Nutritional Assessment (A,B,C,D) Flashcards
1
Q
Define nutritional assessment?
A
“The interpretation of information obtained from dietary, biochemical, anthropometric and clinical studies to gain
- a better understanding/measurement of the risk of nutritional deficiencies and excesses
- an evaluation of the effects from nutritional intervention
- to determine the health status of an individual or population based on their intake and utilisation of nutrients.
2
Q
ANTH- Define anthropometry?
A
Study of human body measurements/physical dimensions and body composition at differing age levels and degrees of nutrition
3
Q
What is the purpose for which the biochemical nutritional assessment system is used?
A
- To detect subclinical deficiency
- To confirm a clinical diagnosis
- Objective mean of assessing nutritional status
- Supplements other nutritional assessment methods
4
Q
What is the purpose for which the clinical nutritional assessment system is used and give examples?
A
To gain information from an individual about medical history (including nutrition-related illnesses, anaemia, pica, supplementation, medication use, anorexia) and identify related pathology
Examples: medical records (source-orientated SOMR & problem-orientated POMR), physical examination
5
Q
What is the purpose for which the dietary nutritional assessment system is used?
A
- Identify individuals/populations at risk of nutritional inadequacy
- Investigate the relationship between diet and disease.
- Monitor outcomes of nutritional intervention
6
Q
ANTH- What are some limitations of the anthropometry nutritional system?
A
- cannot detect deficiencies of some micronutrients
- cannot detect very small changes in LBM/FM
7
Q
What are some limitations of the biochemical nutritional system?
A
- can fail to reflect overall nutritional status as only measures circulating nutrient (as it is based on a measurement from a sample only, doesn’t take into account any stores).
- laboratory limitations (e.g. sample contamination, method-related limitations, subject to other factors - age, sex, ethnicity etc).
8
Q
What are some limitations of the clinical nutritional system?
A
- Non-specificity of physical signs
- Variations in physical patterns/signs
- Signs produced by more than one nutritional issue
9
Q
What are some limitations of the dietary nutritional system?
A
- Can be labour intensive for the assessor and individual
- May not reflect usual consumption
- Under-reporting
- Requires continual motivation
- Based on memory (24-hour recall)
10
Q
Briefly describe a nutritional surveillances purpose? What is the UKs biggest nutritional surveillance/monitoring survey?
A
- Continually monitors selected population groups
- Identifies causes of both chronic and acute malnutrition
- Can be used to formulate interventions
UK survey - National Food Survey (NFS)
11
Q
Briefly describe a nutritional screenings purpose?
A
Idenifying individuals or populations already malnourished or at risk of becoming so
12
Q
Briefly describe a nutritional interventions purpose? What are the three major interventions?
A
Targets population sub-groups ‘at risk’ following nutritional surveys or screening.
- Supplementation
- Fortification
- Dietary approaches
13
Q
What are the 2 prospective dietary assessment methods?
A
- weighed food records
- estimated food records
14
Q
What are the 3 retrospective dietary assessment methods?
A
- 24-hour recall
- FFQ
- Dietary history
15
Q
What are some of the nutritional screening tools?
A
WAVE
REAP
MUST
16
Q
What is the breakdown of the body make-up? (4 things)
A
- fat
- lean muscle
- bone
- water
17
Q
What are some of the uses of anthropometry?
A
- Predict the effects of weight loss or gain on the proportions of body fat and lean tissue
- Investigate fat distribution
- Identify and understand wasting in certain groups (hospital patients, famines)
- To estimate energy requirements
- To further understand the functions of other nutrients
18
Q
ANTH- What factors affect body composition?
A
Sex, age, genetics, exercise, diet, illness or health
19
Q
ANTH- What is the breakdown of the body make-up? (4 things)
A
- fat
- lean muscle
- bone
- water
20
Q
ANTH- What is the importance of anthropometry?
A
- Predict effects of weight change on the proportions of body fat and lean tissue
- Investigate fat distribution
- Understand wasting in certain groups
- To estimate energy requirements (EAR)
- To further understand the functions of other nutrients
21
Q
ANTH- What does lean body mass (LBM) measure?
A
The weight of the body excluding the weight of the fat
22
Q
ANTH- What can lean body mass (LBM) also be called?
A
Fat-free mass (FFM)
23
Q
ANTH- What are the components that FFM/LBM consist?
