1. What is a nutritional assessment?

The British Dietetic Association (BDA) defines nutritional assessment as

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. It can be done by a healthcare professional
or self-assessment using online tools.

This assessment involves measuring body weight, height, blood pressure,

heart rate, waist circumference, muscle mass, bone density, and other
factors that may affect how much food you need to consume. Based on the
data gathered, one can make an informed decision on what a person needs
to eat in order to achieve and maintain health.
The goal of nutrition assessment is to determine if your diet meets your
nutrient requirements, which are based on your age, gender, activity level,
current medical conditions, medications, and lifestyle choices. If your diet
falls below these requirements, you can make any required changes to
improve your eating habits.

• Importance of Nutritional Assessment

we are what we eat. Committing to nutritional assessment helps us know what
we should and should not be eating if we want to live a healthy life. Let's look
at some other reasons why we should prioritize nutritional assessment.

1. Nutritional assessment helps people understand their own dietary intake and
how it compares with the recommended daily allowances for nutrients.
2. Regular nutritional assessment allows us to identify any potential risks
associated with poor nutrition.
3. It helps people make informed decisions about changes to their diets.
4. A nutritional assessment provides information about whether or not there are
specific foods that we shouldn't eat.
5. It helps us learn how to plan meals and snacks ahead so we don't have to rely
on fast food or convenience options.
6. Regular nutritional assessment is the only way to ensure we're getting enough
nutrients from your meals and in the right quantities.
• How Often Should Nutritional Assessment Happen?
A nutrition assessment should be performed at least once every year, depending
on the individual’s health and lifestyle. For example, if we're trying to lose
weight, we may want to do an assessment more frequently than someone who's
maintaining their normal weight.

• Objectives of Nutritional Assessment

The objectives of a nutritional assessment depend on the context of the
program and what we want to achieve.

In the case of a one-on-one program with an individual, the common goal

should be improving the health habits and overall lifestyle of the patient.
Nutritional assessment should also identify and address any cases of possible
malnutrition. Other common objectives are:

1. Nutritional assessment evaluates a person’s overall health and nutritional

status.
2. It identifies possible nutrient deficiencies in an individual
3. Nutritional assessment allows the experts to evaluate the effectiveness of
prescribed treatments.
4. It’s an effective way to monitor progress toward goals set during treatment.
5. It helps us to prevent malnutrition.
6. It provides an opportunity for the experts to educate their patients about
proper nutrition.
7. Nutritional assessment promotes healthy lifestyles.
8. It encourages compliance with recommendations for treatment.

• Types of Nutritional Assessment

There are 2 classifications of the ways to differentiate nutritional assessment which
are the Direct and the Indirect Method. There are a few examples of test that can
be used to assess a person’s nutritional intake each of which has its advantage and
also disadvantage, some of the direct includes:

1. Anthropometry Assessment

2. Biochemical Assessment

3. Clinical Assessment

4. Dietary Assessment

The Indirect Method is divided into:

1. Economic

a. Income
b. Availability of food
c. Prices of food

2. Ecological
3. Vital Health Status

1. Anthropometric Nutritional Assessment

Anthropometric measurements are noninvasive quantitative measurements of the
body that provide valuable assessments of the nutritional status of children and
adults. Typically, it involves the measurement of the size, weight, and
proportions of the body.

Anthropometric measurements are commonly used in the pediatric population to

evaluate the general health status, nutritional adequacy, and the growth and
developmental pattern of the child. An important part of this type of nutritional
assessment is weighing the individual and calculating their body-mass index to
know if they fall within the optimal range

Common anthropometric measurements include:

• Body Mass Index

• Waist Circumference
• Height
• Weight
 • Skinfold thickness
• Bone Mineral Density
• Blood Pressure
• Heart Rate
• Body Fat Percentage
• Other measures of adiposity
• Muscle mass
• Lean Body Mass
• Fat-Free Mass
• Total Body Water
• Visceral fat
• Fasting Blood Glucose
• Lipid profile

2. Biochemical Assessment

Biochemical assessment involves checking the level of nutrients in a person's blood,

urine, or stool, usually through a lab test. These lab tests can help a trained medical
practitioner discover any medical problems affecting your nutritional status or
appetite. For example, a lab scientist might take your blood sample to measure the
level of glucose in your body.

During a full biochemical assessment, the physician will screen the following
biochemical parameters: albumin, prealbumin, CRP, transferrin, hemoglobin, urea
and creatine, lymphocytes, and point deficiencies.

