Nutritional Assessment
Content
Nutritional Assessment
Interpretation of information obtained
from dietary, biochemical, anthropometric
and clinical studies
Information is used to determine the
health status of individuals or population
groups as influenced by the intake and
utilization of nutrients
Most of the slides are adapted from the FN 115 lecture of LSWTengco for
AY 2014-2015
Gibson, 2005
Nutritional Assessment
Nutritional Assessment
Measurement of indicators of dietary
Comprehensive approach, completed by a
status and nutrition related health status
Identify the possible occurrence, nature
and extent of impaired nutritional status
which can range from deficiency to toxicity
registered dietitian,
to define nutritional status that uses
medical, nutrition and medication histories;
physical examination; anthropometric
measurements; and laboratory data
US Department of Health and Human Services
What kind of information will
be obtained from nutritional
assessment?
American Dietetic Association
It may provide information that will answer
the following questions:
WHAT is the nutrition problem and what are
its manifestations or characteristics
WHO are affected
HOW MANY are affected
WHY does the problem exist
1
Purpose of Nutritional Assessment
Program Management Cycle
ASSESSING
THE
SITUATION
Strategic planning
Basis for program modification
Prioritizing
the
problems
Evaluating
the
program
Policy formulation
Planning
the
program
Monitoring
the
program
Implementing
the program
Triple A Cycle
Ultimate purpose of nutritional assessment
ASSESSMENT of the
situation of women
and children
ACTION based on the
analysis and available
resources
ANALYSIS of the
causes of the
problems, roles and
patterns, and capacity
Nutrition Assessment Systems
Nutrition Surveys
Nutrition Surveillance
Nutrition Screening
Nutrition Intervention
To improve human
health and well-being
- World Health Organization
Nutrition Survey
Cross-sectional or one-time assessment of
the nutritional status of the population
Provides information on the extent of
existing nutritional problems
Less likely to identify acute malnutrition
Less likely to provide information on the
possible causes of malnutrition
2
Nutrition Survey
Nutrition Survey
OBJECTIVES
Identifies…
To establish baseline nutritional data
and/or ascertain the overall nutritional
status of the population
WHO are malnourished
HOW MANY are malnourished
WHERE are they
To identify and describe those population
subgroups at-risk to chronic malnutrition
BUT does not give information on…
WHAT type of malnutrition exists (if only
weight-for-age indicator is used)
WHY does it exist
Nutrition Surveillance
Nutrition Surveillance
Continuous monitoring of the nutritional
Data obtained can be used to formulate
status of selected population groups
Data are collected, analyzed, and utilized
for an extended period of time
Identify possible causes of malnutrition
and initiate intervention measures at the
population and subpopulation level
Called ‘monitoring’ when carried out on
selected high-risk individuals
Nutrition Surveillance
Nutrition Surveillance
To promote decisions by governments
concerning priorities and disposal of
resources
Initially identifies…
To formulate predictions on the basis of
current trends
To evaluate the effectiveness of nutrition
programs
WHO are malnourished
HOW MANY are malnourished
WHERE are they
WHAT type of malnutrition exists
(depends on indicator used)
During monitoring it will answer…
WHY it exists
3
Nutrition Screening
Nutrition Screening
Identification of malnourished individuals
EMERGENCY SITUATIONS
• Identify individuals requiring immediate
attention
• Immediately decrease case fatality
requiring interventions
Individual measurements compared with
predetermined risk levels or ‘cutoff’ points
Carried out at individual level and specific
subpopulations considered to be at risk
Less comprehensive than surveys or
surveillance studies
Nutrition Intervention
NON-EMERGENCY SITUATIONS
• Select individuals/households for nutrition
intervention
Nutritional Assessment Methods
(Monitoring and Evaluation)
Determines if programs :
- are implemented as planned
- reach their target group in a cost effective
manner
- have the desired impact
Why so many methods for
assessing nutritional status?
