Lecture 9

Question 1

What is nutritional status?

Answer 1

The balance between nutrient intake and expenditure (health condition).

Question 2

What do measures of nutritional status reflect?

Answer 2

Intake, absorption, metabolism, storage and excretion.

Question 3

What is the nutritional status assessment at an individual level?

Answer 3

Diagnosis, screening, intervention and monitoring.

Question 4

What is the nutritional status assessment at a population level?

Answer 4

Policy setting, programme evaluation and nutritional surveillance.

Question 5

What are the things you do to integrate nutrition into routine clinical care?

Answer 5

1. Past medical history.
2. Family history.
3. Medications, Over the counter/supplements/herbs.
4. Diet/social history/lifestyle history.
5. Review of systems.
6. Physical examination.
7. Laboratory evaluation.
8. Assessment and plan.

Question 6

What is the ABCD(E) of a nutrition assessment?

Answer 6

A = Anthropometric. 
B = Biochemical. 
C = Clinical.
D = Dietary.
(E = Economical/social).

Question 7

What does A stand for in a nutrition assessment?

Answer 7

Anthropometry.

Question 8

Describe anthropometry? and ways to measure anthropometry.

Answer 8

Changes in physical dimensions (weight) and body composition - including rate of change.
Weight.
Height/stature/knee height/ total arm length/arm span.
Circumference.
Other.

Question 9

What are invasive ways (that are rarely used) to measure anthropometry?

Answer 9

Skinfolds.
Bioelectrical impedance.
Body density: under water weighing, BodPod.
Isotope dilution (total body weight).
DEXA (dual energy x-ray absorptiometery).
Total body electrical conductivity.
Magnetic resonance imaging.

Question 10

What is BMI?

Answer 10

Body Mass Index.

Question 11

How do you calculate BMI?

Answer 11

Weight (kg) / height (m2)

*square the height

Question 12

What is the BMI value for an underweight person?

Answer 12

Less than 18.50.

Question 13

What is the BMI value for a normal range person?

Answer 13

18.50-24.99

At average risk of health conditions associated with increasing BMI.

Question 14

What is the BMI value for an overweight person?

Answer 14

25.00-29.99

At increased risk of health conditions associated with increasing BMI.

Question 15

What is the BMI value for an obese person?

Answer 15

> 30.00 (Substantially increased risk)

Question 16

What is the BMI value for an obese class 1 person?

Answer 16

30.00-34.99

At moderate risk of health conditions associated with increasing BMI.

Question 17

What is the BMI value for and obese class 2 person?

Answer 17

35.00-39.99

At severe risk of health conditions associated with increasing BMI.

Question 18

What is the BMI value for an obese class 3 person?

Answer 18

> 40.00

At very severe risk of health conditions associated with increasing BMI.

Question 19

What can distribution of body fat tell us in clinical practice?

Answer 19

Relate to disease independently of obesity e.g. abdominal fat and type 2 diabetes.

Question 20

What is the waist:hip ratio for increased mortality in men and women?

Answer 20

Men = >1.0
Women = >0.8

Question 21

What is the waist circumference for increased mortality risk in men and women?

Answer 21

Men = >102cm
Women = >88cm

Question 22

What is %weight loss (change in body weight over period of time)? and how do you calculate it?

Answer 22

(Usual weight - current weight x 100)/usual weight

Question 23

Describe Biochemistry?

Answer 23

To detect subclinical or marginal deficiencies.
To enhance or support other nutritional data.
Nutrients in blood or ruin, biopsy.
In vivo respond to nutrient supplementation e.g. Hb and iron.

Question 24

What are biochemical test examples?

Answer 24

1. Serum albumin level = measures main protein in blood; determines protein status.
2. Serum transferrin level = indicates iron-carrying protein in blood.

Question 25

What does C stand for in nutritional status?

Answer 25

Clinical.

Question 26

Describe clinical?

Answer 26

[subjective evaluation of overt signs/symptoms-includes medical history] 1. Signs and symptoms of deficiency/toxicity whether likely to be reversible. 2. Measurements of physiologic performance and activities-functional status - oral and dental health. 3. Cognitive status. 4. Use of drugs - drug-nutrient interactions etc.

Question 27

Describe a clinical assessment?

Answer 27

1. Detect signs and symptoms of malnutrition. 2. Medical history. Physical assessment: hair, skin, eyes, mouth, bones. 3. Physiological tests e.g. immune competence, taste, acuity, night blindness, muscle function, cognitive function. 4. Deficiency usually severe before clinically evident. 5. Symptoms may be caused by non-nutritional factors - secondary deficiency. 6. Symptoms may relate to several nutrients.

Question 28

What does D stand for?

Answer 28

Dietary evaluation.

Question 29

Describe dietary evaluation?

Answer 29

1. Food and beverage intake - quality of diet. 2. Food consumption of patterns (changes and trends) and preferences. 3. Usage of supplements (and effect on nutrient). 4. Feeding practices e.g. institutions. 5. Food security/insecurity.

Question 30

What are the main types of approach for dietary evaluations?

Answer 30

1. Diet (food) history 2. Food frequency questionnaire 3. 24 hour recall 4. Food records

Question 31

How do you review the systems? general

Answer 31

Apetite changes; weight loss/gain; clothes tighter/loser.

Question 32

How do you review the systems? skin

Answer 32

The appearance of the skin (in general the pallor).

Question 33

How do you review the systems? GI symptoms

Answer 33

Abdominal pain, nausea, vomiting: - bowel changes - difficulty/pain swallowing, early satiety, indigestion, heartburn - mouth lesions-ulcers, tooth decay; sore tongue, gums.