Dr .ftima .A.

hadoud
MBBCH, MD (ABP).
 Contents
 Objectives.

 Introduction.

 Methods of nutritional assessment.

direct &indirect methods

 Global targets (WHO 2025).

Objectives:

 To know the different methods for assessing

the nutritional status.

 To understand the basic anthropometric

techniques, applications.
 Introduction

 The nutritional status of an individual is often

the result of many inter-related factors.

 It is influenced by food intake (quantity &

quality) and by physical activity.

 The spectrum of nutritional status spread

from obesity to severe under nutrition.
What is the purpose of nutritional
assessment ?
1- Identify individuals or population groups at
risk of becoming malnourished.

2- Identify individuals or population groups who

are malnourished .

3- To develop health care programs that meet

the community needs which are defined by
the assessment.

4- To measure the effectiveness of the nutritional

programs & intervention once initiated.
Assessment methods of nutritional status

A _ Direct methods :
The direct methods deal with the individual and
measure objective criteria :

A. Anthropometry.

B. Biochemical & laboratory evaluation .

C. Clinical examination .

D. Dietary intake assessment .

 Assessment of nutritional status

B_Indirect Methods :
This methods use community health
indices that reflects nutritional influences as :

1. Vital statistics .
2. Assessment of ecological factors.
Direct methods of nutritional assessment :

A. clinical examinations:

 Good nutritional history should be obtained.

 General clinical examination, with special

attention to organs like hair, angles of the
mouth, gums, nails, skin, eyes, tongue,
bones.
Inspection
 Clinical signs Nutritional deficiency

Hair; Protein, zinc & biotin.

Spare &thin Protein deficiency.
Easy to pull out Vit A and C deficiency.
Coiled

Mouth; Riboflavin, niacin and

Glositis Vit C , K, folic acid.
Bleeding gum B2, B6 and niacin.
Angular Stomatitis

Eyes; Vit A deficiency

Night blindness
Conjunctival inflammation
bitot’s spot.
 Clinical signs Nutritional deficiency

Nails; Iron deficiency.

Spooning Protein deficiency.
Transverse line

Skin; Iron, B12 & folic acid.

Pallor. Niacin & PEM
Bruising. Vit C, K & folic acid.
Dermatitis .

Thyroid gland; Iodine deficiency

Goiter

Joint&bone Vit D deficiency.

Direct methods of nutritional assessment

B . Anthropometry

 Weight .

 Height or length in children <2 yr.

 Mid upper arm circumference .

 Head circumference.
weight

 Why ?
 When ?
 How ?
 How we can interpret it ?
Height
Head & chest circumference
Mid upper arm circumference(MUAC)

 MAUC cut-offs for the identification of under

nutrition children have been agreed by WHO
,UNICEF:

 >13.5 normal.
 12.5_13.5 at risk of under nutrition.
 11.5_12.4 moderate under nutrition.
 <11.5 sever under nutrition.
 Nutritional Indices in Adults

 The international standard for assessing body

size in adults is the (BMI), Brocca index and
WHR .

 Brocca index; ideal weight=height in cm – 100.

 BMI = Weight (kg)/ Height (m²)

 Evidence shows that high BMI is associated

with:
type 2 diabetes & high risk of( CVS)morbidity &
mortality
 Measurements for adults

Weight measurements: Weigh in light

no clothes, no shoes and Read to the
nearest 100 gm (0.1kg)
 Hieght
 BMI (WHO - Classification)

 BMI < 18.5 = Under Weight.

 BMI 18.5-24.5 = Healthy weight range.

 BMI 25-30 = Overweight (grade 1 obesity).

 BMI >30-40 = Obese (grade 2 obesity).

 BMI >40 =Very obese (morbid or grade 3

obesity).
IS( BMI) AN ACCCURATE MEASURE OF
OBESITY ?
 Waist circumference

- It has been proposed that waist measurement

alone can be used to assess obesity, and two
levels of risk have been identified
MALES FEMALE
LEVEL 1 > 94cm > 80cm
LEVEL2 > 102cm > 88cm
 Hip Circumference

 It is measured at the point of greatest

circumference around hips & buttocks to the
nearest 0.5 cm.

 Both measurement should taken with a

flexible, non-stretchable tape in close
contact with the skin, but without indenting
the soft tissue.
 Interpretation of WHR

 High risk WHR= >0.80 for females

>0.95 for males

 indicates central (upper body) obesity and is

considered high risk for diabetes & CVS
disorder
 Skin fold thickness measurments

There are different

sites to measure the
skin fold:
1) Triceps skinfold
2) Biceps skinfold
3) Subscapular skinfold
Skin folder measurment
Direct methods of nutritional assessment:

 Biochemical & laboratory evaluation

(A ) laboratory tests : (B) Biochemical tests

 Hg estimation serum retinol .
 Stool &urine serum folate .
serum vit B 12 .
Direct methods of nutritional assessment

D . Dietary intake assessment :

 Weighment of raw foods.

 Weighment of cooked foods.

 Oral questionnaire method.

B .Indirect methods of .N .assessment:

 Vital health statistics

 Mortality &morbidity rate ,IMR, LBW &life

expectancy .

Assessment of ecological factors :

I. Food balance sheet .
II. Socio-economic factors.
III. Health and educational services.
IV. Conditional influences.
Global targets (WHO 2025)
 40% NO.of children < 5 who are stunted.

 50 % of anemia in women reproductive age

 30% in LBW .

 No increase in childhood overweight .

 the rate of exclusive BF in first6 mo. up to 50%.

 Reduce and maintain childhood wasting < 5% .