3. Clinical Nutritional Assessment

Clinical assessment is the simplest and most practical method of ascertaining the
nutritional well-being of a patient. In this case, the physician examines specific areas
of the patient's body to discover any signs of deficiencies. A clinical nutritional
assessment also involves asking the patient whether they have any symptoms that
might suggest nutrient deficiency from the patient.
4. Dietary Assessment
Dietary assessment is the process of collecting information about what a person eats
and drinks over a period of time. In other words, it is a record of the foods one eats
in an attempt to calculate their potential nutrient intake.

The goal of dietary assessment is to identify appropriate and actionable areas of

change in the patient's diet and lifestyle and to improve the overall well-being of the
patient. For a detailed analysis, the health practitioner can deploy one or more of
these methods:

• Diet Record
• 24-hour recall
• Food Frequency Questionnaire

• Nutritional Assessment Tools

Food Frequency Questionnaire

A food frequency questionnaire is a tool that helps you record how often you eat
certain foods on a regular basis. It also asks questions about your eating habits. This
information can then be compared to national guidelines or standards. A food
frequency questionnaire will help you keep track of what you eat regularly. You can
fill it out at home or take it to your doctor's office. The answers provided will help
your doctor make the right decisions about your nutritional health.

When filling out a food questionnaire, write down everything you ate during the past
24 hours. Include all beverages, including water, milk, juice, soda, tea, coffee,
alcohol, and any other drinks. Also, note if you skipped meals. If you're not sure
whether something was eaten, just put an "X" next to the item.

Calorie Calculator
A calorie calculator allows you to fill in the number of calories you consume in a
day. Then, based on your weight, age, gender, height, and activity level, it
determines the number of calories you need each day for a healthy life.

A calorie calculator is only as good as the measurements you input. For instance,
some people might forget to include snacks, such as cookies, crackers, chips, etc.,
when they count calories. And they might underestimate the calories they burn
while exercising. These inaccurate measurements affect the quality of information
you get from the calculator in the end.

To use a calorie calculator, follow these steps:

1. Enter your current weight.

2. Choose from five different activity levels. The higher the level, the greater the
intensity of exercise.

3. Select the number of days you'd like to calculate your daily calorie needs.

4. Click Calculate.

5. Review the results and adjust them as needed.

6. Print out your results.

• Food Pyramid
A food pyramid shows you how many servings of grains, vegetables, fruits, dairy
products, meat, and oils you should eat every day. Each section represents a
specific type of food. For example, the top part of the pyramid shows you how
much whole grain bread, pasta, rice, cereal, oatmeal, and potatoes you should eat.
The bottom part shows you how much fruit, vegetable, fish, meats, and eggs you
should eat.

• Height measurement method

The procedure for measuring a patient’s height is required to accurately calculate
their body mass index (BMI), which should form part of a comprehensive nutrition
screening tool, such as the Malnutrition Universal Screening Tool (MUST)
(Malnutrition Action Group, 2011). This procedure is often delegated to junior staff
but it is important that all staff have received training and understand the rationale
for carrying it out.
Before attempting the procedure, you should check the patient is able to stand
upright. If this is not possible, their height can be estimated using their ulna length
or knee height and converting the measurement using a standardised chart.

Figure: Height measurement technique

The procedure
 1. Review the patient’s notes and identify the rationale for measuring their
height – this will help you to interpret the results.
2. Discuss the procedure with the patient and gain verbal informed consent.
3. Assess the patient’s mobility and ability to stand unassisted then select the
appropriate method for measuring or estimating height.
4. Screen the bed to maintain patient privacy and dignity, and ask them to
remove heavy outdoor clothing so you can visualize their position.
5. Check the equipment has been cleaned and decontaminate your hands
according to local policy. An apron should be worn if the patient needs
physical assistance to get out of their bed or chair.
6. Ask the patient to remove their shoes.
7. Position the patient with their back to the measuring rod on the
stadiometer, ensuring their feet are together and facing forward and their
heels are touching the heel plate or wall (Dougherty and Lister, 2015) (Fig
1). The patient’s knees should be straight, and their shoulders, buttocks,
and head should touch the stadiometer.
8. Ask the patient to look straight ahead and adjust the head plate until it
touches the top of their head. You may need to press down gently on the
patient’s hair.
9. Record the patient’s height to the nearest centimeter in the relevant
documentation.

Weight measurement technique

• Children < 2 years of age – Weigh the child without clothes or a diaper using a
calibrated beam or digital infant scale. Position the child in the center of the scale
tray and read the measurement to the nearest 1-ounce or .1 kg. AAP recommends
weighing infants to the nearest .01 kg or ½ ounce.
• Children > 2 years of age – Weigh the child on a calibrated beam balanced floor
scale or electronic floor scale with increments less than or equal to .1 kg or ¼
pound. Weigh young children without shoes and wear underclothes only, unless
privacy cannot be assured. For older children and young children when privacy
is a concern, weigh the child wearing minimal indoor clothing and without shoes.
 Request child or adolescents stand in the center of the platform of the scale and
remain motionless until the measurement can be obtained. Measure the weight to
the nearest 0.1 kg or ¼ pound. AAP recommends children continue to be weighed
to the nearest .01 kg or ½ ounce when using a digital scale.

