
  • Goiter
  • Vitamin B2 or Riboflavin Deficiency
• Xerophthalmia


  An impairment of night vision, may be treated by supplementation of the daily diet with Vitamin A. Severe cases need large supplements and a simultaneous treatment of eye problem with antibiotics.
• Anemia


  Low hemoglobin, symptoms include tiredness, paleness, breathlessness, heart palpitations, and edema.
• Goiter


  Enlargement of the thyroid glands due to its need for iodine, symptoms include swelling of the neck, difficulty in swallowing and breathing, and a tight feeling in the throat.
• Vitamin B2 or Riboflavin Deficiency


  Symptoms include magenta red tongue, sores at the angle of the mouth and folds of the nose, and itching and scaling of the skin around the nose, mouth, scrotum, forehead, ears, scalp & others.
• Biochemical Assessment


  • Estimation of time desaturation, enzyme activity or blood composition
  • Tests are confined to two fairly easily obtainable fluids: blood and urine
  • Results are generally compared to standards i.e., normal levels for age & sex
  • Objectivity, independent of the emotional and subjective factors that usually affect the investigator
  • Can detect early subclinical states of nutritional deficiency
  • Costly, usually requiring expensive equipment
  • Time-consuming
• Biochemical Parameters or Tests

  • Urea N/ crea ratio
  • Amino acid imbalance test
  • Hydroxyproline excretion in random urine
  • Serum albumin
  • Hemoglobin determination
  • Hematocrit
  • Serum Vitamin A and serum carotene level
• Urea N/ crea ratio

  Index of dietary adequacy, from 3-4 hour urine of 24-hour sample, index of 30 or lower in a random sample is indicative of malnutrition.
• Amino acid imbalance test

  Ratio of four indispensable amino acids and four indispensable amino acids in serum by paper chromatography, high (5-10) in kwashiorkor and low (less than 2) in well-fed children.
• Hydroxyproline excretion in random urine

  Low (0.5-1.5) in clinically malnourished children, normal: 2.0 to 5.0.
• Serum albumin


  Lowered in severe protein depletion, guide to interpretation: High 4.25, Acceptable 3.52 – 4.24, Low 2.80 – 3.51, Deficient less than 2.80.
• Hemoglobin determination


  Cyanmethamoglobin method by spectrophotometry, A.O hemoglobinometer – simple technique, handy equipment, other methods include Sahli's, Talquuist, Copper sulfate specific gravity.
• Hematocrit


  A measure of red cell volume, obtained from a finger prick, values below means anemia exist.
• Serum Vitamin A and serum carotene level

  Low serum Vitamin A reflects prolonged severe dietary deficiency, serum carotene levels reflect recent ingestion of carotene-containing foods.
• Clinical & Biochemical Nutrition Features of Marasmus & Kwashiorkor

  • Edema
  • Wasting
  • Muscle Wasting
  • Growth retardation
  • Mental Changes
  • Appetite
  • Diarrhea
  • Skin changes
  • Hair changes
  • Moon face
  • Hepatic Enlargement
  • Anemia
  • Serum Albumin
  • Urinary urea per gram creatinine
  • Urinary hydroxyproline per gram creatinine
  • Serum essential amino acid index
  • Liver biopsy
• Biophysical Technique or Radiologic Measurements


  • Used in specific studies where additional information regarding change in the bone or muscular performance is required
  • Radiological methods have been used in studying the change of bones in rickets, osteomalacia, osteoporosis and scurvy
  • Common findings related to nutrition problems include: widened concave(cupped) rarified, frayed distal end of long bones in active rickets, healed concave line of increase density at distal ends of long bones in rickets, ground glass appearance of long bone with loss of density in infantile scurvy, increased cardiac size in beri beri, and changes in bone in advanced fluorosis.