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Nutrional status assesment
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- 2. INTRODUCTION The nutritionalstatus of an individual is often the result of many inter-related factors. The spectrum of nutritional malnutrition(FAO- 460 million which contributes about 15% of world population excluding china) Of which 300million falls under south asia Identify individuals or population groups at risk of becoming malnourished To develop health care programs that meet the community needs which are defined by the assessment To measure the effectiveness of the nutritional programs & intervention once initiated 12/18/2016 2
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- 6. DIRECT METHODS OFNUTRITIONAL ASSESSMENT Anthropometric methods Biochemical, laboratory methods Clinical methods Functional assessment Radiological examination 12/18/2016 6
- 7. INDIRECT METHODS OFNUTRITIONAL ASSESSMENT Dietary assessment Ecological variables including crop production Economic factors e.g. per capita income, population density & social habits Vital health statistics ,infant & under 5 mortality & fertility index 12/18/2016 7
- 8. CLINICAL ASSESSMENT Itis an essential features of all nutritional surveys It is the simplest & most practical method of ascertaining the nutritional status of a group of individuals It utilizes a number of physical signs, (specific & non specific), that are known to be associated with malnutrition and deficiency of vitamins & micronutrients ADVANTAGES Fast & Easy to perform Inexpensive Non-invasive LIMITATIONS Does not detect early cases 12/18/2016 8
- 9. ANTHROPOMETRIC METHODS Itis an essential features of all nutritional surveys It is the simplest & most practical method It utilizes a number of physical signs, (specific & non specific), associated with malnutrition and deficiency of vitamins & micronutrients Anthropometric measurements Mid-arm circumference Skin fold thickness Head circumference Head/chest ratio Hip/waist ratio 12/18/2016 9
- 10. 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. For growth monitoring the data are plotted on growth charts over a period of time that is enough to calculate growth velocity, which can then be compared to international standards 12/18/2016 10
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- 14. WEIGHT MEASUREMENT UNDER2 YEARS 12/18/2016 14
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- 17. BMI BODY MASSINDEX(WHO) 12/18/2016 17
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- 20. Advantages of anthropometry Objectivewith high specificity & sensitivity Measures many variables of nutritional significance (Ht, Wt, MAC, HC, skin fold thickness, waist & hip ratio & BMI). Readings are reproducable numerical & gradable on standard growth charts Non-expensive & need minimal training Limitations of Anthropometry Inter-observers errors in measurement Limited nutritional diagnosis Problems with reference standards, i.e. local versus international standards. Arbitrary statistical cut-off levels for what considered as abnormal values. 12/18/2016 20
- 21. FUNCTIONAL ASSESSMENT Functionalindicators of nutritional status are diagnostic tests to determine the sufficiency of host nutritional status Functional indices of nutritional status include cognitive ability, disease response, reproductive competence, physical activity, work performance Increased severity of malnutrition is associated with an increased heart rate Lactation performance Growth velocity Social performance Prenatally undernourished infants show several behavioural impairments 12/18/2016 21
- 22. RADIOLOGICAL EXAMINATION Thesetests are used in specific studies where additional information regarding change in the bone or muscular performance is requiredWhen clinical examination is suggestive rickets, there is healed concave line of increased density at distal ends of long bones usually the radius and ulna. In infantile scurvy there is ground glass appearance of long bones with loss of density. In beriberi there is increased cardiac size as visible through X-rays. Drawback, sophisticated and expensive equipments along with technical knowledge are required in the interpreting data. 12/18/2016 22
- 23. BIO- CHEMICAL &LABORATORYASSESSMENT Hemoglobin estimation is the most important test, & useful index of the overall state of nutrition. Beside anemia it also tells about protein & trace element nutrition. Stool examination for the presence of ova and/or intestinal parasites Urine dipstick & microscopy for albumin, sugar and blood Measurement of individual nutrient in body fluids (e.g. serum retinol, serum iron, urinary iodine, vitamin D) Detection of abnormal amount of metabolites in the urine (e.g. urinary creatinine/hydroxyproline ratio) Analysis of hair, nails & skin for micro-nutrients. 12/18/2016 23
