Nutritional Assessment is a significant part in identifying an individual's

nutritional status. Evaluating the nutritional status will enable health care
members to identify his nutritional care needs . It involves the examination
of individual's physical condition, growth and development behavior, blood
and tissue levels of nutrients and the quality and quantity of nutrient intake.
For easy recall, don't forget to perform the ABCDE.

After accomplishing the nutritional assessment, one can proceed to the

Nutrition Care Process. Just like our very own nursing care process, the
nutrition care process involves 5 steps namely (1) assessing, (2)
identifying, (3) planning, (4) implementing and (5) evaluating (monitoring
and evaluation) which aim to meet the individual's nutrient and nutrient
education needs.

NUTRITIONAL ASSESSMENT
Direction: Follow the steps below and post your output here. Please take
note that this output will also be used in the post task of Module VI. See
rubric below, so you'll know how you will be graded. This is a subgroup
activity (One output for each subgroup).
1. Identify a client. Choose a client who has a medical condition included
in module VI.
2. Perform ABCDE of the nutritional assessment.
3. Compute for BMI, Waist Hip Ratio, Ideal Body Weight (Desirable Body
Weight).
4. Interpret the results. For the BMI, use the Asian as reference.
5. Compute for total caloric requirement.
6. Identify a nutrition problem and formulate a nutrition diagnosis.
7. Follow the format below for your output.
NUTRITION CARE PROCESS
Nutrition Care Process

Nutrition Care Process

•Strategy for meeting nutrient and nutrition

education needs of a person
•5 interrelated steps (1) Assessing;
(2) Identifying ;(3) Planning;
(4)Implementing; (5) Evaluating (Monitoring
and Evaluation)
Nutrition Care Process

Assessing State of Nutrition

•Involves the collection of information and
database
•Basis for designing a plan of action –
nutrition care plan
•Different approaches: biochemical data,
clinical examination findings, medical history,
anthropometric data, psychosocial data
Nutrition Care Process

Assessing State of Nutrition

•Must be accurate, pertinent to the patient

and appropriately interpreted
•May be executed repeatedly after nutrition
intervention to check if a care plan is working
Nutrition Care Process

Identifying Nutritional Problems and Needs

•Available data is organized and interpreted to

identify the problems and needs of the
patient
•Professional clinical judgment must be used
to analyze information
Nutrition Care Process

Identifying Nutritional Problems and Needs

3 Classifications of Nutrition Diagnosis

1. INTAKE - actual problems related to intake of

energy, nutrients, fluids, bioactive substances
through oral diet or nutrition support
Nutrition Care Process

Identifying Nutritional Problems and Needs

3 Classifications of Nutrition Diagnosis

2. CLINICAL - nutritional findings/problems

identified as related to medical or physical
conditions
- includes functional (e.g. swallowing difficulty),
biochemical (e.g. altered laboratory values), weight
(e.g. underweight)
Nutrition Care Process

Identifying Nutritional Problems and Needs

3 Classifications of Nutrition Diagnosis

3. BEHAVIORAL-ENVIRONMENTAL
- nutritional findings/problems identified
as related to knowledge, attitudes/beliefs, physical
environment, or food supply and safety

Note: for more examples of nutrition diagnosis, see the NCP codes
Nutrition Care Process

Identifying Nutritional Problems and Needs

•Must be written in PES format

•P - Problem
•E - Etiology
•S - Signs / Symptoms
Nutrition Care Process

Planning and Prioritizing Objective of Nutritional

Care
•Setting of goals and objectives to meet needs
•Consider the following:
Educational level of client and family
Need for modifying food intake or
supplementing current intake
Other measures that will enable client to
meet nutritional needs
Treat medical problems affecting nutritional
status
Nutrition Care Process

Implementing Strategies to Meet the Objectives

• Specific nutritional interventions are established
• May involve the following:
Food and/or Nutrient Delivery
Nutrition Education
Nutrition Counseling
Coordination of Nutrition Care
• Should be specifically related to the problem and
objective, individualized
• Must describe what, how, why and where as
appropriate
Nutrition Care Process

Evaluating the Nutritional Care Outcomes

(Monitoring and Evaluation)
• Determining the effectiveness of nutritional care
and if modification is necessary
• Must assess the following
Food/Nutrition-Related History
Anthropometric Measurements
Biochemical Data, Medical Tests and
procedures
Nutrition Focused Physical Findings
Nutrition Care Process

