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Flashcards in Nutritional Assessment Deck (48):
1

Nutritional Screening

  • Food and Nutrient Intake Patterns
    • Calorie, macros, vits, minerals
    • Swallowing issues, GI issues,
    • Food habits, misuse of supplements
    • Restricted, therapeutic diet
  • Psych and Social factors
    • Low literacy, language
    • Depression, mental health
    • Resources, income, substance abuse
  • Physical Conditions
    • Age extremes, pregnancy, fat/muscle wasting, organ dysfunction, AIDS, cancer
  • Abnormal Lab Values: visceral proteins, lipids, BG - Medications

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Characteristics of a Good Screen

Simple and quick process Uses data routinely gathered

Facilitates completion of early intervention goals

Includes data on risk factors

Cost effective

**Main goal: Determines need for nutrition assessment

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Individual Assessment

Evaluate, Analyze, Plan, Implement, Evaluate and Record

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Community Assessment

Focus on high risk groups

  • Phases:
    • Screening and assessment
    • Data collection of population
    • Analysis of information to identify health needs and problems
  • Objectives:
    • General goals determined
    • Involving staff and agency decisions
    • Establish time line
  • Program Plan: Plan of action, staff, documentation, sources of funding, budget planning, equipment
  • Evaluation: Assessment should be ongoing, evaluate results, revisions for study purposes or for conversion to regular, ongoing program status

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Anthropometric - Weight

Ideal weight for height (% ideal)

Usual weight (% usual)

Actual weight

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"Ideal Weight"

Met Life Insurance Tables '59 and '83

Some people think we should aim to achieve '59 values because we were thinner back then

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Miller Method

Women: 119 lbs for 5ft + 3 lbs/in

Men: 135 lbs for 5 ft + 3lbs/in

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Frame Size by Wrist Circumference

r = Height (cm) / Wrist Circumference (cm)

  • Males
    • r > 10.4 small
    • r = 9.6-10.4 medium
    • r < 9.6 large
  • Females
    • r > 11 small
    • r = 10.1-11 medium
    • r < 10.1 large

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Body Compartments

Lean Body Mass = Fat Free Mass

Body fat = # and size of fat cells

Body water - LBM contains more water

Mineral Mass - smallest component

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BMI

BMI = wt (kg) / ht (m)

  • 2 2.54 cm/in

Not a good measure if:

  • Very high in muscle mass
  • Low muscle mass
  • Dense/large bones
  • Dehydration, overhydration

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Mid-Upper-Arm Circumference (MAC)

Non-dominant arm

Midpoint between scapula and elbow

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Triceps Skinfold Thickness (TSF)

Requires calipers good estimate of subcutaneous fat

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Mid-Upper-Arm MUSCLE Circumference (MAMC)

Calculated using MAC and TSF to estimate body's skeletal muscle mass

MAC(cm) - [(.314 x TSF(mm)]

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Waist to Hip Ratio

Indicative of android obesity, which correlates with obesity related diseases

Healthy:

  • Women < 0.8
  • Men < 1.0

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Bioelectrical Impedance Analysis (BIA)

  • Body fat/body composition analysis
  • LBM has higher electrical conductivity and low impedance, relative to water, based on electrolyte content
  • Electrodes attached to extremities
  • Electrical and resistance data obtained
  • Highly sensitive to hydration status

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Biochemical Analysis

Most objective and most sensitive data

Quality control can be maintained

Nutrition specific lab data tests on body fluids

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Albumin

Normal: 3.5-5

  • Most abundant and most often measured protein
  • Long Half life - 21 days - can't evaluate short term changes
  • Made in liver
  • Functions to maintain oncotic pressure, keeping fluids in the right places in the body
  • Nonspecific carrier protein
  • Inexpensive nutritional marker in a non-stressed person

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Preablumin / Transthyretin

Normal: 19 - 43

  • Transport protein with many physiological roles
  • Correlates with short term changes in nutritional status in non-stressed person
  • Short half life - 2 days

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Hematocrit

Men: 41-53%

Women: 36-46%

  • Percentage of RBC's in the blood by vol
  • Indicates ratio of RBC vol to total blood vol
  • Low level can be indicative of anemia or blood loss

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Hemoglobin

Men >14

Women >12

  • Oxygen carrying pigment in RBC
  • Formed by developing RBC in bone marrow
  • Low level indicative of anemia

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Blood Level Evaluation

Used for:

  • Absorptive capacity
  • Organ function
  • Disease management
  • Nutritional status
  • Risk for chronic dx
    • Lipid profile
    • CRP
    • Glycosylated Hgb

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Lymphocyte Count

Normal >2700

Decreased in PCM (protein calorie malnutrition)

Affected by many medical conditions, infections, medications (chemo, XRT, steroids)

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Skin Testing

PPD: Purified protein derivative of tuberculin

Mumps

Anergy (no response) can be sign of PCM

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Nitrogen Balance

  • Term used to describe relative balance of daily intake and output of nitrogen
  • Measure of how well tissue proteins are being maintained 

[Protein intake (g) / 6.25] - [UUN*(g) + 4g**]

  • * Measured Urinary Urea Nitrogen
  • ** 4g accounting for average N lost in stool and skin
  • 6.25 g Protein = 1g N

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Catabolism

  • Negative Nitrogen balance
  • ongoing process of the breakdown of tissue proteins
  • Active during stress/illness - body uses its own muscle mass to meet nitrogen requirements

