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NUTR 344: Clinical Nutrition 1 > 1. Nutritional Assessment Pt 1 > Flashcards

1. Nutritional Assessment Pt 1 Flashcards

1
Q

What are the components of a nutritional assessment?

A
  • Anthropometry and body composition
  • Biochemical
  • Clinical
  • Dietary
  • Environmental
  • Functional
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2
Q

Define “nutritional status”.

A

The condition of a body’s nutrient stores as a result of the intake, absorption, and metabolism of energy and nutrients, and the influence of physiological needs and disease-related factors.

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3
Q

Define “nutritional risk”.

A

Risk of having nutrition-related health problems. Could be dietary and pathological related.

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4
Q

What is the difference between a screening and an assessment?

A

Screening: Process of identifying characteristics known to be associated with nutritional problems. The purpose is for quick identification of individuals with nutritional risks and who’d benefit from an assessment/intervention by a dietician. Generally are *easy to use, cheap, *valid, reliable and sensitive.

Assessment: Systematic method for obtaining, verifying, and interpreting data needed to determine nutritional status, nutrition-related problems, their causes, and their significance. Usually performed by dieticians. Includes medical and dietary history, physical examination, anthropometric measurements and analysis of biochemical and functional status. Contains subjective and objective data.

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5
Q

Describe the components of a nutritional screening.

A
  • Weight loss- involuntary
  • Dietary intake- appetite, restrictions, intolerances, route of feeding
  • Pre-existing conditions causing nutrient loss- malabsorption, diarrhea
  • Conditions that increase nutrient reqs. - inflammation, fever, burns, sepsis, injury
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6
Q

What are the goals of nutritional assessments?

A
  • Identify patients needing nutritional support
  • Use as baseline for monitoring/evaluating response to intervention plans
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7
Q

A nutritional intervention plan is provided in order to :

A
  • Prevent/manage disease
  • Identify specific deficiencies
  • Address overall malnutrition
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8
Q

Malnutrition affects more than _____% of hospitalized patients.

What is malnutrition associated with?

A
  1. 50%
  2. Morbidity (above disease state), mortality, longer hospital stays, use of health care (services + costs)
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9
Q

How is anthropometric data evaluated and interpreted?

A
  • Use of established criteria (BMI)
  • NHANES I and II reference tables
  • Nutrition Canada reference tables ( <5 and >95th percentiles indicate risk)
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10
Q

How is biochemical data evaluated and interpreted?

A
  • Cut-off values
  • Normal lab values (differ by institution)
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11
Q

How is clinical data evaluated and interpreted?

A
  • Physical signs and changes (ex: edema)
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12
Q

How is dietary data evaluated and interpreted?

A
  • DRIs- Canada and US harmonization
  • Canada- Canadian Food Guide
  • US- USDA Food Pyramid
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13
Q

How is functional data evaluated and interpreted?

A
  • Cut-offs from cohort studies
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14
Q

What is the typical order of developing a nutritional deficiency? (What assessment method is used to examine each stage?)

A
  1. Dietary deficiency (Dietary)
  2. Lower tissue reserve (Biochemical)
  3. Lower bodily fluid level (Biochemical)
  4. Lower function/tissue (Biochemical/anthropometric)
  5. Lower enzyme activity (Biochemical)
  6. Functional changes (Behavioral/physiological)
  7. Clinical symptoms, VISIBLE OR NOT (Clinical)
  8. Anatomical signs, VISIBLE (Clinical)
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15
Q

Why are dietary inadequacies different to nutritional deficiency?

A
  • Nutritional deficiencies take a long time to develop
  • The requirements set by institutions are meant to cover the 95th percentile of the population; some individuals receive enough at lower levels
  • Dietary inadequacies SUGGEST lack of RDA levels of specific nutrients
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16
Q

What 3 qualities does anthropometry examine?

A
  • Body size
  • Body weight
  • Body proportions
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17
Q

What measurements are taken, in triplicates, to assess anthropometry?

A
  • height
  • weight
  • circumferences (waist, tricep)
  • skinfolds
  • ratios
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18
Q

What does anthropometry allow us to estimate and evaluate?

A
  • Estimate nutritional status
  • Evaluate intervention
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19
Q

What is the limitation of anthropometry?

A

Doesn’t identify specific nutrient deficiencies

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20
Q

Body composition is more specific than anthropometry, because it is a more sophisticated approach. What compartments is the body often divided into?

