Introduction to

Nutritional
Assessment
 Overview of nutritional assessment
I. Good Nutrition Essential for Health
II. Purpose of nutritional assessment
III.Forms and uses of nutritional assessment systems
IV. Introduction to the different methods of nutritional
assessment
V. Opportunities in Nutritional Assessment
VI. Pathogenesis of the Development of Nutritional deficiency
and appropriate method of detecting the condition
VII.Factors to Consider in Designing Nutritional Assessment
Systems
 I. Good Nutrition Essential for Health

• Good nutrition is critical for the well-being of

any society and to each individual within that
society. The variety, quality, quantity, cost, and
accessibility of food and the patterns of food
consumption can profoundly affect health.
Deficiency Diseases Once Common
Deficiency Diseases Once Common
Deficiency Diseases Once Common
Deficiency Diseases Once Common
Deficiency Diseases Once Common
 Chronic Diseases Now Epidemic
Top Leading Cause of Death (WHO, 2016)
• Ischemic Heart Disease
• Stroke
• COPD
• Lower Respiratory Infections
• Alzheimer’s disease and other
dementias
• Trachea, bronchus, lung cancers
• •
Diabetes mellitus
• Road injury
• Diarrheal diseases
• Tuberculosis
Top Leading Cause of Death in the
Philippines (2017)
• Ischemic Heart Disease
• Neoplasms
• Cerebrovascular Disease
• Pneumonia
• Diabetes Mellitus
• Hypertensive diseases
• Chronic Lower Respiratory Infections
Respiratory Tuberculosis
• Other Heart Disease
• Remainder of the Diseases of the
Genitourinary System
 Basic Concepts of Nutritional Assessment
• Nutrition (status) • Nutrition assessment is
assessment or assessment essential in the:
of nutritional status – Identification of
pertains to the individuals and groups
“interpretation of who are nutritionally at-
information derived from risk.
dietary, biochemical, – Determination of
anthropometric, and interventions appropriate
clinical studies” (Gibson, to alter nutrition status.
2005). – Monitoring of nutrition
interventions.
 II. Purpose of nutritional assessment
• Among individuals, • In the community, nutritional
assessment is being done to
nutrition assessment is establish the extent and
being done to establish distribution of the problem and
the nature and etiology to determine the associated
environmental factors in order to
of the problem in order provide appropriate health and
to provide the nutrition services, and facilitate
appropriate treatment the implementation of preventive
programs. The nutritional status
and prevent of the community is the sum of
reoccurrence of the the nutritional status of all
members of the community.
problem.
 III. Forms and uses of nutritional assessment
systems
System Description Objectives Target Group
Nutrition survey Involves the • Identify geographic Can be done for a
collection of data to distribution and/or the population or sub-
determine baseline subpopulation groups population groups at
nutritional status or at-risk of chronic risk of malnutrition.
define the overall malnutrition.
nutritional status of • Determine the overall
a population. nutritional status of the
population.
• Characterize the extent
and nature of
malnutrition.
 III. Forms and uses of nutritional
assessment systems
System Description Objectives Target Group
Nutrition A continuous Identify causes of chronic May involve specific
Surveillance monitoring of the and acute malnutrition. at-risk sub-
nutritional status of May serve as basis for population groups,
selected population formulating interventions identified in earlier
groups for the affected nutrition surveys
population or sub-
population groups.
Monitor the effect of
government nutrition
policies.
Evaluate the efficacy and
effectiveness of nutrition
interventions.
 III. Forms and uses of nutritional
assessment systems
System Description Objectives Target
Group
Nutrition • Nutritional screening can be defined as “a • Identify at-risk Can be
Screening process to identify an individual who is individuals who carried out
malnourished or who is at risk for may require for a
malnutrition to determine if a detailed intervention. population,
nutrition assessment is indicated.” If • Identify targeted to
nutritional screening identifies a person malnourished a specific
at nutritional risk, a more thorough individuals at-risk sub-
assessment of the individual’s nutritional requiring population,
status can be performed. interventions. or on
• Includes comparison of measurements selected
on individuals with pre-determined risk individuals
levels or cut-off points using
measurements that are simple and
cheap, and can be applied rapidly on a
large scale.
 III. Forms and uses of nutritional
assessment systems
System Description Objectives Target Group
Evaluations of Interventions are of Based on the kind of Often targets specific
Nutrition three types: intervention at-risk sub-
Interventions supplementation, population, identified
fortification and in earlier nutrition
dietary approaches. surveys or nutrition
screening.
 III. Forms and uses of nutritional
assessment systems
System Description Objectives Target Group
Assessment System Screening using a • Clarify and expand Used in clinical
in Clinical setting single index nutritional medicine to assess
(biochemical, diagnosis. the nutritional status
anthropometric, or • Establish the of hospitalized
functional tests) severity of patients.
malnutrition
 IV. Introduction to the different
methods of nutritional assessment
Direct Methods Indirect Methods
• Anthropometry • Ecological
• Biochemical • Vital statistics
• Clinical
• Dietary
V. Opportunities in Nutritional Assessment

