ASSESSMENT OF
NUTRITIONAL STATUS
Dr. Piyush Parmar
WHAT IS NUTRITIONAL STATUS?
The nutritional status of an individual
is a balance between the intake of the nutrients
and the expenditure of these in processes of
growth, reproduction and health maintenance.
is influenced by food intake , quantity , quality
and physical health.
The spectrum of nutritional status spreads from
obesity to severe malnutrition.
Nutritional Assessment Why?
To obtain precise information on prevalence and
geographic distribution of nutritional problems
of given community.
To identify individuals or populations
~who are at risk of becoming malnourished &
~who are already malnourished
To develop health-care programs.
To measure the effectiveness of nutritional
programs and interventions once initiated.
METHODS of Nutritional Assessment
Direct – deal with the individuals and
measure the objective criteria
Indirect – use community health indices
that reflect nutritional influences
1. Direct methods of nutritional
Assessment
These can be summarized as ABCD
Anthropometric methods
Biochemical, laboratory methods
Clinical methods
Dietary evaluation methods
2. Indirect methods of Nutritional
Assessment
These include three categories
Ecological variables
Economic factors
Vital health statistics
Direct methods
A. Anthropometric methods
Anthropometry is the measurement of
Height
Weight & other measurements like
Mid Upper-arm circumference
Skin fold thickness
Head and chest circumference
Hip/waist ratio
A. Anthropometric methods
1. Height measurement
The subject stand erect on
stadiometer
The movable head piece is
leveled with head vault
Height is recorded to
nearest 0.5 cm.
For infants infantometer is
used.
A. Anthropometric methods
growth monitoring of a child by comparing with
international / national standards using growth
charts over a period of time.
A. Anthropometric methods
2. Weight measurement
Can be used to assess infants, children, pregnant women
and adults.
Uses a regularly calibrated electronic or balanced-beam
scale.
Measured in light clothes nearest to 100g.
A. Anthropometric Methods
3. Mid Upper-arm Circumference
Circumference left upper arm
at mid point between acromion
process and olecranon
process
Fiber-glass tape which does
not stretch
A. Anthropometric Methods
4. Skin-fold thickness
skin fold calipers are used
(Harpenden and Lange)
measures the thickness of the
skin and subcutaneous fat using
constant pressure applied over a
known area
Common sites: triceps and in the
sub-scapular region
It has value in assessing the
amount of fat and therefore the
reserve of energy in the body
A. Anthropometric Methods
5. Head and chest circumference
A. Anthropometric Methods
6. Waist/hip ratio
Waist measurement
Measured at the level of umbilicus
nearest to 0.5cm
Subject stands erect with relaxed
abdominal muscles, arms at the
side and feet together
Measurement taken at the normal
expiration
A. Anthropometric Methods
Hip measurement
Measured at the point of greatest circumference
around hips to nearest 0.5cm
Close contact with the skin without indenting the
soft-tissues
Subject should be standing and measurer beside
him.
Interpretation of WHR
High-risk WHR=>0.8 in females and =>0.95 in
males indicates central obesity and considered
high-risk for diabetes and cvs disorders.
A. Anthropometric Methods
Advantages
Objectives with high specificity and sensitivity.
Measures many variables of nutritional
Significance. (ht, wt, MUAC, WHR , BMI)
Readings are numerical and gradable on
standard growth charts.
Readings are reproducible.
Non-expensive and needs minimal training.
A. Anthropometric Methods
Limitations of Anthropometry
Inter-observers error in measurement.
Limited nutritional diagnosis.
Problems with reference standards i.e. local
versus international.
Direct methods
B. Biochemical & laboratory methods
I. INITIAL LABORATORY ASSESSMENT
Haemoglobin estimation
most important test when accurately measured,
tells about overall state of nutrition (anemia,
and also protein and trace element nutrition)
Blood is collected from a finger, ear lobe or heel
prick
Haemoglobinometres which are simple, cheap
and reasonably accurate are used
B. Biochemical & laboratory methods
2. Haematocrit or packed cell volume (PCV)
percentage of the blood volume composed of red
cells.
important in the diagnosis of anemia.
3. Red cell counts and blood films
the size and uniformity of the red blood cells can
be seen.
Use of such slides may facilitate the diagnosis of
malaria and the haemoglobinopathies.
Parasites if present can be seen.
B. Biochemical & laboratory methods
4. Stool examination
For presence of ova and/ or intestinal parasites
When assessed quantitatively parasite load can
be known
5. Urine examination
Dipstick and microscopy for albumin, sugar and
blood
B. Biochemical & laboratory methods
II. SPECIFIC LAB TESTS
6. Measurement of nutrients in body fluids
e.g. serum retinol, serum iron
7. Measurement of abnormal metabolites
e.g. urinary iodide, urinary creatinine/
hydroxyapatite ratio
B. Biochemical & laboratory methods
Advantages
Useful in detecting early changes in body
metabolism and nutrition
precise , accurate and reproducible.
Useful to validate data obtained from dietary
methods e.g. comparing salt intake with 24-hour
urinary excretion.