A

Fat mass and fat-free mass

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21
Q

When analyzing fat mass, what measurements are often taken?

A
  • Skinfold thickness; to measure subcutaneous adipose tissue
  • Waist circumference; abdominal fat
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22
Q

When analyzing fat-free mass, what tests can be performed on what specific sub-categories?

A
  • Plasma proteins- albumin, TTR, and RBP tests
  • Viscera- delayed hypersensitivity tests (ex: skin test reactions to antigens to test for lack of proteins)
  • Skeletal muscle- MAMC (arm muscle circumference), CHI (creatinine height index)
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23
Q

Fat-free mass and fat mass are subjective to the individual. On average, however, what is the usual composition of the body?

A
  • 75% fat-free mass
  • 25% fat mass
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24
Q

What makes up fat-free mass?

A
  • Skeleton
  • Skin
  • Extracellular water
  • Plasma proteins (least amount)
  • Viscera
  • Skeletal muscle (most amount)
25
Q

In the typical 70-kg man, there is approximately 12kg of protein on average. Of the fat-free mass, what are the average weights of each protein-containing subcategory?

A
  • Skeleton and skin = 4.5kg
  • Plasma proteins = 0.3kg
  • Viscera= 1.5kg
  • Skeletal muscle= 6.0kg
26
Q

How is height measured when a patient can stand?

A
  • Using a stadiometer
  • Conditions: barefoot, heels and shoulders against wall, Frankfurt plane (eyes parallel to floor)
27
Q

How is height measured when the patient cannot stand?

A
  1. Knee Height: calipers used and indexed equations based on age, sex, and race to determine proportional height
  2. Arm span (if unable to stand straight): NOT RECOMMENDED, not suitable for Asians, African Americans, spinal deformities
28
Q

Why are frame size measurements useful?

A

Can use them to interpret percentiles of muscle area.

29
Q

What are the wrist circumference intervals?

A
30
Q
  1. What does body weight measure?
  2. How is body weight measured?
  3. What are the considerations required for measuring body weight?
  4. What are the limitations of the body weight measurement?
A
  1. Measure of the total sum of body compartments/stores
  2. Standing, chair, or bed scales
  3. Timing, hydration changes, minimal clothing and no shoes
  4. No single measure accounts for body composition; amputees need to be considered
31
Q

Amputation adjustments for body weight measurements

A
32
Q

How is BMI calculated?

A

Weight (kg) / Height2 (m2)

33
Q

How does BMI work? Who does it apply to?

A
  • Works by cut-offs (not as accurate to individual)
  • For males and non-pregnant females, <65 years old
34
Q

BMI Cut-off values (<65)

A
35
Q

BMI Cut-off values (>65)

A
36
Q
  1. What are the limitations of BMI?
  2. Why is it still considered a useful tool?
A
  1. Doesn’t consider body composition (muscles, amputees, …); varies by age/sex/ethnicity; limited application for athletes; must be accompanied by other measurements (circumference…)
  2. Better than weight or height alone; only validated method for estimating healthy body weight (@ population levels)
37
Q

What is a good goal weight for individuals above/below the healthy BMI range of 18.5-25 kg/m2?

A
  • If under av. BMI: Aim for BMI of 18.5
  • If over av. BMI: Aim for BMI of 25
38
Q

What do usual body weight assessments (UBW%) help interpret?

A

Different stages of malnutrition indications from involuntary weight loss.

39
Q

Why is % weight change clinically relevant? How is it calculated?

A

It predicts nutritional risk and health complications.

40
Q

What does involuntary weight loss ALWAYS include?

A

Loss of fat and fat-free mass (MUSCLE)

41
Q

What can involuntary weight loss predict?

A
  • Mortality
  • Surgical outcomes/post-operative complications
  • Frailty
  • Malnutrition
  • Risk of functional impairment
42
Q

What is the purpose of measuring body circumference and areas?

A

To assess some skeletal muscle and body fat stores

43
Q

What are some of the body circumference and area measurements that can be taken?