A nthropometry
◦ B iochemical
◦ C linical
◦ D ietary
◦ E cological
◦
Stages in the development of
nutritional deficiency
4
Stages in the development of
nutritional deficiency
Primary deficiency
Stages in the development of
nutritional deficiency
Secondary deficiency
Decreased activity in nutrient-dependent enzymes
Decreased level in reserve tissue store
Functional Changes
Decreased level in body fluids
Clinical symptoms
Decreased functional level in tissues
Anatomical Changes
Stage Depletion Stage
1
Dietary Inadequacy
3
4
Decreased functional level in tissues
DIETARY INADEQUACY
Generalized scheme for the
development of nutritional deficiency
2
Cont’d
Method(s) Used
Dietary
Decreased level in reserve
tissue store
Biochemical
Decreased level in body
fluids
Biochemical
Decreased functional level
in tissues
Anthropometric/
biochemical
Generalized scheme for the
development of nutritional deficiency
Stage Depletion Stage
5
Decreased activity in
nutrient-dependent enzyme
Method(s) Used
Biochemical
6
Functional Change
Behavioral/
Physiological
7
Clinical Symptoms
Clinical
8
Anatomical Sign
Clinical
Gibson, 1990
Anthropometric Methods
• Measurements of
the physical
dimensions and
gross composition
of the body
• Measurements
vary with age and
degree of nutrition
Gibson, 1990
Anthropometric Methods
Used to detect moderate and severe
degrees of malnutrition
Advantage: provide information on past
nutritional history
5
Biochemical/Laboratory Methods
Involves measuring nutrient or its metabolite
in blood, feces, or urine
Several stages in the development of
Clinical Methods
Uses medical history and physical
examination to detect signs and symptoms
associated with malnutrition
nutritional deficiency state can be identified
Signs vs symptoms
Signs
• observations made by a qualified examiner
during physical examination
Symptoms
• disease manifestations that the patient is
usually aware of and are reported by the
patient
Ecologic method
• Collection of information on a variety of
other factors known to influence the
nutritional status of individuals or
populations
Dietary Methods
Involves surveys measuring the
quantity of the individual foods
and beverages consumed during
the course of one to several days
Assessment of patterns of food
use
Types of Nutritional Assessment
Direct Assessment
Indirect Assessment
Examples
• Socio-economic and demographic data
• Food prices
• Cash earning opportunities
• Food expenditure
• Health and vital statistics
6
Direct Assessment
Indirect Assessment
1. Anthropometry
1. Dietary
2. Biochemical
2. Ecological
3. Clinical
Acknowledgments
1. References
Gibson RS. Principles of nutritional assessment. New York: Oxford
University Press, 2005.
Lee RD, Nieman DC. Nutritional Assessment. 4th edition.
Singapore. McGraw-Hill. 2007.
2. Photos
Downloaded from FNRI website
3. Slides
Slides are courtesy of Dr. Milagros Querubin, Ms. Carleneth
Fernandez, and Ms. Lorena Tengco
7
Interpretation of information obtained
from dietary, biochemical, anthropometric
and clinical studies
Information is used to determine the
health status of individuals or population
groups as influenced by the intake and
utilization of nutrients
Most of the slides are adapted from the FN 115 lecture of LSWTengco for
AY 2014-2015
Gibson, 2005
Nutritional Assessment
Nutritional Assessment
Measurement of indicators of dietary
Comprehensive approach, completed by a
status and nutrition related health status
Identify the possible occurrence, nature
and extent of impaired nutritional status
which can range from deficiency to toxicity
registered dietitian,
to define nutritional status that uses
medical, nutrition and medication histories;
physical examination; anthropometric
measurements; and laboratory data
US Department of Health and Human Services
What kind of information will
be obtained from nutritional
assessment?
American Dietetic Association
It may provide information that will answer
the following questions:
WHAT is the nutrition problem and what are
its manifestations or characteristics
WHO are affected
HOW MANY are affected
WHY does the problem exist
1
Purpose of Nutritional Assessment
Program Management Cycle
ASSESSING
THE
SITUATION
Strategic planning
Basis for program modification
Prioritizing
the
problems
Evaluating
the
program
Policy formulation
Planning
the
program
Monitoring
the
program
Implementing
the program
Triple A Cycle
Ultimate purpose of nutritional assessment
ASSESSMENT of the
situation of women
and children
ACTION based on the
analysis and available
resources
ANALYSIS of the
causes of the
problems, roles and
patterns, and capacity
Nutrition Assessment Systems
Nutrition Surveys
Nutrition Surveillance
Nutrition Screening
Nutrition Intervention
To improve human
health and well-being
- World Health Organization
Nutrition Survey
Cross-sectional or one-time assessment of
the nutritional status of the population
Provides information on the extent of
existing nutritional problems
Less likely to identify acute malnutrition
Less likely to provide information on the
