nutriotional

• Nutritional status


  The current body status, of a person or a population group, related to their state of nourishment (the consumption and utilization of nutrients)
• Factors affecting nutritional status

  • Internal/constitutional factors (age, sex, nutrition, behavior, physical activity and diseases)
  • External environmental factors (food safety, cultural, social and economic circumstances)
• Ideal nutritional status


  When the supply of nutrients conforms to the nutritional requirements or needs
• Diets are rated according to the balance of nutrients they provide, and not solely on the type of food eaten or the amount of calorie intake by the food pyramid guide
• Nutritional status categories


  • Optimal nutritional status
  • Undernutrition (severe underweight)
  • Overnutrition (morbid obesity)
• Optimal nutritional status


  • Sufficient nutrients are consumed to support day to day body needs and any increased metabolic demands (Growth, illness, pregnancy)
  • Powerful factor for health and well-being, major modifiable and powerful element in promoting health, preventing and treating diseases and improving the quality of life
• Malnutrition


  • May increase risk of (susceptibility to) infection and chronic diseases
• Undernutrition


  • Nutrient intake is inadequate to meet day to day need or add metabolic demand
  • Vulnerable groups: infants, pregnant women, low incomes, hospitalized people, aging adults
• Overnutrition


  • Consumption of nutrient in excess of body need
  • Can lead to obesity and risk for heart disease, type 2 Diabetes Mellitus, Hypertension, stroke, Gall Bladder disease, sleep apnea, and osteoarthritis
• Nutritional assessment


  The systematic process of collecting and interpreting information in order to make decisions about the nature and cause of nutrition related health issues that affect an individual
• Purposes of nutritional assessment

  • Identify individuals or population groups at risk of becoming malnourished
  • Identify individuals or population groups who are malnourished
  • Develop health care programs that meet the community needs which are defined by the assessment
  • Measure the effectiveness of the nutritional programs & interventions once initiated
• Components of nutritional assessment

  • Anthropometric measurements
  • Biochemical parameters
  • Clinical Methods
  • Dietary Methods
• Anthropometric methods


  • Measurement of body height, weight & proportions
  • Compared to reference data to evaluate nutritional status
  • Indicate general nutritional status but don't identify specific nutritional deficiencies
  • Used to evaluate both under & over nutrition
  • Reflect current nutritional status, don't differentiate between acute & chronic changes
• Other anthropometric measurements


  • Mid-arm circumference
  • Skin fold thickness
  • Head circumference
  • Head/chest ratio
  • Hip/waist ratio
• Height measurement


  1. Subject stands erect & bare footed on a stadiometer with a movable head piece

  2. Head piece is leveled with skull vault & the height is recorded to the nearest 0.5 cm
• Weight measurement


  1. Use a regularly calibrated electronic or balanced-beam scale

  2. Weigh in light clothes, no shoes

  3. Read to the nearest 100 gm (0.1kg)
• Body Mass Index (BMI)


  International standard for assessing body size in adults, computed as Weight (kg)/ Height (m²)
• Waist measurement


  1. Measured at the level of the umbilicus to the nearest 0.5 cm

  2. Subject stands erect with relaxed abdominal muscles, arms at the side, and feet together

  3. Measurement taken at the end of a normal expiration
• Waist circumference


  Predicts mortality better than any other anthropometric measurement
• Waist circumference levels


  • Level 1 (maximum acceptable): > 94 cm for males, > 80 cm for females
  • Level 2 (obesity): > 102 cm for males, > 88 cm for females
• Hip circumference measurement


  1. Measured at the point of greatest circumference around hips & buttocks to the nearest 0.5 cm

  2. Subject should be standing

  3. Measurements taken with a flexible, non-stretchable tape in close contact with the skin, but without indenting the soft tissue
• Waist/Hip Ratio (WHR)


  High risk WHR: > 0.80 for females, > 0.95 for males (waist measurement > 80% of hip measurement for women and > 95% for men indicates central obesity and high risk for diabetes & CVS disorders)
• BMI for children & teens is interpreted differently than for adults
• Clinical assessment


  • Utilizes physical signs associated with malnutrition and deficiency of vitamins & micronutrients
  • Includes good nutritional history and general clinical examination
• Dietary assessment methods

  • 24 hours dietary recall
  • Food frequency questionnaire
  • Dietary history since early life
  • Food diary technique
  • Observed food consumption
• 24 hours dietary recall


  A trained interviewer asks the subject to recall all food & drinks taken in the previous 24 hours
• Food frequency questionnaire


  • Subject indicates intake (frequency & quantity) per day, per week & per month for a list of around 100 food items
  • Inexpensive, more representative & easy to use
  • Limitations: long questionnaire, errors with estimating serving size, needs updating with new commercial food products
• Dietary history


  • Aims to discover the usual food intake pattern of individuals over a relatively long period of time
  • Includes a 24hr recall and questions about usual eating patterns
  • Estimates nutrient intakes over a long period of time
  • Disadvantages: takes about one hour, requires experienced nutritionist/dietitian interviewer
• Food diary


  • Food intake (types & amounts) recorded by the subject at the time of consumption
  • Collection period range between 1-7 days
  • Reliable but difficult to maintain
• Observed food consumption


  • Meal eaten by the individual is weighed and contents are exactly calculated
  • Highly accurate but expensive and time/effort intensive
• Initial laboratory assessment


  • Lab tests based on blood and urine can indicate nutritional status but are influenced by non-nutritional factors
  • Hemoglobin estimation is the most important test and useful index of overall nutrition
• Specific lab tests


  • Measurement of individual nutrient in body fluids
  • Detection of abnormal amount of metabolites in the urine
  • Analysis of hair, nails & skin for micronutrients
• Advantages of biochemical methods

  • Useful in detecting early changes in body metabolism & nutrition before clinical signs appear
  • Precise, accurate and reproducible
  • Useful to validate data from dietary methods
• Limitations of biochemical methods

  • Time consuming, expensive
  • Cannot be applied on large scale
  • Needs trained personnel & facilities