NUTRITION AND METABOLIC ASSESSMENT

Nutrition

Anthropometric Measures

Height, weight, and body mass index

Height should ideally be measured with a stadiometer. However, it is possible to estimate height by arm span
or knee-height measurement in some subjects who are unable to stand.
Serial weight measurements to assess trends of weight gain or loss are particularly useful in providing objective
insight into changes over time. Sustained weight loss from baseline (over 6 months) can be categorized into
mild (< 5%), moderate (5%-10%), or severe (>10%).
Weight is proportional to height, and this relationship, known as the BMI, is one of the most commonly used
and simplest anthropometric measures. BMI is calculated with the following equations:

BMI = weight (kg)/height2 (m2)

BMI = (weight [lb] X 703)/height2 (in2)

BODY MASS INDEX

NORMAL ABNORMAL
18.5-24.9 Underweight - < 18.5
Overweight - 25-29.9
Obese - 30

Skinfold thickness
Skinfold thickness is an indirect measure of subcutaneous adipose tissue using skinfold calipers at various
body sites. Body density and percentage body fat can then be estimated based on these measurements.

Tricep skinfold thickness measurement with plastic calipers. Subscapular skinfold thickness measurement with plastic
calipers.
Mid-arm muscle circumference and mid-upper-arm muscle area
Mid-arm muscle circumference (MAMC) has been used for reflection of muscle protein reserves. This is
performed in addition to triceps skinfold measurement to calculate mid-upper-arm muscle area, which
correlates with lean body mass. These anthropometric measures have proven easy to perform and correlate
with mortality in older adults and in patients with cirrhosis.

Upper arm length measurement and mid-arm mark.

The following equations are used for mid-upper arm muscle area:

Men (cm2): Area = ([arm circumference { x triceps skinfold}]2/4) - 10

Women (cm2): Area = ([arm circumference { x triceps skinfold}]2/4) - 6.5

Table 2: Standards for Upper Arm Muscle Area in Adults (From the Merck Manual of Diagnosis and
Therapy, edited by Robert Porter. Copyright 2012 by Merck Sharp & Dohme Corp., a subsidiary of
Merck & Co, Inc, Whitehouse Station, NJ. Available at http://www.merckmanuals.com/professional/.
Accessed 11/18/2013).
Percentage of Standard (%) Men (cm2) Women (cm2) Muscle Mass
100 20* 54 11 30 7 Adequate
75 40 22 Marginal
60 32 18 Depleted
50 27 15 Wasted
*Mean mid upper arm muscle mass 1 standard deviation. From the National Health and Nutrition Examination
Surveys I and II.

Hair
ABNORMAL FINDINGS INDICATION
Spare & thin Protein, zinc, biotin
Deficiency
Easy to pull out Protein deficiency
Corkscrew Vit C & Vit A
Coiled hair deficiency
Mouth
ABNORMAL FINDINGS INDICATION
Glossitis Riboflavin, niacin, folic acid, B12 deficiency
Bleeding & spongy gums Vit. C,A, K, folic acid & niacin deficiency
Angular stomatitis, cheilosis & fissured tongue B 2,6,& niacin deficiency
Leukoplakia Vit.A,B12, B-complex, folic acid & niacin
Sore mouth & tongue Vit B12,6,c, niacin ,folic acid & iron

Eyes
ABNORMAL FINDINGS INDICATION
Night blindness, exophthalmia Vitamin A deficiency
Photophobia-blurring, Vit B2 & vit A
conjunctival inflammation deficiencies

Nails
ABNORMAL FINDINGS INDICATION
Spooning Iron deficiency
Transverse lines Protein deficiency

Skin
ABNORMAL FINDINGS INDICATION
Pallor Folic acid, iron, B12
Follicular hyperkeratosis Vitamin B & Vitamin C
Flaking dermatitis PEM, Vit B2, Vitamin A, Zinc & Niacin
Pigmentation, desquamation Niacin & PEM
Bruising, purpura Vit K ,Vit C & folic acid

Thyroid Gland
ABNORMAL FINDINGS INDICATION
Goiter Iodine Deficiency

Joints and Bones

ABNORMAL FINDINGS INDICATION
imperfect calcification, softening, and distortion vitamin D deficiency (Rickets)
of the bones typically resulting in bow legs
ground-glass osteopenia vitamin C deficiency (Scurvy)
Metabolism

1.Vital signs
Variations in temperature may associated with thyroid dysfunction. Cardiovascular changes such as
bradicardia , tachycardia, hypotension or hypertension maybe seen with endocrine problems.

2.Height and weight

Changes in weight may be associated with endocrine problems. Growth pattern abnormalities suggest
problems associated with growth hormone. Thyroid disorders and diabetes mellitus are example for
disorders that can affect body weight.

3.Integument
The nurse should note the colour and text of the skin, hair, and nails. The hair distribution should be
noted on the head, face,trunk, and extremities. Dull brittle hair, excessive hair growth or hair loss
indicates endocrine dysfunction.

4. Head
The size of the head should be examined. Facial features should be symmetric. Eyes should be
inspected for position shape and eye movement.

5. Neck
When inspecting the thyroid gland first observation should be made in the normal position, then in slight
extension, and then as the patient swallows some water. The trachea should be in midline and neck
should appear symmetric. If there is no noticeable enlargement of the thyroid gland, palpation can be
done. Water should be available for the patient t swallow as a part of the examination. There are two
types of thyroid palpation.

For anterior palpation the nurse stands in front of the patient, with patients neck flexed. The thumb is
placed over the cricoid cartilage and moved over the isthmus as the patient swallows. Then each lateral
lobe is palpated before and while the patient swallows water.

For posterior palpation , examiner stands behind the patient. With thumb of both hands rest on nape of
the neck of the patient, uses the index and middle fingers for the thyroid isthmus and for the anterior
surfaces of the lateral lobes. The thyroid is palpated for size shape, symmetry, tenderness and for any
nodules.

6. Extremities
The size ,shape, symmetry, and general proportion of hand and feet should be noted. Muscle strength
and deep tendon reflexes should be noted. In the upper extremities, the presence of tremors is assessed
by placing a piece of paper in the outstretched fingers, palm down.