Nutrition

ASSESSMENT OF NUTRITIONAL STATUS

Learning objectives
• Value the use of nutritional diagnosis in clinic and at the level of population.
• Understand the implications for using nutritional indices.
• Define anthropometry.
• List 10 nutritional indices.
• List the requirements for measuring anthropometric data.
• List two references used for anthropometric indices.
• Understand the implications of international references for assessment of local people.

Learning objectives

• Compare the interpretation of single Vs multiple serial measurements of indices.
• List the data needed for calculation of nutritional indices.
• Identify a computer program used for calculating nutritional indices.
• Learn the formula for calculating z score.
• Identify the cut-off values for percentiles and z-score used for defining malnutrition and obesity.
• Differentiate between acute and chronic malnutrition.


INTRODUCTION


The nutritional status is influenced by food intake, quantity & quality, & physical health.

Nutritional Assessment Why?

The purpose of nutritional assessment is to:

• Identify individuals or population groups at risk of becoming malnourished.

• Identify individuals or population groups who are malnourished

Nutritional Assessment Implications?

• 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


Anthropometric Methods (Definition)


Anthropometry is the measurement of body height, weight & proportions.


It is an essential component of clinical examination of infants, children & pregnant women.

Nutritional indices

Anthropometry for children
Growth assessment is an essential component of pediatric medicine.
The most powerful tool in growth assessment in children is the growth chart. It requires:
• Accurate scale
• A measuring board (stadiometer). For infants, the measure of linear growth is length, taken by two examiners (one to position the child) with the child supine on a measuring board. For older children, the measure is stature, taken with a child standing on a stadiometer
• A tape measure.









• The old version of standard growth charts were based on data collected by the National Center for Health Statistics, 1977 (NCHS). These normalized growth curves are recommended by the World Health Organization (WHO) for international use.
• Newer standards are being used, based on a nationally representative sample collected from 1988 to 1994 as part of the US National Health Examination (NHES) and National Health and Nutrition Examination Surveys (NHANES-III) data. Published by CDC in year 2000.

Reference values

Disparities in growth between developed and developing countries reflect nutritional rather than genetic differences.

Remember: The NCHS curves are less appropriate for adolescents. Growth during adolescence is linked temporally to the onset of puberty, which varies widely across populations.

Why to accept the international standards as reference in Iraq

Ideally, individuals should have several anthropometric measurements over time. A decline in an individual's anthropometric index from one point in time to another could be an indication of illness and/or nutritional deficiency that may result in serious health outcomes.
A single set of measurements may be used for screening populations or individuals to identify abnormal nutritional status and priority for treatment.

How many measurements do we need?

Information is needed on each individual's:


• Sex
• age (in months for under 5 years of age)
• Weight (Kg)
• Height (cm)
• head circumference (cm)
• arm circumference (cm)
Data needed for calculation?

• The reference group is defined by gender and age group.

• Epi-info is a CDC published computer software that can calculate nutritional indices
Calculation?