Evaluating the Nutritional Care Outcomes

(Monitoring and Evaluation)

•Should include:
Comparison (before and after intervention)
Explanation of the effectiveness or
ineffectiveness of intervention
Suggestions for revising the care plan
Nutrition Care Process

THANK YOU!
Nutritional Assessment
Nutritional Assessment

Nutritional Screening

• Purpose:

To quickly identify individuals who are

malnourished or at nutritional risk and to
determine if more detailed assessment is
warranted
Nutritional Assessment

Anthropometry
Biochemical
Clinical
Dietary
Estimates
Nutritional Assessment

ANTHROPOMETRY-measurement of variations of physical

dimensions and gross composition of the human body at different
age levels and degrees of nutrition

•Weight
•Height
•BMI
•Hip Circumference
•Waist Circumference
•Waist Hip Ratio
•Body Frame
Nutritional Assessment

ANTHROPOMETRICS
• WEIGHT – provides a crude evaluation of overall fat and
muscle stores
• BODY MASS INDEX (BMI)- used to estimate degree of obesity
• HEIGHT- suggests linear dimension comprising of legs ,
pelvis, spine and skull
• KNEE HEIGHT- used to determine stature of patients whose
standing height cannot be taken accurately
• WAIST TO HIP RATIO (WHR)- valuable indicator of body fat
distribution and adiposity; valuable guide in evaluating
health risk; also called abdominal/gluteal ratio
Nutritional Assessment

Anthropometrics
• WAIST CIRCUMFERENCE – marker of abdominal fatness;
valid indicator for both men and women
• BODY FRAME SIZE- allows the weight to be adjusted for
height to reflect a more suitable desirable weight range;
body build (muscularity, bone thickness and body
proportions) affect body weight
• MID-UPPER ARM CIRCUMFERENCE (MUAC)- used to
evaluate fat stores; measures the size of the arm and all of
its components: muscle mass, subcutaneous fat and bone;
provides an estimate of the arm soft tissue or wasting
Nutritional Assessment

INTERPRETING BMI
Source: Adapted from WHO 1995,WHO 2000. WHO 2004

CLASSIFICATION ASIAN BMI (kg/m2) WHO BMI (kg/m2)

Underweight <18.5 <18.5

Normal Range 18.5- 22.9 18.5-24.9

Overweight >23 >25 -29.9

At Risk 23-24.9

Obese I 25-29.9 30-34.9

Obese II >30 35-39.9

Obese III >40

Nutritional Assessment

BMI COMPUTATION
Nutritional Assessment

BMI COMPUTATION

Male 5’8” tall; 77 Kg

Convert the height to meter square
• 5 ft x 12 in/ft = 60 in + 8 in= 68 inches
• 68 in x 2.54 cm/in = 172.72 cm
• 172.72 cm x 1m/100 cm = 1.7272 m
• 1.7272 m x 1.7272 m = 2.98 m2
Divide the weight in kg by the height in meter2
• 77 kg / 2.98 m2 = 25.83 kg/m2 (BMI) Obese l
Nutritional Assessment

BODY FAT DISTRIBUTION

• WAIST HIP RATIO

• Ratio of 1.0 or greater in men or 0.8 or greater in women is
indicative of android obesity (apple shape) and an increased
risk for obesity related diseases
Nutritional Assessment

Waist Hip Ratio Computation

• WHR = Waist Circumference (WC)

Hip Circumerence (HC)

Female WC = 36 inches HC = 44 inches

WHR = 36
44
= 0.82 android obesity (apple shaped); increased risk for
obesity related illness
Nutritional Assessment

WAIST CIRCUMFERENCE
•Women >35 inches
•Men >40 inches

•Have high risk of central obesity related

health problems
Nutritional Assessment

BODY FRAME SIZE

• The subject’s right hand is extended
• Measure wrist circumference at the joint just distal to the
styloid process
• Calculate the ratio of height to wrist circumference with
this equation:
r= Height (cm)
Wrist circumference (cm)
Sex Large Medium Small
Male <9.6 9.6-10.4 >10.4
Female <10.1 10.1-11.0 >11.0
Nutritional Assessment

Mid-Upper Arm Circumference (MUAC)

•Children aged 1 to 5 years

MUAC (cm) Level of Nutrition
>14 Normal
12.5-14 Mild/Moderate Malnutrition
<12.5 Severe Malnutrition
Nutritional Assessment

