UNIT 3: 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).

This differs from nutritional screening which is a brief risk assessment which can be
carried out by any healthcare professional and which may lead to a nutritional
assessment by a dietician..

Nutritional assessment, in any application, has three general purposes:

•Detection of deficiency states

•Evaluation of nutritional qualities of diets, food habits, and/or food supplies

•Prediction of health effects.

Following a structured assessment path enables health professionals to carry out a

quality nutritional assessment in order to identify those who need nutritional
intervention, and to improve clinical decision making using a person centred approach.
The process promotes consistent quality of practice; is user friendly; and allows effective
monitoring of patients. A structured assessment pathway does not remove autonomy; it
encourages professional judgement and informed decision making at every stage. The
process provides a rationale for the nutritional intervention, and allows for revision of
the plan as individual circumstances change over time.

3.1.1 THE PRINCIPLE OF HEALTHY EATING:

A healthy diet during all stages of life is crucial to prevent several non-communicable
chronic diseases (NCDs), such as obesity and diabetes.

Together with physical activity, a healthy diet is essential to achieve a “sustainable

health”, which is defined as “a healthy and active ageing avoiding the risk of diseases”.

Both the Food and Agriculture Organization of the United Nations (FAO) and the
World Health Organization (WHO) agree with the key principles of a healthy diet,
which are as follows:

 Eat a variety of foods to ensure adequate intake of nutrients.

 Eat plenty of fruits and vegetables. At least 400 g (i.e. five portions) of fruit
and vegetables per day.
 Consume whole grains, nuts and healthy fats rich in unsaturated fatty
acids.
  Reduce the intake of saturated fats. To prevent unhealthy weight gain in the
adult population, saturated fats should be reduced to less than 10% of total
energy intake.
 Limit sugar intake. Free sugars intake should be reduced to less than 10% or to
less than 5% of total energy for additional health benefits. This would be
equivalent to 50 g or 25 g of free sugars per day, respectively.
 Drink water regularly. Good hydration is crucial for an optimal health.
 Consumption of alcohol. There is no safe level of alcohol consumption;
therefore, alcohol is not a part of a healthy diet.
A detailed guidance of a balanced meal that gathers these principles is the “Healthy
Eating Plate”. The Healthy Eating Plate proposed by Harvard University divides a plate
in 4 parts:

 half of the plate for vegetables and fruits,

 a quarter for whole grains:
 and the other quarter for healthy proteins.

3.1.2 NUTRITION STATUS

Definition

The definition of nutrition status varies by discipline. In general it refers to the presence
or absence of malnutrition. The term “malnutrition” applies to both underweight and
overweight populations. Malnutrition is defined as “any disorder of nutrition status
including disorders resulting from deficiency of nutrient intake, impaired nutrient
metabolism, or overnutrition.”

Although no singe index can accurately indicate poor nutrition status, weight and
weight history are the parameters most commonly used. This method has limitations.
Weight alone does not indicate the nature and extent of tissue loss in patients with
cachexia. It also does not indicate specific metabolic or biochemical nutritional issues.

ASSESSMENT OF NUTRITIONAL STATUS

WHAT IS NUTRITIONAL STATUS?

● is a balance between the intake of the nutrients and the expenditure of these in
processes of growth, reproduction and health maintenance.

● is influenced by food intake , quantity , quality and physical health.

The spectrum of nutritional status spreads from obesity to severe malnutrition.

Nutritional Assessment Why? 

● To obtain precise information on prevalence and geographic distribution of
nutritional problems of given community. 

● To identify individuals or populations ~who are at risk of becoming malnourished &

~who are already malnourished 

● To develop health-care programs.  To measure the effectiveness of nutritional

programs and interventions once initiated.

METHODS OF Nutritional Assessment

Direct – deal with the individuals and measure the objective criteria  Indirect – use
community health indices that reflect nutritional influences

1. Direct methods of nutritional Assessment.

These can be summarized as ABCD ( Anthropometric methods, Biochemical

laboratory methods , Clinical methods, Dietary evaluation methods

2. Indirect methods of Nutritional Assessment These include three categories

Ecological variables, Economic factors, Vital health statistics

DIRECT METHODS-

A. ANTHROPOMETRIC METHODS

Anthropometry is the measurement of Height, Weight & other measurements like Mid
Upper-arm circumference,Skin fold thickness  Head and chest
circumference,Hip/waist ratio.

