1. Assessment of Nutritional Status By Izhar PG Scholar Dept of TST NIUM Bangalore

2. IntroductionThe nutritional status of an individual is often the result of many interrelated factors. Understanding these factors is essential in order to: assess malnutrition, design programmes which tackle nutrition problems, and correctly inform programme management and evaluation

3. This is the most commonly used framework for understanding the causes of malnutrition. (adapted from the UNICEFconceptual framework).

4. Learning Objectives: To understand basic anthropometric techniques and the applications

5. Nutritional Assessment Why? The purpose of nutritional assessment is to Identify individual or population groups who are malnourished. Identify individual or population groups at risk of becoming malnourished. To develop health care programmes that meet the community needs which are defined by the assessment. To measure the effectiveness of the nutritional programmes and intervention once initiated.

6. Methods of Nutritional Assessment Direct and Indirect

7. Direct methods of nutritional assessment: These are summarized as ABCD.

8. Indirect method of nutritional assessment These included three categories.

9. Clinical assessment It is the simplest and most practical method of ascertaining the nutritional status of a group of individuals. Detection of relevant signs helps in establishing the nutritional diagnosis.

10. Clinical Assessment: Advantages Fast and easy to perform Inexpensive Non Invasive Limitations:

11. Clinical Signs of nutritional deficiency Hair

12. Mouth

13. Eyes

14. Nails

15. Skin

16. Anthropometric methods Anthropometry is the measurement of body height, weight and proportions.

17. Other anthropometric measurements Mid arm circumferences Skin fold thickness Head circumference Head/ Chest ratio Hip/ Waist ratio

18. Anthropometry for children Accurate measurement of height and weight is essential. The results can then be used to evaluate the physical growth of the child.

19. Measurement of adults Height: The subject stands erect and bare footed on a stadiometer with a movable head piece. The head piece is leveled with skull vault and height is recorded to the nearest 0.5 cm.

20. Nutritional Indices in adults The international standards for assessing body size in adults is the body mass index.(BMI) BMI is computed using the following formula. BMI = Weight (Kg)/ Height (met)2

21. BMI ( W.H.O Classification) BMI < 18.5 = Underweight BMI 18.5 – 24.9 = Healthy weight range BMI 25 – 30 = Overweight ( Grade 1 obesity) BMI > 30 – 40 = Obese ( Grade 2 obesity) BMI > 40 = very obese ( morbid or grade 3 obesity)

22. Advantages of anthropometry Objective with high specificity and sensitivity. Readings are numerical and gradable on standard growth charts. Limitations of anthropometry Inter observers errors in measurement. Limited nutritional diagnosis. Problems with reference standards i.e local verus international standards.

23. Dietary Assessment Nutritional intake of human is assesses by five different methods. These are 24 hours dietary recall. Food frequency questionnaire. Dietary history since early life. Food dairy technique. Observed food consumption.

24. Initial laboratory assessment Hb estimation is the most important test and useful index of the overall state of nutrition. Specific lab tests Measurement of individual nutrient in body fluids( e.g serum reinol, serum iron, urinary iodine, vit D) Detection of abnormal amount of metabolites in urine ( e.g urinary creatinine) Analysis of hair, nails and skin for micronutrients.

25. Advantages of biochmical method It is useful in detecting early changes in body metabolism and nutrition before the appearance of overt clinical signs. It is precise, accurate and reproducible. Limitations Time consuming expensive

26. If you want to know more…………… Nutrition and development: a global challenge - adapted from Nutrition and development - a global assessment, written by FAO and WHO for the International Conference on Nutrition, 1992. United Nations Standing Committee on Nutrition/Administrative Committee on Coordination(ACC/SCN) Second report on the World Nutrition Situation: Vol.1: Global and Regional Results, ACC/SCN Geneva, 1992. The double burden of malnutrition – Case studies from six developing countries. FAO Food and Nutrition Paper 84, Rome 2006. http://www.fao.org/docrep/009/a0442e/a0442e00.htm Measurement and Assessment of Food Deprivation and Undernutrition - FIVIMS Proceedings, International Scientific Symposium held in FAO, Rome 26-28 June 2002. FAO 2003. http://www.fao.org/DOCREP/005/Y4249E/Y4249E00.HTM Conducting small-scale nutrition surveys: A field manual. FAO, 1990, 186p, English, Spanish, French ISBN 202851. http://www.fao.org/docrep/009/a0442e/a0442e00.htm#Contents Body mass index - A measure of chronic energy deficiency in adults. FAO Food and Nutrition Paper 56, 1994. http://www.fao.org/docrep/T1970E/T1970E00.htm

27. Thank you….