Nutrition

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Nutrition is the intake of food, considered in

relation to the body’s dietary needs.
Good nutrition – an adequate, well balanced
diet combined with regular physical activity –
is a cornerstone of good health.
Poor nutrition can lead to reduced immunity,
increased susceptibility to disease, impaired
physical and mental development, and
reduced productivity
Source: www.who.int
 Nutritional Status (Nutriture)
Condition of the body arising from the
utilization of nutrients.
Nutritional Assessment

Definition:
The interpretation of information
from dietary, laboratory,
anthropometric, and clinical
studies
Gibson, R.S.,2005
 Purpose
The information derived is used to
determine the nutritional status of individuals or
population groups as influenced by the intake
and utilization of nutrients.
 Forms and uses
1. Nutrition Survey
 Establishes baseline nutritional data or ascertain
the overall nutritional status of the population.
 Identify and describe population sub-groups at risk
for chronic malnutrition.
 Serves as the first step in an investigation into the
causes of malnutrition.
 Generate valuable information on the extent of
existing nutritional problems.
 Vital tool in evaluating nutrition interventions.
Forms and uses…cont…

2. Nutrition Surveillance
Continuously monitor the nutritional status of
selected population groups.
Identify the possible causes of both chronic
and acute malnutrition.
Monitor the effect of government nutrition
policies and evaluating the efficacy and
effectiveness of nutrition intervention
programs.
Forms and uses…cont…

3. Nutrition Screening
Identify malnourished individuals requiring
intervention. Applied on the whole
population with the purpose of identifying the
subpopulation considered to be at risk.
Forms and uses…cont…

4. Nutrition Interventions
 Resolve or improve the nutrition problem.
 Provide the basis for monitoring progress and measuring outcomes (evaluation).
Source: https://www.andeal.org

Monitoring is used to assess service provision, utilization, coverage and sometimes the cost
of the program. Effective monitoring is essential to demonstrate that the expected result is
probably from the intervention.

Evaluation requires the choice of an appropriate design to assess the performance or effect
of the intervention.
1. within group design (adequacy evaluation)
2. between-group quasi-experimental design (plausibility
evaluation)
3. Randomized, controlled, double-blind experimental trial (probability
evaluation)

 3 types of nutrition intervention:

1. Supplementation
2. Fortification
3. Dietary Approaches
 Methods of Nutritional Assessment

Direct deals with individual and measures objective

data (ABCD)

Indirect uses community indices that reflect

community nutritional status and needs (ecological,
economic factors, cultural and social habit, and vital
health statistics)
Pathogenesis of Nutritional Deficiency
WHAT HAPPENS IN THE ASSESSMENT METHOD TO
BODY REVEAL CHANGES

Primary deficiency
Or Diet history
Secondary deficiency caused
by problem in the body Health history

Declining nutrient
Laboratory test
stores

Abnormal functions
Laboratory test
inside the body

Physical (outward) signs Physical examination and

and symptoms anthropometric measures
 Causes of a State of Negative Balance

1. Inadequate Intake - Poor food supply, poor food choices, feeding

or swallowing difficulties
2. Poor Absorption - Coeliac disease, inflammatory bowel disease,
alcohol excess and dietary tannins,
3. Increased Requirement - Growth, pregnancy and lactation, many
chronic illnesses and recovery from weight loss
4. Increased Losses - Renal disease, poorly controlled diabetes,
burns and widespread skin disease
5. Altered Metabolism -Alcohol excess, drugs, disease,
environmental pollution and genetic variations in metabolism

***The known medical and non-medical risk factors for the development of a
nutritional deficiency will exert their influence through one or more of the five
possible causes
Other Factors That Influence the Clinical Recognition of
Nutritional Deficiencies
Time scale - The time taken for a nutritional
deficiency to develop in an individual who was
previously adequate varies enormously.

Population distribution - When dealing with

populations in which severe deficiencies are not
commonplace there is likely to be a decreasing
proportion of the population that can be
assigned to the categories progressing from
adequacy to death.
For example, in British women of child-bearing age: %
have an intake below the LRNI, many but not all of these
are likely to have symptoms (fatigue and irritability), but
only % have anaemia (mild organ failure) and very few if
any are dying as a result of anaemia.
 Other Factors That Influence the Clinical Recognition of
Nutritional Deficiencies
Symptoms versus signs - In the development of a
deficiency, because symptoms precede the development
of signs, there are usually many more people with
symptoms of a deficiency than there are with signs of one.
Additionally those with signs of a nutritional deficiency
should also have symptoms as well as an identifiable
cause(s) for their deficiency.

Not all “deficiencies” are clinically important - An

inadequate intake is usually defined as an intake below the
Lower Reference Nutrient Intake, LRNI, “an amount that is
enough for only the few people in a group that have low
needs”
However it will be adequate for some and some others
may also adapt to a low intake without any significant
health consequences especially if the remainder of their
diet is healthy.
References:
Snapshot NCP Step 3: Nutrition Intervention
https://www.andeal.org/vault/2440/web/files/20140527-NI%20Snapshot.pdf
Nutrition. https://www.who.int/topics/nutrition/en/
Nutritional assessment. https://www.slideshare.net/Qurrotulain1/assessment-of-nutritional-status-
10719622?next_slideshow=1
How nutritional deficiencies develop.
http://www.stewartnutrition.co.uk/nutritional_assesment/how_nutritional_deficiencies_develop.html
Gibson, RS. (2005). Principles of Nutrition Assessment, 2nd Ed. Oxford University Pres. New York
Rolfes, S. Pinna, K, and Whitney, E. (2005). Understanding Normal and Clinical Nutrition. 10th Ed. Wadsworth,
Cengage Learning. Belmont CA.
Thank you
 Task:
Map the development stages of three common
nutritional deficiencies in the country and
identify the assessment approaches for each
stage.