NUTRITIONAL ASSESSMENT

Fikirte Gedamu(BSc, MPHN)

Óctober 2024

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 Nutritional assessment
• Nutritional assessment is an interpretation of
anthropometric, biochemical (laboratory), clinical
and dietary survey data to tell whether a person/
group of people is well nourished or
malnourished (Over nourished or under
nourished).
• There are direct and indirect methods of
assessing Nutritional status
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 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
• 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

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 Indirect methods
• Indirect methods include assessment of
indicators of the food and nutrition situations
in the area/ region of interest by looking at
certain data that are closely related to
malnutrition or aggravated by malnutrition.
These include:
1. Economic factors: Income, Availability of
food, Prices of food
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Cont …
2. Ecological variables including crop
production.

3. Vital Health Status: Cause specific mortality

rates, Age specific mortality rates, Health
service statistics, Rate of nutritionally relevant
infections

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 A. Anthropometric assessments
Anthropometry comes from two words:
❑Anthropo= Human, and Metry = measurement.
❑Definition: - Anthropometry refers to
measurement of variations of physical
dimension and gross composition of human
body at different levels and degrees of
nutrition

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 Purposes of Anthropometric
measurements
• Anthropometric measurements are performed
with two major purposes in mind:

IN CHILDREN: to assess physical growth

IN ADULTS: to assess changes in body

composition or weight

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 Anthropometric measurements of
growth #1
• Growth performance of children is an excellent
reflection of their underlying nutritional status.
Children adapt to the chronic nutritional insult
by either reducing their rate of growth or by
totally failing to grow.

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 Anthropometric measurements of
growth #1
• Therefore, assessment of growth performance of
children is one very important purpose of
anthropometric measurements.

• The following body measurements are good

indicators of growth performance of children at
different ages when combined with the cut-off points.

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Head Circumference (HC):
❑Measured using flexible measuring tape
around 0.6cm wide to the nearest 1mm.
❑It is the circumference of the head along the
supraorbital ridge anteriorly and occipital
prominence posteriorly.
❑HC is useful in assessing chronic nutritional
problems in under two years old children.
❑But after 2 years as the growth of the brain is
sluggish it is not useful.

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Head circumference measurement

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 LENGTH
• A wooden measuring board (also called sliding
board) is used for measuring length.
It is measured in recumbent position in children
<2 yrs old to the nearest 1mm.
It is always > height by 1-2cm.
One assistant is needed in taking the
measurement
Measurement is read to the nearest mm
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 HEIGHT
• Is measured in children > 2 yrs and a adults in
standing position to the nearest 0.1 cm.
• The head should be in the Frankfurt plane during
measurement, knees should be straight and the heels
buttocks and the shoulders blades, should touch the
vertical surface of the stadiometer ( anthropometer) or
wall.
• Stadiometer or portable anthro pometer can be used
for measuring.

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 WEIGHT
Weighing sling (spring balance) also called
salter scale is used for measurement of weight in
children < 2 years.
In children the measurement is performed to
the nearest 10g.
In adults and children >2 years, beam balance
is used and the measurement is performed to the
nearest 0.1 kg.
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 INDICES DERIVED FROMTHESE
MEASUREMENTS
• What is an index? It is a combination of two
measurements or a measurement plus age.
The following are few of them: -
Head circumference-for age
Weight-for-age -– a measure of underweight
or wasting and stunting combined(composite
index)
Height-for-age – a measure of stunting or
chronic under nutrition
Weight for height-measure of wasting or
acute malnutrition
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 Cont …
• both weigh for age and weight for height are
indices sensitive to acute changes to nutritional
status
Height for age of children in a given
population
indicates their nutritional status in the long run.
The best example is change in the average
height of children in the industrialized countries
towards higher values following improvements
in nutrition, control of infectious problems etc.
This is called Secular change (trend) in Height
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 Measure of observational error
• Accuracy and precision are two measures of
observational error.
• Validity: is how close a given set of
measurements are to their true value, while
• Precision: is how close the measurements are
to each other.
• In other words, precision is a description of
random errors, a measure of statistical
variability.