A
  • MAC: Mid-upper arm circumference
  • MAMC: Mid-upper arm muscle circumference
  • MAMA: Mid-upper arm muscle area
  • cMAMA: Corrected MAMA *****best skeletal muscle indicator
  • MAFA: Mid-upper arm fat area
  • Waist circumference ****abdominal fat indicator
44
Q
  1. What is skinfold thickness indicative of?
  2. What do the measurements assume?
  3. Which sites are used for measurements?
  4. How are the measurements evaluated?
A
  1. Indicates subcutaneous adipose tissue
  2. Assumes each site is representative of total body stores; can estimate total body fat
  3. Biceps, triceps (*most common), subscapular (back), suprailiac (front)
  4. TSF and subscapular reference tables
45
Q

Where on the body are the MAC and MAMA measurements taken?

A

At the midpoint

46
Q

What does the MAC (mid-upper arm circumference) reflect?

What is its limitation?

A
  • Reflects muscle, bone, and subcutaneous fat
  • Not sensitive to changes in muscle
47
Q

What does the MAMC (mid-upper arm muscle circumference) measure?

What does it correct for?

What is its limitation?

A
  • Measures MAC and TSF [MAMC= MAC (mm) - (π x TSF)]
  • Corrects for subcutaneous fat
  • Insensitive to small muscle changes
48
Q

What does the MAMA (mid-upper arm muscle area) account for?

What is the measurement equation?

What is its limitation?

A
  • More sensitive to muscle changes than MAMC and more accurately represents total body muscle mass
  • MAMA = MAMC2/4π *includes bone
  • Insensitive to small muscle changes; less valid for elderly and obese patients (skinfolds are harder to measure)
49
Q

What does the cMAMA reflect?

What are the equations for men and for women?

A
  • Reflects only the muscle without the bone
  • For men: cMAMA = MAMA - 10
  • For women: cMAMA = MAMA - 6.5
50
Q

What does the MAFA (mid-upper arm fat area) reflect?

What is it a better indicator of?

What is the equation used?

A
  • Reflects sub-cutaneous adipose tissue stores
  • Indicator of total body fat; better than a single skinfold measurement
  • MAFA = [TSF x 0.5 MAC] - [0.25π(TSF)2]
51
Q

What are the percentage cutoffs for MAMA and MAFA measurements?

A
52
Q

What is waist circumference reflective of?

Where is it measured?

What measurements in men/women signify abdominal obesity?

A
  • Reflects abdominal subcutaneous and visceral fat stores
  • Measured at level of lilac crest/navel
  • Men: >102cm Women: >88cm *****in caucasians
53
Q
  1. What does a patient with a high BMI and low WC indicate?
  2. What does a patient with a high BMI and high WC indicate?
  3. What can be deduced from these relationships?
A
  1. Low risk for CVD and Type II DM; accommodates high muscle mass
  2. Higher risk for CVD and Type II DM
  3. WC indicates risk independently of BMI
54
Q

Though less used now, the waist:hip ratio measurement can be used to estimate __________.

What is the normal value for males and females?

A
  • distribution of abdominal adipose and muscle tissue
  • Men: >1,0 Women: >0.8
55
Q

What are other, more sophisticated techniques of measuring body composition other than anthropometry? (list in order of increasing sophistication)

A
  • BIA: Bioelectrical impedance
  • DXA: Dual energy X-ray absorptiometry
  • BOD POD: Air displacement plethysmography
  • Hydrodensitometry: under water weighing ***used to be gold standard
  • MRI: Magnetic resonance imaging **** current gold standard
56
Q

Which body composition measuring technique fits this description:

  • Measures impedance to a low-frequency electrical current (mainly from fat)
  • Estimates fat mass, fat-free mass and total body water
  • Rapid, safe, non-ivasive
  • Limitations: influenced by hydration status, less precise in atypical bodies, limited reference data
A

BIA: Bioelectrical impedance

57
Q

In BIA measurements, if a scale with no handles is used, what is the limitation of the measurement?

A

It is not as valid because it only registers the traveling of the current through the lower half of the body and extrapolates from there.

58
Q

Which body composition measuring technique is described:

  • Imaging technique based on attenuation of radiation from different tissue densities
  • Measures bone, soft lean and fat tissues, whole body and segments
  • May estimate visceral fat
  • Gold standard for bone density
  • Limitations: expensive, minimal radiation exposure, assumes normal hydration
A

DXA: Dual energy x-ray absorptiometry

59
Q

Which body composition method is described:

  • Total body volume measured by air displacement in a chamber
  • Comparable to hydrostatic weighing; based on fat and lean tissue density
  • Limitations: limited access, residual lung volume must be measured
A

BOD POD: Air displacement

NUTR 344: Clinical Nutrition 1 (15 decks)

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