B. Biochemical & laboratory methods
Limitations of biochemical & laboratory methods
Time consuming and expensive
Cannot be applied on large scale
Reveal only current nutritional status
Direct methods
C. Clinical methods
Essential feature of all nutritional surveys
Simplest and most practical method
Utilizes a number of physical signs (specific and
non-specific) that are known to be associated
with malnutrition and deficiency of vitamins and
other micro-nutrients.
C. Clinical methods
General Clinical examination with special
attention to organs like hair, angles of mouth,
gums, nails, skin, eyes, tongue, muscles, bones
& thyroid gland.
Detection of relevant signs helps in establishing
the nutritional diagnosis.
C. Clinical methods
Clinical signs of nutritional deficiencies.
1. Hair
Spare and thin Protein, Zinc, Biotin,
deficiency
Easy to pull out Protein deficiency
Cock-screw Vit A and Vit C deficiency
coiled
Depigmentation Protein deficiency
C. Clinical methods
2. Mouth
Bleeding and Deficiency of
spongy gums Vit C, A, K, Folic
acid, Niacin
Glossitis , Deficiency of
Cheililitis Riboflavin,
Niacin, Folic
acid, B12 and
proteins.
C. Clinical methods
2. Mouth
Angular B2, 6 & Niacin
stomatitis, deficiency
cheilosis and
fissured tongue
Leukoplakia Vit A, B12, B-
complex, Folic
acid and Niacin
deficiency
C. Clinical methods
3. Eyes
Xerosis of First clinical
conjunctiva or sign Vit A
Xerophthalmia deficiency
Bitots spots Moderate
deficiency of Vit
A deficiency
C. Clinical methods
3. Eyes
Corneal Severe Vit a
ulceration and deficiency –
keratomalacia medical
emergency
Night blindness, Vit A and Vit B2
photophobia, deficiency
blurring of
vision
C. Clinical methods
4. Nails
Spooning of Iron deficiency
nails
Transverse Protein
lines deficiency
C. Clinical methods
6. Glands
Goiter Iodine deficiency
C. Clinical methods
7. Skeletal system
Beading of ribs Vit D deficiency
(rickety rosary),
bow legs
Epiphyseal Vit D deficiency
enlargement,
skeletal
deformities, bone
tenderness
C. Clinical methods
8. Muscles
Wasting of muscles PEM, severe protein
deficiency
Functional Indicators
Also-’physiological
indicators’
These reflect the
functional
consequence of a
deficiency
particularly useful for
detecting early
perturbations in
nutritional status
Functional Indicators
System nutrients
1. Structural integrity
RBC fragility Vit E, Se
capillary fragility Vit C
tensile strength Cu
2. Host defense
WBC chemotaxis P/E, Zn
WBC phagocytic capacity P/E , Fe
WBC bactericidal capacity P/E , Fe, Se
T cell blastogenensis P/E , Zn
delayed cutaneous hypersensitivity P/E , Zn
3. Hemostasis - prothrombin time Vit K
4. Reproduction- sperm count Energy, Zn
5. Nerve function- nerve conduction Vit B1, B12
dark adaptation Vit A, Zn
6. Work capacity
heart rate P/E, Fe
vasopressor response Vit C
Immune function: malnutrition leads to a decline in
immune function
These immune changes predispose children to severe
and chronic infections, infectious diarrhea, which
further compromises nutrition
Studies of malnourished children showed changes in
the developing brain, including,
a slowed rate of growth of the brain,
lower brain weight,
thinner cerebral cortex,
decreased number of neurons,
insufficient myelinization, and changes in the
dendritic spines.
Assessment of dietary intake
This is actually an assessment of food
consumption through dietary surveys.
It provides information about dietary intake
patterns, specific foods consumed and
estimated nutrient intakes.
Reviewing dietary data may suggest risk
factors for chronic diseases and help to
prevent them.
Diet surveys may be carried out by the
following methods:
1. weighment of raw foods
2. weighment of cooked foods
3. Oral questionnaire method
Other methods include
•Food records or diaries (including weighed intakes)
•Food frequency questionnaires (FFQ's)
•Dietary histories
•Observed intakes
Weighment of raw foods:
It is the most widely used method in India.
The survey team visits the household and
weighs all the food that is going to be
cooked and eaten as well as that which is
wasted or discarded.
Duration of survey: varies between 1 and
21 days. Most commonly for 7 days which is
called the dietary cycle.
• Weighment of cooked foods:
Foods are analyzed in the state
in which they are consumed.
• This method is not easily
acceptable.
Food Frequency Questionnaires (FFQ) –
FFQ's are standardized forms inquiring about the frequency of intake
of different foods or food groups.
not as accurate as other measures but useful in large population
studies
or when studying the association of a specific food (s) and a disease.
Oral questionnaire method:
Inquiries are made about the nature and quantity of foods eaten
during the previous 24-48 hours. It may also include dietary
habits and practices
If taken correctly, it can give reliable results.
Thank you