Advantages of Anthropometric methods: Objectives with high specificity and

sensitivity.  Measures many variables of nutritional Significance. (ht, wt, MUAC,
WHR , BMI)  Readings are numerical and gradable on standard growth charts. 
Readings are reproducible.  Non-expensive and needs minimal training.

Limitations of Anthropometry  Inter-observers error in measurement.  Limited

nutritional diagnosis.  Problems with reference standards i.e. local versus
international.

DIRECT METHODS-

B. BIOCHEMICAL AND LABORATORY METHODS

I. INITIAL LABORATORY ASSESSMENT 

1. Haemoglobin estimation  most important test when accurately measured, tells about
overall state of nutrition (anemia, and also protein and trace element nutrition)  Blood
is collected from a finger, ear lobe or heel prick  Haemoglobinometres which are
simple, cheap and reasonably accurate are used.

2.Haematocrit or packed cell volume (PCV) - percentage of the blood volume

composed of red cells.  important in the diagnosis of anemia.

3.Red cell counts and blood films  the size and uniformity of the red blood cells can be
seen.  Use of such slides may facilitate the diagnosis of malaria and the
haemoglobinopathies. Parasites if present can be seen.

4.Stool examination- For presence of ova and/ or intestinal parasites. When assessed
quantitatively parasite load can be known.

5. Urine examination - Dipstick and microscopy for albumin, sugar and blood.

II. SPECIFIC LAB TESTS

6. Measurement of nutrients in body fluids  e.g. serum retinol, serum iron

7. Measurement of abnormal metabolites  e.g. urinary iodide, urinary creatinine/

hydroxyapatite ratio

Advantages 

Useful in detecting early changes in body metabolism and nutrition,  precise , accurate
and reproducible. Useful to validate data obtained from dietary methods e.g. comparing
salt intake with 24-hour urinary excretion.

Limitations of biochemical & laboratory methods - Time consuming and

expensive  Cannot be applied on large scale  Reveal only current nutritional status

C. CLINICAL METHODS

General Clinical examination with special attention to organs like hair, angles of mouth,
gums, nails, skin, eyes, tongue, muscles, bones & thyroid gland.  Detection of relevant
signs helps in establishing the nutritional diagnosis.

D. DIETARY INTAKE EVALUATION METHODS

Assessment of dietary intake. This is actually an assessment of food consumption

through dietary surveys. It provides information about dietary intake patterns, specific
foods consumed and estimated nutrient intakes. Reviewing dietary data may suggest
risk factors for chronic diseases and help to prevent them. Diet surveys may be carried
out by the following methods: 1. weighment of raw foods 2. weighment of cooked foods
3. Oral questionnaire method.

UNIT 3.2 MENU PLANNING

“ FACTORS TO CONSIDER IN MENU PLANNING”

Menu is a list of food and beverages offered to customers and the prices. A menu may
be à la carte – which presents a list of options from which customers choose – or table
d'hôte, in which case a pre-established sequence of courses is offered. Menus may be
printed on paper sheets provided to the diners, put on a large poster or display board
inside the establishment, displayed outside the restaurant, or put on a digital screen.

5 TYPES OF MENU

A LA CARTE
An a la carte menu lists the prices for each item separately. While the prices
tend to be higher, a la carte menus have more flexibility. Customers can choose
individual items and combine them any way they want.

DU JOUR MENU
Du jour menus change daily, depending on what’s available or what the chef
prepared. So, “chicken du jour” means the chicken that’s available today. Likewise,
“soup du jour” is the soup that’s available today.

CYCLE MENU
A cycle menu is a menu or part of a menu that has repeated options over a
specific period of time. The cycle menu definition is fairly intuitive given its name.

STATIC MENU
A static menu is a larger menu, typically divided into categories, that doesn’t
change very often. It’s the most widely used menu today, and it’s what you likely think
of when you think of menus.

FIXED MENU
A fixed menu is a menu with few options and a fixed total price. It can be
confused with static menus because the words, outside of the context of menu names,
are similar. But the fixed menu definition is far different from that of the static menu.

A fixed menu is also commonly called a set menu, and there are two common
types. The table d’hote menu and the prix fixe menu.