A
- Water
- Bone Minerals
- Non-Bone Minerals
- Protein
24
Q
ANTH- Fat mass (FM) consists of what percentage of water and adipose tissue?
A
Water - 20%
Adipose Tissue - 80%
25
ANTH- What are the body fat ranges for an average 30 year old male (inc. %)? Do these percentages increase or decrease with age?
Underweight/Underfat - \<8%
Healthy - 8-19%
Overweight/Overfat - 20-25%
Obese - \>25%
Percentages increase slightly with increased age
(40-59yrs \>3%)
(60-79yrs \>3%)
\*WHO guidelines
26
ANTH- What are the body fat ranges for an average 30 year old female (inc. %)? Do these percentages increase or decrease with age?
Underweight/Underfat - \<21%
Healthy - 21-33%
Overweight/Overfat - 33-39%
Obese - \>39%
Percentages increase slightly with increased age
(40-59yrs \>2%)
(60-79yrs \>1%)
\*WHO guidelines
27
ANTH- What are the measurable compartments?
1. Body weight
2. Fat Mass (FM)
3. Fat-Free Mass (FFM)
4. Total Body Water (TBW)
5. Extracellular Fluid (ECF)
6. Bone Mineral Content (BMC)
7. Elemental Analysis (N, C, Cl, Na, K).
28
ANTH- Aside from anthropometry, what are some other methods of measuring body composition?
- DEXA Scanning
- Bioelectrical impedance
- 3D optical imaging (new revolution)
29
ANTH- What are the anthropometric measuring methods?
1. Weight/height indices (BMI aka Quetelet index, Broca Index and Benn Index).
2. Body Fat %
3. Skinfold Thickness
4. Waist/Hip Circumference Ratio (WHR)
5. Waist Circumference (WC)
6. Frame size
7. Air Displacement
8. Electrical Conductance
9. Head circumference (children)
30
ANTH- What are the standard BMI classifications?
\<18.5 - Underweight
18.5-24.9 - Normal
25.0-29.9 - Overweight
30.0 - 34.9 - Obese Class I
35.0 - 39.9 - Obese Class II
\>=40.0 Obese Class III
\*WHO Classifications
31
ANTH- A BMI classification would not be appropriate for what groups?
Pregnant women or professional athletes
32
ANTH- BMI is based on which particular population? What is the difference for non-Caucasian populations?
Caucasian.
The category range is slightly lower (e.g. 18.5 - 25kg/m2 for Caucasians vs 18.5 - 23kg/m2 for non-Caucasians)
33
ANTH- Where would you take a waist circumference (WC) measurement? What are the advantages and limitations of this method?
Between the lower rib and iliac crest against bare skin
Advantages: Low cost, quick, provides information on disease risk in patients with a BMI 25-35 kg/m2
Limitations: Invasive, reliability (provides little information for those who already have a BMI \>35 kg/m2), cultural sensitivity
34
ANTH- An increased WC measurement would be disadvantageous how?
Increased risk for the development of diseases associated with obesity such as CVD, type 2 diabetes, hypertension
35
ANTH- What are the ideal WC reference values for males and females? Does this differ for anyone?
Males:
\<94cm desirable, 94-102 increased risk, \>102cm substantial risk.
Females: \<80cm desirable, 80-88cm increased risk, \>88cm substantial risk
This differs for people of differing ethnicities.
36
ANTH- What does the anthropometric method of waist/hip ratio (WHR) describe about a person?
The distribution of subcutaneous and intra-abdominal adipose tissue
37
ANTH- What are some advantages and limitations of WHR measurments?
Advantages:
- Minimally invasive
- Cost effective
- Can identify dichotomous fat distribution (apple v pear)
Limitation
- The WHR won't change if both hip and waist measurements increase (i.e. weight gain).
38
ANTH- What is the equation to measure someone's frame size?
```
r = H/C
r = ratio
H = Body Height (cm)
C = Right Wrist Circumference (cm)
```
39
ANTH- What is the advantages to taking skinfold thickness measurements? Limitations?
Advantages:
Inexpensive & quick.
Increased measurements improves error margin
Limitations:
Requires trained examiner
Invasive
Prone to error for;
Older patients
Obese patients
HIV patients (misproportioned body fat)
40
ANTH- Skinfold thickness measurements assume what? Is this the same for both genders?
That there is a constant relationship between subcutaneous fat and total body fat.
It may not be as consistent for women as they biologically have more internal fat.
