269 CHS (# 5) – PART II

Evaluation of Nutritional Status

(Nutritional Assessment)
 2- Biochemical test
(Biomarkers of dietary intake)
 2- Biochemical test
(Biomarkers of dietary intake)
All estimates of food intake are subjective.
 Some subjects forget,
 Some did not notice what food they ate,
 Some do not report because they would be ashamed to
admit having that food, drink or amount.

The search is on for biomarkers which are objective

biochemical indices of dietary intake.
For some food components there are useful
biomarkers; for others there is nothing available.
Example: protein intake is reflected by 24-hr urinary
nitrogen.
Biochemical tests:
Biochemical tests are an integral part of
modern medical diagnosis:
-Take sample of: blood, urine, feces
-Measure for levels of enzymes,
nutrients OR metabolites
Examples:
-Serum albumin indicative of protein status
-Blood hemoglobin indicative of iron status
-Plasma sodium & potassium
concentrations are essential for diagnosing
& treating difficult electrolyte disorders
-Plasma or red cell folate & plasma B12
should be measured before treating patient
with megaloplastic anemia
With most other nutrients also, biochemical
tests have been developed which can be
used:
(a) To confirm diagnosis of a deficiency disease in
places where it is uncommonly seen or where
the clinical picture is complicated, OR

(b) In community surveys and general practice to

find individuals with subclinical nutrient
deficiencies.
 Biochemical indicators of
nutritional status

Biochemical indicators can include assessment

of blood and urine samples for levels of:
o A variety of nutrients, &/or
o Their by-products, or
o For levels of nutrient-linked enzyme activities.

Analysis may also be performed on samples of hair.

 Blood samples
Blood can provide a great deal of information.
Analysis can be used to determine:
 Actual levels of a nutrient in relation to expected values
– Plasma vit C, red cell folate
 The activity of a nutrient-dependent enzyme
– Transketolase for thiamin
 The activity of a nutrient-related enzyme
– Alkaline phosphatase for vit D
 The rate of a nutrient-dependent reaction
– Clotting time for vit K
 The presence of a nutrient carrier or its saturation level
– Retinol-binding protein
– Transferrin (iron)
 Levels of nutrient-related products
– Lipoprotein levels
 Urine and hair
Urine
o For some nutrients such as sodium, iodine,
phosphorus urinary excretion is the best
way to establish status…..
But complete urine collections are difficult to
obtain.
Hair
o Levels of some trace elements
o Scientific accuracy not proven
 Data Interpretation

 Caution… for many nutrients there is inadequate

information to establish guidelines.

 Guidelines for interpretation must take into

account age, sex, pregnancy, lactation,
inflammation, infection, trauma etc..

 Cut-offs -often derived from healthy individuals