A. Health-Care Organizations
B. Diabetes Mellitus
C. Weight Management
D. Heart Disease and Cancer
E. Nutrition Monitoring
F. Nutritional Epidemiology
VI. Pathogenesis of the Development of Nutritional deficiency
and appropriate method of detecting the condition
 VII. Factors to Consider in Designing
Nutritional Assessment Systems
A. Study Objectives
B. Sampling Protocol
C. Methods of nutritional assessment
D. Validity, Reproducibility or Precision, Accuracy and
errors
E. Sensitivity, Specificity, Predictive value and Prevalence
F. Ethical Issues
G. Indices and Indicators
H. Evaluation of Nutritional Assessment Indices
 A. Study Objectives
• The study objectives should be the major basis
for selecting the design of the assessment
system and the measurements or indices
 B. Sampling Protocol
• Consider the sampling frame, time, resources,
and logistical constraints
Methods of nutritional assessment
• Direct Methods
• Indirect Methods
 D. Validity, Reproducibility or Precision,
Accuracy and errors
• Validity is the adequacy with which any measurement,
index or indicator reflects what is intended to
measure.
• Precision or Reproducibility is the degree to which
repeated measurements of the same variable give the
same value. It is reduced by random measurement
errors.
• Accuracy is a term to describe the extent to which the
measurement is close to the true value. Accuracy is
reduced due to systematic errors or bias.
 D. Validity, Reproducibility or Precision,
Accuracy and errors
• Random errors generate errors generate a deviation from the
correct result due to chance alone. They lead to measurements
that are imprecise. Individual biological variation, sampling error,
and measurement error are the three (3) major sources of random
errors.
• Systematic error or bias causes a result to depart from the true
value in a consistent direction. This error reduces the accuracy of a
measurement.
• Confounding or a confounding variable is defined as characteristic
that is distributed differently in the study and control groups and
that may influence the outcome being assessed.
E. Sensitivity, Specificity, Predictive value and
Prevalence
• Sensitivity of an index or indicator refers to the extent by
which the index or indicator reflects the nutritional status
or predicts changes in nutriture.
• Specificity of an index or indicator refers to the ability of
the index or indicator to identify and classify those persons
who are genuinely well nourished.
• Predictive value is the likelihood that a test correctly
predicts the presence or absence of malnutrition or a
disease.
• Prevalence is the number of individuals with malnutrition
or disease during a given time period.
 F. Ethical Issues
• Ethical approval or clearance from the
appropriate human ethics committees (or Review
Board) must be obtained by the principal
investigators/researchers whenever humans are
involved and before actual data collection begins.
• Basic guidelines for research on human subjects
must be strictly complied with.
• Informed consent should be requested from each
respondent.
 G. Indices and Indicators
• Index or indices are raw measurements
combined together. Indices are often evaluated
at the population level by comparing them
with predetermined limits or cut-off points of
reference standards.
• Indicators are information that is used to
measure changes which occur during the
course of program and allows one to monitor
the progress of the program.
 H. Evaluation of Nutritional Assessment
Indices
• Reference Distribution
– Reference distribution can be used to derive reference limits and a reference
interval.
• Reference Limits
– Reference limits are generally defined so that a stated fraction of the
reference values would be less than or equal to the limit, with a stated
probability.
• Cut-off points and Trigger Levels
– Cut-off points are based on the relationship between nutritional assessment
indices and low body stores, functional impairment, or clinical signs of
deficiencies.
– Trigger values may highlight regions or populations, where specific nutrient
deficiencies are likely to occur, or may serve to monitor and evaluate
intervention programs
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