NUTRITIONAL ASSESSMENT

Definition: -

Nutritional assessment is the interpretation of anthropometric, biochemical (laboratory), clinical and

dietary data to determine whether a person or groups of people are well nourished or malnourished
(over-nourished or under-nourished).

The ABCD Methods: -

Nutritional assessment can be done using the ABCD methods. These refer to the following:

i. Anthropometry
ii. Biochemical/biophysical methods
iii. Clinical methods
iv. Dietary methods.

1. Anthropometry

Anthropometry Anthropo means 'human' and metry means 'measurement". It uses several different
measurements including length, height, weight and head circumference.

Length: A wooden measuring board (also called sliding board) is used for measuring the length of
children under 2 yrs. old to the nearest millimetre. Measuring the child lying down always gives
readings greater than the child's actual height by 1-2 cm

Height: - measured with the child or adult in a standing position (usually children who are two years
old or more). Head should be in the Frankfurt position (a position where the line passing from the
external ear hole to the lower eye lid is parallel to the floor). The shoulders, buttocks and the heels
should touch the vertical stand. Either a stadiometer or a portable anthropometer can be used for
measuring. Measurements are recorded to the nearest millimetre.

Weight: -A weighing sling (spring balance), also called the 'Salter Scale' is used for measuring the
weight of children under two years old, to the nearest 0.1 kg. In adults and children over two years a
beam balance is used and the measurement is also to the nearest 0.1 kg. In both cases a digital
electronic scale can be used if you have one available. Do not forget to re-adjust the scale to zero
before each weighing. You also need to check whether your scale is measuring correctly by weighing
an object of known weight.

The head circumference (HC): - Measurement of the head along the supra orbital ridge (forehead)
anteriorly and occipital prominence (the prominent area on the back part of the head) posteriorly.
Measured using flexible, non-stretchable measuring tape around 0.6cm wide. HC is useful in
assessing chronic nutritional problems in children under two years old as the brain grows faster
during the first two years of life. But after two years the growth of the brain is more sluggish and HC
is not useful.

CONVERTING MEASUREMENT TO INDICES

An index is a combination of two measurements or one measurement plus the person's age,

 Weight-for-age
  Height-for age

Weight for age = Weight of the child x 100

Weight of the reference child of the same age

Weight for height = Weight of the child x 100

Weight of the reference child of the same age

Body mass index (BMI) is the weight of a child or adult in kg divided by their height in metres
squared:

BMI = Weight (kg)

(Height in metres)2

 Birth weight is weight of the child at birth and is classified as follows:

 more than 2500 grams = normal birth weight
 1500-2499 grams = low birth weight
 less than 1500 grams = very low birth weight

Measurement of fat mass

 A non-pregnant adult-BMI is 18.5 and 25 kg/m²

 If an adult person has a BMI of less than 6kg / (m ^ 2) they will not be able to do much
physical work because they will have very poor energy stores.
 In addition, they will be at increased risk of infection due to impaired immunity.

Measurement of fat free mass

An accurate way to measure fat-free mass is to measure the Mid Upper Arm Circumference (MUAC).
The MUAC is the circumference of the upper arm at the midway between the shoulder tip and the
elbow tip on the left arm. The mid-arm point is determined by measuring the distance from the
shoulder tip to the elbow and dividing it by two. A low reading indicates a loss of muscle mass.

2. Clinical methods of assessing nutritional status

Clinical methods of assessing nutritional status involve

 checking signs of deficiency at specific places on the body

 asking the patient whether they have any symptoms that might suggest nutrient deficiency
from the patient.
Clinical signs of nutrient deficiency include:

 pallor (on the palm of the hand or the conjunctiva of the eye)
 Bitot's spots on the eyes
 pitting oedema
 goitre and severe visible wasting

3. Dietary methods of assessment

 Dietary methods of assessment include looking at past or current intakes of nutrients from
food by individuals or a group to determine their nutritional status.
 You can ask what the family or the mother and the child have eaten over the past 24. hours
and use this data to calculate the dietary diversity score.
 Dietary diversity score is an indicator of both the balance of nutrient consumption and the
level of food security (or insecurity) in the household.
 The higher the dietary diversity score in a family, the more diversified and balanced the diet
is and the more food-secure the household.
 As part of the dietary assessment, you should also check the salt iodine level of households
using the single solution kit (SSK).
 This enables you to determine whether the salt iodine level is 0, more than 15 parts per
million (PPM) or less than 15 PPM.
 Normally, an iodized salt should have iodine level of more than 15 PPM to be effective in
preventing iodine deficiency and its consequences.