MUAC
Adults
•MUAC (cm) Level of Nutrition
•Male > 23 Normal
<23 Malnourished
•Female > 22 Normal
<22 Malnourished
 Nutritional Assessment

BIOCHEMICAL – laboratory/diagnostic test results or values

FBS Triglycerides Lipid Profile

HbA1c Creatinine
SGPT
Nutritional Assessment

CLINICAL – manifestations seen on clients

Polyuria
Polydipsia
Pruritus
Weakness
Weight loss
Nutritional Assessment

Dietary

•24 hour food recall-type and amount of food

eaten for the past 24 hours
•Food frequency questionnaire-type, quantity
and frequency of eating listed food item
•Food preferences-the selection of one food
item over the other
Nutritional Assessment

Food and Nutrient Intake Risk Factors

• Nutrient intake greater than required
• Swallowing difficulties
• Gastrointestinal disturbances, bowel irregularities
• Impaired cognitive function or depression
• Unusual food habits (pica)
• Misuse of supplements
• Restricted Diet
• Inability or unwillingness to consume food
• Increase or decrease in activities of daily living
Nutritional Assessment

ESTIMATES

•CALCULATION
IBW/DBW (Ideal Body
Weight/Desired Body Weight)
CBW (Corrected Body Weight)
TEA/TER (Total Energy
Allowance/Total Energy
Requirement)
etc.
Nutritional Assessment

HOW TO COMPUTE DESIRABLE BODY

WEIGHT (DBW/IBW)
Nutritional Assessment

Calculate for the IBW

•12 year old Male

•6 months baby boy

Nutritional Assessment

Ideal Body Weight

Hamwi (5 feet Rule of Thumb)

Female = 100 lbs Male = 106 lbs

for 5ft + 5 lbs for 5ft + 6 lbs
per inch over 5ft per inch over 5ft
Nutritional Assessment

Ideal Body Weight

Hamwi
•ADD 10% for
•LARGE-framed subjects
•SUBTRACT 10% for
•SMALL-framed subjects.
Nutritional Assessment

Calculating IBW (HAMWI)

Female 5 ft Large Frame
100 lbs (5 ft)
+ 10 lbs (10% for large Frame)
110 lbs  50 kgs

Male 5 ft 3 inches Medium Frame

106 lbs (5 ft)
+ 18 lbs (3 in X 6 lbs)
124 lbs (56.36 kgs)
Nutritional Assessment

Adjustment of Body Weight

for Obese Patients (if BMI is >25)

Corrected Body Weight (CBW)

= [(Actual Wt (kg) - IBW) x 0.25] + IBW (kg)
Nutritional Assessment

Calculating Corrected Body Weight

Example:
ABW 70kg; Ht 5 ft 2 in; IBW 50kg (Hamwi); Female

CBW = [(70kg – 50kg) x 0.25] + 50 kg

= (20kg x 0.25) + 50 kg
= 5 kg + 50kg = 55kg
Nutritional Assessment

How to Compute Nutritional Requirement

A nutritional requirement is the Total Energy

Requirement (TER) which represents the
total amount of energy expended per day

“calories”
Nutritional Assessment

Total Energy Requirement

TER = IBW x Physical Activity

If OBESE (for weight reduction)

TER =CBW x (25 to 30 Kcal/Kg )
Nutritional Assessment

Estimating TER for Adults

• NDAP FORMULA
ACTIVITY Kcal/Kg
Bed rest but mobile 27.5

Sedentary (very 30
light)
Light 35

Moderately Active 40

Very Active 45
Nutritional Assessment

Activity Level

• Sedentary – secretary, clerk, typist (using electric

typewriter), administrator, cashier, bank teller
• Light- teacher, nurse, student, lab technician,
housewife with maids
• Moderately Active-housewife without maid, vendor,
mechanic, jeepney and car driver
• Very Active – farmer, laborer, cargador,coal miner
fishermen,heavy equipment operator
Nutritional Assessment

Body Weight

Ideal Body Weight

Actual Body Weight
Corrected Body Weight

•Note: Ideal Body Weight is used in

computing for TER if the BMI is within
normal range
Nutritional Assessment

EXAMPLE

Male Executive, Sedentary Lifestyle,

Medium Body Frame
Ht =. 5’8”
ABW = 86 kg
IBW = 70 kg
CBW = 74 kg
BMI = 28.85 kg/m2
TER= 30 kcal/kg x 74 kg=2220 or 2200 kcal
Nutritional Assessment

THANK YOU!