41
ANTH- Where can you take skinfold measurements?
Thigh, chest, abdomen, calf, triceps.
42
ANTH- What does electrical conductance measure?
The differences in electrolyte content between FM and FFM tissues. FFM has greater conductivity than FM.
43
ANTH- What are the advantages and limitations of bioelectrical impedance?
Advantages:
Convenient, rapid and safe.
Limitations:
Assumes the participant is adequately hydrated. Dehydration results in the overestimation of fat
Instrument cost
44
ANTH- What is the usual current used on a participant using bioelectrical impedance?
50 kHZ
45
ANTH- What is DEXA scanner used to measure?
- Bone mineral density (usually osteoporosis)
- To determine FM and FFM
46
ANTH- What is an advantage and limitation of the DEXA scanner?
Adv: Safe, quick and effective
Dis: Expensive and hydration matters
47
ANTH- How is weight/height measured in children?
BMI/age = percentile
48
ANTH- What are the percentile classifications (UK) for children's weight?
```
Undernourished = BMI \<2nd percentile
Overweight = BMI \>91st percentile
Obese = BMI \>98th percentile
```
\*SACN guidelines
49
ANTH- What other anthropometric measurement can be used for children \<2 years? What can this tell us?
Head circumference.
Assessment of mental development
50
ANTH- What position should participant be in in order to get a weight/height measurement?
Frankfurt position
Ensure Frankfurt plane is horizontal
51
What is the equation for BMI?
BMI = weight(kg)/(height(m))2
body fat % can be estimated using another formula with the BMI
52
How do you calculate waist / height ratio?
What is the ideal range?
Waist / height = ratio
0.4-0.49
53
When is the best time to weigh someone?
- Same time of day
- Empty bladder
- Fasted (or before a meal)
54
What are the equations for estimating body fat % using BMI (male and female)?
% body fat (men) = (1.218 x BMI) -10.13
% body fat (women) = (1.48 x BMI) -7
55
What are the healthy WHR measures for both men and women? What does an increased WHR indicate?
Women WHR = \<0.8
Men WHR = \<0.9
Increased risk for the development of weight related health concerns/disease
56
Demonstrate how you would measure height and weight accurately.
Height - stand straight, arms by side, palsm facing inwards, horizontal frankfurt plane (lower eye in line with ear canal), heels together, shoulders, buttocks and heels touching the wall/stadiometer
Weight - scales on hard flooring, calibrated to 0, minimal clothing, ideally fasted, empty bladder, look ahead, repeated for accuracy
57
Demonstrate how you would measure waist and hip circumference accurately.
Waist - midpoint between lowest rib and illiac crest, exhaling, tape measure with no elasticity, repeat for accuracy
Hip - Accurate place for sex (female: widest point of buttocks, men: 2-4 in below navel), tape measure with no elasticity, feet together, arms across the chest and exhale, repeat for accuracy
58
What measures of anthropometry are most important when assessing growth of a baby or toddler? How would you measure these indices and what are the practical considerations to be taken into account?
Baby- Head circumference, BMI/age = percentile.
\<2nd percentile - undernourished
\>91st percentile - overweight
\>98th percentile - overnourished
Toddler - Head circumference, BMI \>2 years
59
Assuming that the person who is sitting in this viva is a 25 year-old male athlete, describe how you would measure his height and weight.
BMI could still be used as a method as not all athletes are strength training large people.
BMI measurements would still be supplemented with other methods such as skinfold thickness, body fat %, waist circumference, especially bioelectrical impedence analysis OR bioelectrical impedence vector analysis, to gain an overall conclusion
60
Discuss the most appropriate method(s) for assessment of weight status in athletes
Bioelectrical impedence analysis (**BIA)** or bioelectrical impedence vector analysis **(BIVA),** and skinfold measurements
61
What is a static biochemical test? What is a limitation of this testing?
What is a functional biochemical test? What is an example? Limitation?
**Static:** Based on a measurement of a nutrient present in the blood, plasma, urine or tissue.
**Limitation**: Fails to reflect overall nutrient status, only takes into account circulating nutrient
**Functional:** Proposed that the outcome of a nutrient deficiency and its biological importance cannot be merely measured using a static test, but instead can be measured by the failure of one or more phytsiological proceesses associated with that nutrient.
**Example**: Measurement of dark adaptation to assess Vitamin A status
**Limitation:** Can be nonspecific and only provides a general observation