TABLE D’HOTE MENU- A table d’hote menu is a menu that offers a choice of
appetizer, entree, and dessert all at a fixed total price. It’s the set menu that provides
the most freedom.
PRIX FIXE MENU- A prix fixe menu is a fixed menu with little to no variability
for a fixed total price. It typically includes an appetizer, an entree, and a dessert. While
guests can usually modify these based on dietary restrictions or preferences, there is
only one option to choose from per course. Wine pairing menus that include things like
a wine pairing with salmon or a turkey wine pairing are often prix fixe menus.
A prix fixe menu is similar to a table d’hote menu, just without the choices. In
that sense, it’s less a selection of choices and more a list of what will be served. Prix fixe
menus may seem rigid, but they’re excellent choices for chef-driven restaurants that
want food items served as the kitchen intends.

Menu planning is the process of deciding what you will eat for each meal, including
main dishes, side dishes, and desserts. It also entails knowing how many meals to plan
for and when to serve them. Menu planning helps you maximize the use of each
ingredient. If you plan your menu carefully, you'll pinpoint every dish for which a
particular ingredient works. Also, this will enable you to use the least variety of
ingredients possible since some will likely cut across different cuisines.

PURPOSE OF MENU PLANNING

1. Work will flow more smoothly
2. Guests will be served more effectively
3. Profit will be greater

2 BASIC RULES IN MENU PLANNING

1. Knowing your guests
2. Knowing your operation

5 COMPONENTS OF OPERATION
1. Theme or Cuisine
2. Equipment
3. Personnel
4. Quality Standards
5. Budget

FACTORS TO CONSIDER IN MENU PLANNING

þ CAPABILITY AND CONSISTENCY- the capability of the chefs or cooks to produce

the quality and quantity of food necessary is a basic consideration. The use of
standardized recipes and cooking procedures will help ensure consistency.

þ EQUIPMENT- in order to produce the desired menu items, the proper equipment
must be installed in an efficient layout. Menu items are selected to avoid overuse of one
piece equipment.

þ PRICE- is the major factor in menu selection. Food cost and portion size and control
are the best indicators of the price to change for dishes on a menu.
þ NUTRITIONAL VALUE- restaurant guests are become increasingly concerned about
the nutritional value of food. This is creating a higher demand for the healthier items,
such as fish and shellfish because have far less than fat less fat than other protein foods.

þ MENU TRENDS- defining a scientific dining behavior or demand in cuisine among a

certain population would then qualify as a menu trend. Focus on certain areas of the
country as well as consider multiple demographic variables such as age, income, ethnic.

þ INGREDIENTS AVAILABILITY- a menu is primarily based on what can be bought in

the market. In fact, this should really be the basis for planning a specific dishes. Always
consider food in season. Think of available ingredients for those off-season.

þ FOOD HABITS OF CUSTOMERS- food managers can make a survey in the vicinity
where food establishment is located. The survey can consider the culture of the people
living in the vicinity ( their customs, traditions, religion and etc.) people will patronize a
food establishment where their needs and desires, as well as their beliefs and practices
are not violated in the food they eat.

þ AMOUNT OF MONEY AVAILABLE- a food establishment has a definite budget

intended for food preparation. Control in expenses, by operating the given budget,
allows the food manager to predict cost and at the same time predict profit.

þ AMOUNT OF TIME AVAILABLE- food preparations must meet deadlines. Customers

has their own meal schedule to meet. Quick service is one important asset of an ideal
establishment.Food ordered should be prepared in the shortest time possible. To realize
this, time-saving techniques must be employed by the cooks especially if orders to keep
coming in.

þ ENVIRONMENTAL CONDITIONS- one thinks of hot summer months and the cold
rainy months. Specific dishes offered in food establishments should consider the
environmental temperatures. Special hot foods can be offered on cold rainy seasons and
vice versa. Aside from the regular menu of the establishment, will be seasonal offerings
in keeping with the conditions of the environment.

https://www.zmchdahod.org/pdf/college/
NUTRITIONALASSESSMENT27102018PSM.pdf

https://www.slideshare.net/mimieazhar/menu-and-menu-planning-206167369

https://www.bapen.org.uk/nutrition-support/assessment-and-planning/nutritional-
assessment#:~:text=Nutritional%20assessment%20is%20the%20systematic,(BDA)%2C
%202012).

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