NUTRITIONAL SCREENING

 Main objective: To identify malnourished individuals and/ are at ↑ nutritional risk

 Advantages: simple, specific, efficient, quick, reliable, inexpensive

ADULT NUTRITION SCREENING AND ASSESSMENT ALGORITHM

 Involuntary loss or gain of wt: >10% (6mos) or >5% (1mo)

 Wt of 20% over or under ideal body weight
 Altered diets: total parenteral or enteral nutrition, recent surgery
 Inadequate nutrition intake for >7 days

RAPID NUTRITION SCREENING METHODS

 Rapid Nutrition Screen: lost weight w/o trying, lost _ kg, eating poorly/ decreased appetite
o 2 or more: at risk for malnutrition
 Malnutrition Universal Screening Tool: BMI, % wt loss, acutely ill (likely w/o intake >5 days)
o 0 (low risk), 1 (medium risk), >2 (high risk)
 Short Nutritional Assessment Questionnaire: unintentional wt loss, decreased appetite, tube feedings
o 0-1(well nourished), 2 (moderately malnourished), >3 (severely malnourished)

NUTRITIONAL STATUS ASSESSMENT

ANTHROPOMETRIC

 Ideal Body Weight (IBW)

o Hamwi Method (in lbs) : M=106 (1st 5 ft) + 6 (succeeding ft); F=100 + 5
o Tannhausser’s (in kg): IBW= (Ht in cm – 100) – [0.10 x (Ht in cm – 100)]
 BMI = kg/m2; diagnose obesity; Overestimation (muscular indiv) Underestimation (lost muscle mass)
o <18.5 (Under), 18.5-22.9 (normal), 23-24.9 (Over), 25-29.9 (obese 1), >30 (obese2)
 WC: abdominal fat; F (>31 inches, 80 cm), M (>35 inches, 90 cm); ↑visceral fat: ↑insulin resistance
 Body Composition: measures amount and distribution of fat and lean body mass
o Skin Fold Measurement: subcutaneous fat(50% of TBF), <3mm: complete exhaustion of fat store
o Middle Arm Muscle Circumference (MAMC): skeletal muscle mass;
o Dual Energy Xray Absorption (DEXA): diff densities of FM, bone, lean body mass; EXPENSIVE
o Total Body Water: allow for calculation of total body fat; used in research
o Total Body Potassium: K40 isotope(0.012%); used in research

DIETARY, NUTRITIONAL HISTORY, CURRENTINTAKE

 Risk for nutritional problems: inadequate intake, impaired absorption, ↓utilization, ↑ losses and req

Methods to Collect Data

 Nutrition History
 1-7 Day Food Record: GOLD STD; measure for quantification; ¤ most accurate, !time intensive, undereported
 24-Hour Food Recall: open ended questions; ¤ standardize !retrospective (depends on memory)
 Usual Daily Intake: snap shot of eating behavior; ¤ more representative, ! not useful for accurate assessment
 Food Frequency Questionnaire: large epidemiological studies, ! limited number of food and choices
 Factors affecting food req.:
o ↑needs (growth, lactation, fever, recovery, stress, trauma, smoking, alcohol, aging)
o change in absorption (GI illness, drug-nutrient or nutrient-nutrient interaction)
o change in storage, processing, or activation of a nutrient (interaction with drugs & nutrient)
o change in excretion of nutrient (GI motility issues, diet intake, fiber intake)
o change in transport (pH changes, protein carrier availability)
o effects of nutrient drug interaction

BIOCHEMICAL OR LABORATORY DATA: assess micronutrient intake and deficiency

  Prolonged PT(normal:12-15sec): Vit K deficiency, anticoagulant therapy, sever liver disease
 Low Albumin levels: infection, burns, trauma, CHF, fluid overload, severe liver disease

MALNUTRITION: 1o (inadequate/ poor quality food intake), 2o (diseases alter food intake)

 Starvation Related to Malnutrition: without inflammation Marasmus

 Chronic Disease Related Malnutrition: chronic inflammation (mild to mod) cachexia
 Acute Disease Related Malnutrition: acute inflammation (severe) Kwashiorkor
 Marasmus:
 Kwashiorkor:
 Cachexia: