Nutrition in Clinical

Practice
Dr. Mashael Huwaikem
May 16th, 2023
Nutrition Assessment
+Nutritional assessment is the systematic process of collecting
and interpreting information in order to make decisions about
the nature and cause of nutrition related health issues that
affect an individual (British Dietetic Association (BDA), 2012).
Purpose of Nutrition Assessment
+Identifies individual at nutritional risks.
+Identifies the appropriate nutritional plan.
+Forms a basis for evaluating the nutrition care plan.
Nutrition Assessment Components
+History
+Physical Assessment
+Anthropometrics and body composition
+Biomedical Assessment
History
+It includes two parts:
+Medically and Socially
+ Medical: clinical diagnoses, drug and medication, surgery or acute illness,
significant weight loss, physical or mental disabilities,
+ Social: lifestyle, income, marital status, emotional problem and religion.

+Diet
+ Food quality and quantity, preferences, allergies, appetite, taste changes, feeding
aids or assistance, supplement intake, chawing and swallowing problems, cultural
restrictions.
+ Food intake information should be taken by using food intake measurements.
Physical Assessment
+To identify physical sign or symptom that reflecting
malnutrition.
+Some signs and symptoms are not seen till late stages of
nutrition deficiencies.
+Signs and symptoms must be followed by appropriate
biomedical, anthropometrics and dietary investigations.
Anthropometrics and Body Composition
+It is used to determine body size and composition of muscles
and fat.
1. Height (Ht) 9. Mid Arm Circumference (MAC)

2. Weight (Wt) 10. Triceps Skin Fold Thickness (TSF)

3. Body Mass Index (BMI) 11. Mid Arm Muscle Circumference (MAMC)
4.%Usual Body Weight (%UBW) 12. Mid Arm Muscle Area (MAMA)
5. % of Weight Change (%Wt.change)
6. Ideal Body Weight (IBW)
7. % Ideal Body Weight (%IBW)
8. Frame Size
Biomedical Assessment
+Biomedical data can be used to detect sub-clinical nutritional
deficiencies.
+It may be altered by nutrients, medications or illness.
+Blood and urine are the most common sources of laboratory
tests.
+ Visceral proteins, hematology, lipid profile, macronutrients,
and nitrogen balance are the most used to detect body
nutritional status.
Nutrition
Screening
Nutrition Screening
+It should be completed within 24 hours of admission of all
hospital patients.
+This standard ensure that nutrition addressed early and that
intervention is provided in timely manner and on an ongoing
basis.
+Patients considered to be at nutritional risks may exhibit any of
the following:
Nutrition Screening
+Actual or potential for developing malnutrition:
+Involuntary weight loss
+ Loss more than 10% of usual body weight within 6 months
+ Loss more than 5% of usual body weight within 1 month
+ Patient at 20% more or less than ideal body weight
+BMI < 18
+Visceral protein Test Mild Moderate Severe
Albumin (g/dl) <3.5 <2.7 <2.1
depletion
Transferrin (mg/dl) <200 <150 <100
Prealbumin (mg/dl) <15 <10 <5
Cholesterol <160mg/dl
Creatinine Height Index (CHI) <75%
Nutrition Screening
+Altered diet
+ The patient is receiving total parenteral nutrition (TPN) or enteral nutrition
(EN)
+Inadequate intake resulting from any of the following factors :
+ Orders for nothing by mouth (NPO) x 3days
+ Clear liquid diet x 5 days
+ Malabsorptive disorder
+ Impaired the ability to ingest
+ Increase metabolic requirement
+ GI disturbance
+ Nausea Diarrhea
+ vomiting Constipation
Nutrition Screening VS Nutrition Assessment

+Nutrition screening is a first-line process of identifying

patients who are already malnourished or at risk of becoming
malnourished.
+Nutrition assessment is detailed investigation to identify and
quantify specific nutritional problems.
Anthropometrics and Body Composition
+1- Height (Ht)
+ Taken by measuring tape or stadiometer
+ It should be measured without shoes
+ Patient should stand erect, looking straight ahead
without tipping head up or down
+ Use a horizontal bar should be placed on the top
of the head
+ Height should be read to the nearest 0.5 cm
+ For patient who are unable to stand, other
techniques are used as: arm span, knee height
+ 1inch= 2.54 cm
Anthropometrics and Body Composition
+2- Weight (Wt)
+ Taken by standing scales (beam balance scale)
+ Scales should be zero before measurement
+ Patient should wear minimal cloths, no shoes and
standing in the center of scale with no assistance
+ Changes in body hydration status should be noted in
case of
+ Lower limb edema (LLE) è -2 kg of AWt
+ Ascites è - 3-5 kg pf AWt

+ 1kg = 2.2 lb
Anthropometrics and Body Composition

+3- Body Mass Index (BMI)

+It is an estimate of body fat and a good for patient risk for diseases
that relate to overweight and obesity.
+It is very practical and useful measurement that allows easy
determination of categories of weight status.
!" Classification BMI (kg/𝒎𝟐 ) Obesity Class
+BMI = #" !
Interpret from table
Underweight <18.5
Normal 18.5 – 24.9
Overweight 25- 29.9
Obesity 30 34.9 I
Moderate obesity 35 – 39.9 II
Extreme obesity >40 III
Anthropometrics and Body Composition

+4.%Usual Body Weight (%UBW)

+It indicates malnutrition
𝑨𝒄𝒕𝒖𝒂𝒍 𝒃𝒐𝒅𝒚 𝒘𝒕
+%UBW = 𝒙 𝟏𝟎𝟎
𝑼𝑩𝑾
Anthropometrics and Body Composition

+5- % of Weight Change (%Wt.change)

+It indicates weight loss

𝑼𝑩𝑾 0𝑨𝒄𝒕𝒖𝒂𝒍 𝒃𝒐𝒅𝒚 𝑾𝒕

+%Wt. Change = 𝑼𝑩𝑾
𝒙 𝟏𝟎𝟎
Anthropometrics and Body Composition

+6- Ideal Body Weight (IBW)

+it can be determined using
+ A. Metropolitan Height and Weight Tables for Adult
Anthropometrics and Body Composition
+6- Ideal Body Weight (IBW)
+ B. Hamwi Method

+It is a rough estimate if Wt is not available

+Men= 48.18 kg for first 150 cm (+1.1 kg/cm over 150 cm or -1.1
kg/cm under 150 cm )
+Women 45.45 kg for first 150 cm (+0.91 kg/cm over 150 cm or -
0.91 kg/cm under 150 cm )
+* +10% for large frame size
+* -10% for small frame size
Anthropometrics and Body Composition

+6- Ideal Body Weight (IBW)

+ C. Depending on BMI

+IBW = 𝑯𝒕𝟐 𝒙 𝟐𝟐. 𝟓 for women

+IBW = 𝑯𝒕𝟐 𝒙 𝟐𝟒 for men
Anthropometrics and Body Composition

+7-% Ideal Body Weight (%IBW)

+It indicates malnutrition
%&"'() +,-. /"
+%IBW = 01!
𝑥 100
Anthropometrics and Body Composition

+ 8- Frame Size
+ Can be determined by wrist circumference (WC) or elbow breadth technique
+ Using wrist circumference technique
+ Measure WC below styloid process
+ Calculate the ration of Ht to WC
!" (%&)
+ r=
()(%&)
+ Compare r value to interpret the frame size

Frame size Men Women

Small ≥ 10.4 ≥ 11.0
Medium 9.6 10.4 10.1 -11.0
Large ≤ 9.6 ≤ 10.1
Anthropometrics and Body Composition

+ 9- Mid Arm Circumference (MAC)

+ MAC decreases with malnutrition in
fat and muscles hypertrophy
+ It reflects skeletal muscle, bone and
subcutaneous fat
+ It is intensive for changes in skeletal
muscles
Anthropometrics and Body Composition

+10- Triceps Skin Fold Thickness (TSF)

+To estimate the subcutaneous adipose
stores in the body
+Taken by using a special caliper as follow:
+a. at 1 cm above mid-arm point, grasp (by
fingers) a vertical fold with underlying fat
+b. gently pull the fold from the muscles,
apply the caliper at right angel
+Record the measurement
Anthropometrics and Body Composition

+10- Triceps Skin Fold Thickness (TSF)

+> 90 %tile è Normal
+90 – 51 %tile è Mild depletion of adipose fat
+50 – 30 %tile è Moderate depletion of adipose fat
+ < 30 %tile è Severe depletion of adipose fat
Anthropometrics and Body Composition

+11- Mid Arm Muscle Circumference (MAMC)

+MAMC = MAC– (3.14 x TSF)
+It reflects the skeletal muscle and bone within arm (to estimate
muscle mass)
+Interpret MAMC from the previous table MAC
+MAMC > 90 %tile è Normal
+ 90 – 81 %tile è Mild depletion of somatic protein
+ 80 – 70 %tile è Moderate depletion of somatic protein
+ < 70 %tile è Severe depletion of somatic protein
Anthropometrics and Body Composition

+12- Mid Arm Muscle Area (MAMA)

:%; <(>.?@ A BCD)
+MAMA = @ A (>.?@)
+It reflects skeletal muscles and bone within arm
+More adequate and sensitive for changes in somatic protein and
stores than MAC.
Questions ?