NUTRITION ASSESSMENT IN KAPKATET COUNTY HOSPITAL , KERICHO COUNTY

SPECIAL NUTRITION ASSESSMENT DONE

BYCHERUIYOT SAMBU

CLINICAL NUTRITIONISTMSCN/BSCN/DCM

DEFINITION: NUTRITION ASSESSMENT: Is

A comprehensive analysis of a person’s nutrition status that uses health, socioeconomic,

drug, and diet histories; anthropometric measurements;

physical examinations; and laboratory tests.

Type of History What It Identifies

Health history Current and previous health problems and family health history that affect nutrient needs, nutrition status, or the need for intervention to prevent or alleviate health problems

Socioeconomic history Personal, cultural, financial, and environmental influences on food intake, nutrient needs, and diet therapy options

Drug history Medications (prescription and over-the-counter), illegal drugs, dietary supplements, and alternative therapies that affect nutrition status

Diet history Nutrient intake excesses or deficiencies and reasons for imbalances

Historical Data Used in Nutrition Assessments

outline1. WAIST

CIRCUMFRENCE

2. TRICEPS SKIN FOLD (TSF)

3. WAIST/HIB

4. PHYSICAL EXAMINATION

5. CLINICAL ASSESSMENT

6. HEAD CIRCUMFRENCE

Anthropometric MeasurementsUsed in Nutrition Assessments

Type of Measurement What It Reflects

Abdominal girth measurement

Abdominal fluid retention and abdominal organ size

Height-weight Over-nutrition and under-nutrition; growth in children

Head circumference Brain growth and development in infants and children under age 2

Skin-fold Subcutaneous and total body fat

Waist circumference Body fat distribution

The purpose of determining waist girth is to gain a measure of the amount of abdominal fat (visceral fat), which has been linked to increased risk of coronary heart disease and diabetes.

The waist measurement is taken by a tape at the narrowest waist level, or if this is not apparent, at the mid point between the lowest rib and the top of the hip bone (illiac crest).

Waist or Abdominal Girth (circumference)

≥102cm (adult male) & ≥88 cm (adult female) considered having abdominal obesity

A measure of subcutaneous fat stores taken at the midpoint of the posterior aspect of the humerus.Correlates closely with percentage of body fat and with total body fat.Triceps skin-fold thickness varies between 6 -12mm in lean individuals and between 40 - 50mm in obese individuals.

Triceps skin-fold (TSF)

Men Women

Risk cm inches cm inches

Very High > 120 > 47 > 110 43.5

High 100 - 120 39.5 - 47 90 - 109 35.5 – 43

Low 80 - 99 31.5 - 39 70 - 89 28.5 – 35

Very Low < 80 < 31.5 < 70 < 28.5

Adapted from Ellie Whitney and Sharon Rady Rolfes; Under standing Nutrition, Twelfth

Edition. 2011

Waist–hip ratio or waist-to-hip ratio (WHR) is the ratio of the circumference of the

waist to that of the hips.Waist/hips

WHR is used as a measurement of obesity,

Waist–hip ratio

Male FemaleHealth Risk Based Solely on WHR

0.95 or below 0.80 or below Low Risk

0.96 to 1.0 0.81 to 0.85 Moderate Risk

1.0+ 0.85+ High Risk

The Waist to Hip Ratio Calculator indicates your probable health risks. People with more weight around the waist, face more health risks than people who carry more weight around their hips

OBESITYWaist/hip ratio - divide the waist circumference by the hip circumference. Above 0.95 for men (or 0.8 in women) indicative of a health risk

WHO states that abdominal obesity is defined as a waist–hip ratio above 0.90 for males and above 0.85 for females, or a body mass index

(BMI) above 30.0

Physical examinationsBody System Healthy Findings Malnutrition Findings What the

Findings Refl ect

Hair Shiny, firm in the scalp Dull, brittle, dry, loose; falls out

PEM

Eyes Bright, clear pink membranes adjust easily to light

Pale membranes; spots; redness adjust slowly to darkness

Vitamin A, B vitamin, zinc, and iron

Teeth and gums

No pain or caries, gums firm teeth bright

Missing, discolored, decayed teeth; gums bleed easily and are swollen and spongy

Mineral and vitamin C status

Glands No lumps Swollen at front of neck PEM and iodine status

Tongue Red, bumpy, rough Sore, smooth, purplish, swollen

B vitamin status

Physical examinations

ADVANTAGES

Fast & Easy to performInexpensiveNon-invasive

LIMITATIONSDid not detect early cases

Trained staff needed

Skin Smooth, firm, good color

Off-color, scaly, fl aky, cracked, dry rough, spotty; “sandpaper” feel orsores; lack of fat under skin

PEM, essential fatty acid, vitamin A, B vitamin, and vitamin C status

Nails Firm, pink Spoon-shaped, brittle, ridged, pale Iron status

Internal systems

Regular heart rhythm, heart rate, and blood pressure; no impairment of digestive function, reflexes, or mental status

Abnormal heart rate, heart rhythm, o rblood pressure; enlarged liver, splee nabnormal digestion; burning, tingling of hands, feet; loss of balance, coordination, mental confusion, irritability, fatigue

PEM and mineral status

Muscles and bones

Muscle tone; posture, long bone development appropriate for age

“Wasted” appearance of muscles swollen bumps on skull or ends of bones; small bumps on ribs; bowed legs or knock-knees

PEM, mineral, and vitamin D status

Physical examinations CONT…

Vitamin B complex deficiency

• Glossitis • Cheilosis• Stomatitis• Neurological problems• Anaemia• Ariboflavinosis (Riboflavin)• Beri beri (Thiamine)• Pellagra (Niacin)• Birth defects (Folate)• Infertility (Folate + B12)

Clinical assessment …

Iodine deficiency disorder

• Deficiency of micronutrient iodine

• Thyroid hormone deficiency• Features:• Goitre• Swelling over legs

(myxoedema)• Voice change• Skin changes• Abortions

Clinical assessment …

• Lesions on the back of the hands and ‘Casal’s necklace’

Pellagra

Clinical assessment …

ANGULAR CHEILITIS

Ariboflavinosis

Clinical assessment …Vitamin D (Rickets)

• bony deformities• rickety rosary• tetany• osteomalacia

HEAD CIRCUMFERENCE• Brain growth takes place 70% during fetallife, 15% during infancy and remaining 10% during pre-school years.

• Head circumference are routinely recorded until 5 years of age.

• If scalp edema or cranial moulding is present , measurement of scalp edema may be inaccurate until fourth or fifth day of life .

•The head circumference is measured by placing the tape over the occipital protuberance at the back and just over the supraorbital ridge and the glabella in front.

Age Head circumference (cm)

At birth 34 – 35

2 months 38

3 months 40

4 months 41

6 months 42 - 43

1 year 45 - 46

2 years 47 - 48

5 years 50 - 51

• During first year there is 12 cm increase in head circumference , while 1 – 5 year age , only 5 cm gain occur in head size.

• Adult head size is achieved between 5 to 6 years .

Expected head circumference in children

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