- 24. Advantages It is usefulin detecting early changes in body metabolism & nutrition before the appearance of overt clinical signs. It is precise, accurate and reproducible . Useful to validate data obtained from dietary methods e.g. comparing salt intake with 24-hour urinary excretion. Disadvantages Time consuming Expensive They cannot be applied on large scale Needs trained personnel & facilities 12/18/2016 24
- 25. INDIRECT ASSESSMENT Healthy foodunhealthy(tasty)food 12/18/2016 25
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- 28. DIETARY ASSESSMENT Nutritionalintake of humans is assessed by five different methods. These are: 24 hours dietary recall Food frequency questionnaire Dietary history since early life Food dairy technique Observed food consumption 12/18/2016 28
- 29. 24 HOURS DIETARYRECALL A trained interviewer asks the subject to recall all food & drink taken in the previous 24 hours. It is quick, easy, & depends on short-term memory, but may not be truly representative of the person’s usual intake 12/18/2016 29
- 30. FOOD FREQUENCY QUESTIONNAIRE In this method the subject is given a list of around 100 food items to indicate his or her intake (frequency & quantity) per day, per week & per month. inexpensive, more representative & easy to use. Limitations: long Questionnaire Errors with estimating serving size. Needs updating with new commercial food products to keep pace with changing dietary habits. 12/18/2016 30
- 31. DIETARY HISTORY Itis an accurate method for assessing the nutritional status. The information should be collected by a trained interviewer. Details about usual intake, types, amount, frequency & timing needs to be obtained. Cross-checking to verify data is important. 12/18/2016 31
- 32. FOOD DAIRY Foodintake (types & amounts) should be recorded by the subject at the time of consumption. The length of the collection period range between 1- 7 days. Reliable but difficult to maintain. 12/18/2016 32
- 33. OBSERVED FOOD CONSUMPTION The most unused method in clinical practice, but it is recommended for research purposes. The meal eaten by the individual is weighed and contents are exactly calculated. The method is characterized by having a high degree of accuracy but expensive & needs time & efforts. 12/18/2016 33
- 34. INTERPRETATION OF DIETARYDATA 1. Qualitative Method using the food pyramid & the basic food groups method. Different nutrients are classified into 5 groups (fat & oils, bread & cereals, milk products, meat-fish- poultry, vegetables & fruits) determine the number of serving from each group & compare it with minimum requirement. 12/18/2016 34
- 35. INTERPRETATION OF DIETARYDATA 2. Quantitative Method The amount of energy & specific nutrients in each food consumed can be calculated using food composition tables & then compare it with the recommended daily intake. Evaluation by this method is expensive & time consuming, unless computing facilities are available. 12/18/2016 35
- 36. VITAL STATISTICS Morbidity& mortality data indicate extend of high risk in a community MORTALITY Mortality particularly in age group of 1-4 is related to malnourishement Infant mortality rate Second year mortality rate Rate of low birth weight Life expectancy MORBIDITY Morbidity datas like pem, anaemia, xerophthalmia other vitamin deficiencies , diarrhoea provide aditional nutritional status to the community 12/18/2016 36
- 37. NATURAL HISTORY OFDISEASE 12/18/2016 37
- 38. LOW BIRTH WEIGHT Less than 2.5kg Based on gestational age Preterm Term Postterm Low birth weight Preterm Small for date babies 12/18/2016 38
- 39. SOCIAL ASPECTS OFNUTRITION Problems of malnutrition Under nutrition Over nutrition Imbalance specific deficiency Ecological factors Food balance sheet Conditioning influences Cultural influences Socio economic factors Food production Health education & services Nutritional surveillance, rehabilitation Nutritional supplementation 12/18/2016 39
- 40. PREVENTIVE & SOCIALMEASURES Action at family level Action at community level Action at national level Action at international level 12/18/2016 40
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- 42. SOURCE Ministry ofhealth & family welfare WHO (world health organization) FAO(food & agriculture organization Essential paediatrics ghai Parks text book of preventive & social medicine Motherchildnutrition.org 12/18/2016 42
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