Nutrition assessment

The first step before delivering specialized nutrition support is to perform a nutritional assessment and determine nutrient requirements based on the patient s nutritional status and clinical conditions. Collect subjective and objective data to determine a patient s level of nutrition, to identify patients with malnutrition or at risk for malnutrition, and to identify risk factors that may put a patient at risk for nutrition-related problems.1 A nutrition assessment should include 1,19... 

There are several approaches and methods to conducting a nutrition assessment, but one approach that has been validated is the Subjective Global Assessment (SGA).1 Application of the SGA requires gathering the data just listed and assessing these parameters (i.e., weight change, change in diet, GI symptoms, functional capacity, and physical examination)... 

Protein requirements must be based on the patient s nutrition assessment and appropriate amounts provided (based on IBW or AdjBW for obese patients) to facilitate anabolism and wound healing, and avoid adverse effects (e.g., azotemia and uremia). 

After performing a nutrition assessment and estimating nutritional requirements, determine the optimal route to provide specialized nutrition support (e.g., oral, enteral, or parenteral). If PN is deemed necessary, venous access (i.e., peripheral or central see below) for PN infusion must be obtained. Finally, formulate a PN prescription, and administer PN according to proper safety guidelines. 

After completing a full nutrition assessment (e.g., SGA),1,19 estimating the patient s daily fluid, calorie, and protein... 

American Society for Parenteral and Enteral Nutrition Board of Directors and the Clinical Guidelines Task Force. Nutrition assessment-adults. J Parenter Enteral Nutr 2002 26 1SA-138SA. 

Nutrition assessment allows identification of individuals at risk for underand overnutrition. 

The Joint Commission on Accreditation of Healthcare Organizations standards require a nutrition screening typically within 24 to 72 hours of hospital admission. Patients determined not to be at risk for malnutrition should be reevaluated every 7 to 14 days. Patients determined to be at risk for malnutrition need a nutrition assessment and care plan. 

The goals of nutrition assessment are to identify the presence (or risk) of developing undernutrition and complications, estimate nutrition needs, and establish baseline parameters for assessing the outcome of therapy. 

Nutrition assessment is the first step in developing a nutrition care plan and includes a clinical evaluation, anthropometric measurements, and biochemical and immune function studies. 

Nutrition affects immune status both directly and indirectly. Total lymphocyte count and delayed cutaneous hypersensitivity reactions are immune function tests useful in nutrition assessment. 

Clinical presentation of protein-energy malnutrition and nutrition assessment are discussed in Chap. 57. 

In a placebo-controlled randomized supplementation trial (approved by the ethic commission of Ethiopia) in the rural area (AZOZO) district of Gondar Ethiopia from 220 households, 161 children (2-5 years of age) were selected at random for the study at a first visit to the local clinic, nutritional assessment, and stool examination (parasites or ova) were performed (Biesalski et ah, 1999). 141 children with parasites were treated with mebendazole. Heparin blood was obtained for assessment of vitamin A, RBP, and TTR (transthyretine) concentrations. 

The Hornsey (1956) procedure and its modifications have received widespread acceptance as relatively rapid measures of the adequacy of cure development in processed meats. The Hornsey procedure is also an accurate method for nutritional assessment of heme and heme iron content of meats (Carpenter and Clark, 1995), where ppm heme iron = ppm total heme/11.7. However, one caveat should be noted. The total heme pigment measurement is higher in cured meats than in similar uncured samples. Roasted turkey breast meat, for example, was reported by Ahn and Maurer (1989a) to have 23,26,34, and 34 ppm total pigment in samples formulated with 0, 1, 10, and 50 ppm nitrite, respectively. This effect should be considered to avoid overestimation of the heme iron content of cured meats. 

Designed to study a probability sample of the noninstitutionalized civilian population of the United States, NHANES also conducted nutritional assessment of three high-risk populations preschool children (6 months to 5 years old), those 60-74 years old, and the poor (persons below the poverty level) (NRC 1991). Each year, the current NHANES samples 5,000 persons, representative of the U.S. civilian household population, in 15 geographic locations. There is also an effort to oversample some demographic groups, including blacks and Mexican Americans (Schober 2005). 

German JB, Roberts MA, Watkins SM. Personal metabolomics as a next generation nutritional assessment. J Nutr 2003 133 4260-5266. 

The tools for nutritional assessment include medical history and screening aides, physical examination and anthropometric measurements, biochemical assessment, and tests of immune function. A general health assessment and medical history are required to rule out causes of secondary malnutrition such as poor oral health, chronic illness, disease, and medication. Malnutrition is influenced by lifestyle, which includes alcohol usage in adults, food preference, eating habits, social interactions, and economic status. Various screening tools, such as the DETERMINE checklist (White et al., 1991), are available to assess the risk of malnutrition. 

Gurney JM, Jelliffe DB Arm anthropometry in nutritional assessment normograms for rapid calculation of muscle circumference and cross sectional muscle and fat mass. Am J Clin Nutr 26 912-915,1973. 

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