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Anabolism

Positive Nitrogen Balance

Process of re-synthesizing tissue proteins

Active during growth, recoery and weight training 

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Clinical - General Appearance

Confusion: thiamin, Niacin, dehydration

Weakness: PCM, B12, Niacin, anemia

Neuropathy: thiamin, chromium, pyridoxine

Psychmotor changes: Kwashiorkor (protein malnutrition - no albumin, no oncotic pressure, fluid goes into abdomen)

Sensory losses: Niacin

Dementia: B12, thiamin

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Clinical - Hair

Luster, color, alopecia, scalp

PCM, protein, EFA's, zinc, copper

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Clinical - Skin

Scaling around nostrils: Riboflavin

Scaly dermatitis: niacin, Vit A, zinc, EFA's

Swollen, moon face: protein

Pale: anemia

Dry, poor turgor: dehydration

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Clinical - Nails

Cup-like depressions: IRON

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Clinical - Eyes

Pale conjunctiva: Anemia

Dry, dull conjunctiva: Vit A

Night Blindness: Vit A

Redness, fissuring at corners: Riboflavin, pyridoxine

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Clinical - Mouth

Angular Cheilosis: Riboflavin

 - Swollen lips, buccal mucosa extends to lips

Magenta Tongue: Riboflavin

Mucosal Atrophy: Niacin

Bleeding Gums: Vit C and Vit K

Flourosis - White areas in the enamel of teeth: too much flouride 

Dental Caries: decreased flouride, excess sugar 

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Clinical - Muscles, Skeleton

Cachexia: general malnutrition, protein wasting

Bruising: Vit C, K

Tremor: electrolytes

Edema: protein

Rickets, osteoporosis, bone pain: calcium, Vit D, Phosphorus 

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Clinical - Abdomen, GI Function

Ascites: PCM, protein, other disorders

Diarrhea: PCM, thiamine, malabsorption, IBD, infection, meds, antibiotics

Bloating, distention: lactose, intolerances, disorders, meds

Appetite: PCM, thiamine, niacin, meds, other problems 

Taste changes: zinc, meds

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Diet History

  • Usual food and beverage habits
  • Meal patterns, changes on weekend
  • likes, dislikes
  • Food allergies and intolerances
  • ETOH and drugs
  • Vitamins and supplements
  • Physical and Sedentary activities 

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24 Hour Recall

Guided by clinician

Type and amount of each food and beverage in the previous 24 hours 

Downfalls:

  • may not reflect typical intake
  • Not ideal for individuals with memory problems
  • Misreported portion sizes

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Nutrient Intake Analysis

"Calorie Count"

Collected by direct observations - may yield inconsistent and subjective estimates of food consumption

Portion sizes vary

Labor intensive

For studies, use pre meal and post meal weights

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Food Records

3-7 Days of analysis

Need to teach client how to describe, measure and record foods 

Best method to obtain accurate info

Downfalls

  • Data is only as good as the record
  • Intake may be influenced by recording process
  • Not good for people who can't read

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Food Frequency Questionnaire

Assessment of nutrient intake over an extended period of time

Retrospective

Clinician guided or client centered

Not ideal for individuals with memory problems

Useful for group studies of disease risk and incidence

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Caution with Dietary Assessment Tools

10-45% underreport food intake

Underreporting:

  • increases as children age
  • women > men
  • obese > non-obese

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Harris-Benedict Equation

  • Intended for adults, not kids
  • Estimated Basal (BEE)

Women: BEE = 655 + 9.56W + 1.85H - 4.68A

Men: BEE = 66.5 + 13.75W + 5H - 6.75A

Downfalls

  • Overestimates by 7-24%
  • 45-81% accuracy
  • Does not factor in body composition
  • Activity level is difficult to assign
  • Taller and heavier than 1919
  • young/old and underweight/overweight not represented 

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Activity Levels - Harris Benedict

  • Sedentary 1-1.39
  • Bed Bound 1.2
  • Low Activity 1.4-1.59
  • Active 1.6-1.89
  • High 1.9-2.5

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Mifflin St. Jeor Equation

  • Healthy Population
  • 82% accuracy in non-obese

Women: REE = 10W + 6.25H - 5A - 161

Men: REE = 10W + 6.25H - 5A + 5

Activity Levels

  • Sedentary: 1.2
  • Obese: 1.3
  • Light Activity: 1.4-1.6
  • Moderate: 1.55
  • Very High: 1.725

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Ballpark Method

  • 15 kcal/lb (maintenance)
  • 13 kcal/lb (weight loss)
  • 17 kcal/lb (weight gain)

Ranges

  • 14-20 kcal/kg
    • Obese
    • inactive
    • Chronic dieters
  • 30 kcal/kg
    • Very active women
    • Active men
  • 25-29 kcal/kg
    • Adults >55
    • Active women
    • Sedentary men
    • Hospitalized, non-stressed patients
  • 35-45 kcal/kg
    • Underweight
    • Very active men
    • Malnourished
    • Catabolic

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Adjusted BW

[(Actual BW - Ideal BW) x 0.25] + IBW

  • Debated
  • Equation to try to account for excess actual body weight
  • Assumes 25% of excess BW is metabolically active 

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Protein Requirements

  • Healthy adults: 0.8g / kg IBW
  • Minimum to maintain N balance in healthy adult = 0.5 g/kg BW

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Malnutrition

Prevalent in low income families

Prevalent in hospitalized, chronically ill and especially in elderly

Can occur at any weight

May result in poor growth, osteoporosis, lowered resistance to infections, poor healing, increased morbidity and mortality 

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