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• Taking age and sex into consideration,
Measurements are expressed as follows:
– Z-score
– Standard Deviation
– Percent of the median
– Percentiles
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 MUAC cut-offs
• For children taller/greater than 6 5 cm
• New WHO standards recommend MUAC <
11.5 cm as criteria for severe malnutrition
among children of age 6 months and above.
•Pregnant/lactating women are severely
malnourished if their MUAC is less than 170
mm
• It is a sensitive indicator of risk of mortality
• Useful for screening of children for
community based nutrition interventions
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 Measurements Used to Assess Fat
Mass
• Weight & Height(Body mass index )

• Waist to Hip circumference ratio

• Skin fold thickness

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 Body mass Index(BMI)
• Body mass index the best method for assessing
adult nutritional status as the index is not
affected by the height of the person

Therefore, it is most frequently used for

assessing adult nutritional status.

BMI = weight (kg)

height2 (m)
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 B. BIOCHEMICAL/BIOPHYSICAL
(LABORATORY) METHODS
• This involves measurement of either total amount of
the nutrient in the body, or its concentration in a
particular storage site (organ) in the body or in the
body fluids.
• This group includes those that are indicative of defect
in intermediary metabolism in other words they occur
when there is a biochemical lesion(Depletion).
• by biochemical tests and/or by tests that measure
physiological or behavioral functions dependent on
specific nutrient.
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 Factors affecting the validity of static
biochemical tests
• Physiological factors(pregnancy, diurnal
variation, homeostatic regulation, physical
exercise, age, sex, recent dietary intake)
• Pathological(inflammatory stress, infection,
weight loss)
• Analytical(sample collection, sensitivity &
specificity of the test, hemolysis, sample
contamination, accuracy and precision of the
method)

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 Functional biochemical tests
• urinary creatinine to assess protein of skeletal
muscles

• Serum retinol levels and serum retinol binding

protein for assessment of vitamin A deficiency

• Hemoglobin and heamatocrit levels are used in

the assessment of iron defciency anemia

• ferittin is also uses to assess IDA

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 C. CLINICAL METHODS
• This are detection of deviations from the
normal state of nutrition just by observing and
interpreting clinical signs and symptoms of
deficiency or under intake, for instance, see the
following

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 D. Dietary Assessment
• This method is used to assess the nutrient intake of an
individual or a group from food over a longer period
of time, usually to see the association between diet
and disease.
• The most challenging task in conducting dietary
assessment is to measure/estimate the amount of food
consumed at individual levels, there are five
methods/techniques by which dietary intakes can be
estimated
• These include
– Food records/Diaries
– 24-hour recall
– Food frequency 34
 24-hour recall
➢ is gathered by interview or by asking the client to
recall actual intake for the past 24-hours. The main
purpose is to determine an overall usual eating
pattern of an individual. This method depends on the
memory of the informant and the ability to estimate
serving portions.

➢ It is best followed by a food frequency questionnaire

to verify and clarify initial data.

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 Food frequency questionnaire
• uses a list of specific food items to record intakes
over a given period (day, week, month, year).

• Responses are obtained by interview, or it may be a

self-administered questionnaire.

• Questionnaire can be semi-quantitative when subjects

are asked to quantify usual portion sizes of food
items, with or without the use of food models.

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 Checklist approach
• The approach is similar with food frequency
approach
• The difference is that food frequency approach
is retrospective, but Checklist approach is
prospective
Diet history
• It is an assessment of the usual individual
intake
• It is used for clinical purposes

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 Role of the nurse in the promotion of nutrition
A.Nutrition Education / Care
1.In the Hospital – the nurse has the most constant and
intimate association withthe patient.
a. Maintaining lines of communication with the doctors and
dietician regarding patient’s dietary needs
b. Interpret the diet to the patient
c. Assisting patient at meal times
d. Observing, recording and reporting patient’s response
e. Planning for home care

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 Cont…
• 2.Out Patient / Clinic Nurse-
• the nurse can help in the selection of inadequate and
appropriate diet by using educational approach which
the patient understand and accepts.
• 3.In School – nutrition education must begin in
kindergarten and continue throughout the elementary
and secondary school which affords the best
opportunity for helping the child to understand &
establish attitudes and practices concerning food
selection.
• 4.CHN Nurse – she’s in the position to observe
community nutrition problems morec losely provision
of instructions in food

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