nutrition assessment

Overview

  • Key elements of nutrition assessment

Social History

  • access to food
    • financial access: can afford?
    • mobility: can obtain?
  • preparing food
    • who cooks
    • can patient cook, how often?

Diet History

  • specific diet?
    • gluten free, low carb, keto, paleo, vegan
  • food intolerance, allergies
    • lactase def, fructose intol, red meat (a-gal)
  • dining out, how often
  • 24 hour diet recall, calorie count inpatient, food diaries
    • what you ate for breakfast, lunch, dinner yesterday
  • vitamins and supplements

PMHx

  • GI illnesses preventing absorption
    • oropharynx: dysphagia, tooth extractions (do you still have molars)
    • stomach: PUD, chronic nausea, gastroparesis
    • intestine: diarrhea, celiac dis, crohn's
  • chronic illnesses

SHx

  • stomach: ulcer operations, resection, bypass
  • intestine anastomoses
  • cholecystectomy

Symptoms

  • appetite increased or decreased
  • edema as sx of depleted albumin storage
  • pica: urge to chew ice

Weight Hx

  • current weight, BMI
  • ideal body weight
    • estimate using weight after finishing high school (where when they finished road to adult)
    • Hamwi method
    • NHANES survey
  • % ideal body weight: body weight should be +- 10% IBW
  • maximum lifetime weight
  • desired weight
  • recent change in weight

BMI

  • weight/height kg/m2
  • surrogate for adiposity (fat mass/total mass)

Adiposity

  • bioelectric impedance: signal sent from one part to another. Fat is insulator
  • DEXA: in research setting
  • underwater weighing: uses buoyancy of fat

fat distribution

  • uses waist/hip ratio as surrogate for central obesity
  • waist circumference

Longitudinal weight history

  • most dangerous: emergency if loses more than in box

Daily energy requirements

  • Harris-Benedict Equation: gender, weight, height, age
  • indirect calorimetry: measures O2 consumption, CO2 consumption
  • rule of thumb:

Protein requirements

  • lean body mass (estimates for somatic protein store)
  • plasma protein as surrogate to measure visceral protein
    • albumin: half life 3 weeks. Negative acute phase reactants
    • prealbumin: half life 2-3 days, also -APR
  • nitrogen balance: calorie count (cumbersome)
  • rule of thumb:

Vitamin and mineral

  • water soluble: B12, thiamine, folic acid
  • fat: ADEK, INR
  • iron storage
  • macro minerals: electrolytes
  • trace minerals: Cu, Co, etc.