possible causes of malnutrition
2
Nutrition Survey
Nutrition Survey
OBJECTIVES
Identifies…
To establish baseline nutritional data
and/or ascertain the overall nutritional
status of the population
WHO are malnourished
HOW MANY are malnourished
WHERE are they
To identify and describe those population
subgroups at-risk to chronic malnutrition
BUT does not give information on…
WHAT type of malnutrition exists (if only
weight-for-age indicator is used)
WHY does it exist
Nutrition Surveillance
Nutrition Surveillance
Continuous monitoring of the nutritional
Data obtained can be used to formulate
status of selected population groups
Data are collected, analyzed, and utilized
for an extended period of time
Identify possible causes of malnutrition
and initiate intervention measures at the
population and subpopulation level
Called ‘monitoring’ when carried out on
selected high-risk individuals
Nutrition Surveillance
Nutrition Surveillance
To promote decisions by governments
concerning priorities and disposal of
resources
Initially identifies…
To formulate predictions on the basis of
current trends
To evaluate the effectiveness of nutrition
programs
WHO are malnourished
HOW MANY are malnourished
WHERE are they
WHAT type of malnutrition exists
(depends on indicator used)
During monitoring it will answer…
WHY it exists
3
Nutrition Screening
Nutrition Screening
Identification of malnourished individuals
EMERGENCY SITUATIONS
• Identify individuals requiring immediate
attention
• Immediately decrease case fatality
requiring interventions
Individual measurements compared with
predetermined risk levels or ‘cutoff’ points
Carried out at individual level and specific
subpopulations considered to be at risk
Less comprehensive than surveys or
surveillance studies
Nutrition Intervention
NON-EMERGENCY SITUATIONS
• Select individuals/households for nutrition
intervention
Nutritional Assessment Methods
(Monitoring and Evaluation)
Determines if programs :
- are implemented as planned
- reach their target group in a cost effective
manner
- have the desired impact
Why so many methods for
assessing nutritional status?
A nthropometry
◦ B iochemical
◦ C linical
◦ D ietary
◦ E cological
◦
Stages in the development of
nutritional deficiency
4
Stages in the development of
nutritional deficiency
Primary deficiency
Stages in the development of
nutritional deficiency
Secondary deficiency
Decreased activity in nutrient-dependent enzymes
Decreased level in reserve tissue store
Functional Changes
Decreased level in body fluids
Clinical symptoms
Decreased functional level in tissues
Anatomical Changes
Stage Depletion Stage
1
Dietary Inadequacy
3
4
Decreased functional level in tissues
DIETARY INADEQUACY
Generalized scheme for the
development of nutritional deficiency
2
Cont’d
Method(s) Used
Dietary
Decreased level in reserve
tissue store
Biochemical
Decreased level in body
fluids
Biochemical
Decreased functional level
in tissues
Anthropometric/
biochemical
Generalized scheme for the
development of nutritional deficiency
Stage Depletion Stage
5
Decreased activity in
nutrient-dependent enzyme
Method(s) Used
Biochemical
6
Functional Change
Behavioral/
Physiological
7
Clinical Symptoms
Clinical
8
Anatomical Sign
Clinical
Gibson, 1990
Anthropometric Methods
• Measurements of
the physical
dimensions and
gross composition
of the body
• Measurements
vary with age and
degree of nutrition
Gibson, 1990
Anthropometric Methods
Used to detect moderate and severe
degrees of malnutrition
Advantage: provide information on past
nutritional history
5
Biochemical/Laboratory Methods
Involves measuring nutrient or its metabolite
in blood, feces, or urine
Several stages in the development of
Clinical Methods
Uses medical history and physical
examination to detect signs and symptoms
associated with malnutrition
nutritional deficiency state can be identified
Signs vs symptoms
Signs
• observations made by a qualified examiner
during physical examination
Symptoms
• disease manifestations that the patient is
usually aware of and are reported by the
patient
Ecologic method
• Collection of information on a variety of
other factors known to influence the
nutritional status of individuals or
populations
Dietary Methods
Involves surveys measuring the
quantity of the individual foods
and beverages consumed during
the course of one to several days
Assessment of patterns of food
use
Types of Nutritional Assessment
Direct Assessment
Indirect Assessment
Examples
• Socio-economic and demographic data
• Food prices
• Cash earning opportunities
• Food expenditure
• Health and vital statistics
6
Direct Assessment
Indirect Assessment
1. Anthropometry
1. Dietary
2. Biochemical
2. Ecological
3. Clinical
Acknowledgments
1. References
Gibson RS. Principles of nutritional assessment. New York: Oxford
University Press, 2005.
Lee RD, Nieman DC. Nutritional Assessment. 4th edition.
Singapore. McGraw-Hill. 2007.
2. Photos
Downloaded from FNRI website
3. Slides
Slides are courtesy of Dr. Milagros Querubin, Ms. Carleneth
Fernandez, and Ms. Lorena Tengco
7