Figure: Hanging weight measuring scale for children

• What is MUAC?
Mid-upper arm circumference, often shortened to MUAC, is a measurement that
allows health workers to quickly determine if a patient is acutely malnourished. PIH,
as well as many other organizations, measures the circumference of a patient’s arm
at the midpoint between his or her shoulder and elbow.
• Why is it important?

The burden of malnutrition is staggering. According to a series of articles in the

Lancet, more than 3 million child deaths every year are associated with
malnutrition. Put another way, nearly half of all children who die each year do
so because they don’t have access to enough of the right food. Our health
workers in Haiti, Malawi, Lesotho, and Rwanda, among other locations,
encounter malnourished patient every day. MUAC provides a fast and effective
screening method.

• Cut of point of MUAC

Figure: cut off point of MUAC with z-score

• Waist hip circumference
Waist-to-hip ratio (WHR) is one of several measurements your doctor can use to see
if excess weight is putting your health at risk. Unlike our body mass index (BMI),
which calculates the ratio of our weight to our height, WHR measures the ratio of
our waist circumference to our hip circumference. It determines how much fat is
stored on your waist, hips, and buttocks. Not all excess weight is the same when it
comes to your health risks.

One 2021 showed that people who carry more of their weight around their
midsection (an apple-shaped body) may be at a higher risk of heart disease, type 2
diabetes, and premature death than people who carry more of their weight in their
hips and thighs (a pear-shaped body).

Even if your BMI is within a moderate range, your risk of disease may be increased.

According to WHO, a moderate WHR is:

• 0.9 or less in men

• 0.85 or less for women

In both men and women, a WHR of 1.0 or higher increases the risk of heart disease
and other conditions that are linked to having overweight.

• Waist-to-hip ratio chart

• 24-hourr recall method
A 24-hour dietary recall (24HR) is a structured interview intended to capture detailed
information about all foods and beverages (and possibly, [glossary term:] dietary
supplements) consumed by the respondent in the past 24 hours, most commonly,
from midnight to midnight the previous day.

• Purpose
Twenty-four-hour diet recall interviews (24HRs) are used to assess diet and to
validate other diet assessment instruments. Therefore it is important to know how
many 24HRs are required to describe an individual's intake.
The 24-hour recall is collected in three phases (Triple Pass):
1. A quick list of foods eaten or drunk.
Respondents are asked to report everything that they had to eat or drink on the
previous day between midnight and midnight. This recall session is not interrupted.
At the end of the recall, respondents are invited to add any additional items not
initially recalled.
2. Collection of detailed information concerning the items in the quick list. For each
item of food or drink, respondents are asked to provide additional detail.
a) The time at which the food or drink was consumed.
b) A full description of the food or drink, including brand name where available.
c) Any foods likely to be eaten in combination e.g. milk in coffee
d) Recipes and other combinations of foods e.g. sandwiches
e) The quantity consumed, based on household measures, photographs of different
portion sizes of foods or weights.
f) Any leftovers or second helpings.
3. A recall review in which respondents are given an opportunity to provide
additional information and for the interviewer to prompt for information about foods
or drinks not mentioned.
The interviewer reviews all the food eaten and drunk in chronological order, prompts
for any additional eating or drinking occasions or foods/drinks possibly consumed,
and clarifies any ambiguities regarding the type of food eaten or portion size. Finally,
the interviewer asks the respondent to name the place where each food or drink item
was consumed. All of the information gathered is recorded by the interviewer on the
record sheet in the booklet called Food Consumption Record: Individual 24-hour
recall.

• In general information required:

• What type of food or drink was it?

• How was it bought? – fresh, canned, frozen, dehydrated etc?

• Was the item smoked or not e.g. ham, bacon, etc.

• Was it homemade – if so – what were the ingredients?

• How was it cooked – boiled, poached, fried, etc?

• If it was cooked in fat, fat was used in pastry or cakes or any other dish, or if
any fat was added to e.g. a sandwich or baked potato, what sort of fat or oil was
used?

• If it was a dried/dehydrated product e.g. hot chocolate was it reconstituted using

water, milk (specify type e.g. skimmed, semi-skimmed, whole) or both? Etc

• Was the item coated before cooking? E.g. flour, batter, egg, breadcrumbs

• Was it unsweetened, or sweetened with sugar or artificial sweeteners e.g.

Candarel?

• Was it low or reduced fat / low or reduced calorie?

Thank you