Nutritional Assessment:
Interpretation of information from dietary, laboratory, anthropometrics and clinical Studies
Nutritional Status:
Expression of balance between intake and expenditure of energy and nutrients of an organism ( ekspresi keseimbangan antara
masukan dan keluaran energi dan zat-zat gizi suatu organisme dalam kurun waktu tertentu )
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3. 4. 5. 6. 7.
dietary methods laboratory examination anthropometric measurements Biophysical measurement clinical examinations assessment of ecological factors Vital statistics
1.CLINICAL SIGNS:
- physical - related to inadequate nutrition - to be done by experienced persons - lack of specificity
* non-nutritional influence may give similar appearance dry skin maybe xerrosis skin (vit A defic. or dryness due to hot area) Bitots spot (vit A defic.)vs conjuctival irritation due to dust or smoke (for a long period)
need additional supportive information may be two dimensional: occur both in deficiency or in recovery
2. NUTRITIONAL ANTHROPOMETRY
measurements of variations of the physical dimensions and gross composition of human body at different age and degrees of nutrition -> influenced by genetics (growth potential) and environment
GENETICS
QUALITY OF OVUM AND SPERMS SEEN IN QUALITY AND QUANTITY OF SEL DIVISION AND GROWTH SEEN AS INTENSITY AND SPEED OF SEL DIVISION, MATURATION O CELLS, AGE OF PUBERTY, LINEAR GROWTH CEASATION IN DEVELOPED COUNTRIES, ENVIRONMENT IS WELL CONTROLLEDGENETICS PLAY MORE ROLE.
ENVIRONMENT
Intra uterine: nutritional, mechanical, toxins, endocrine, radiation, infection, stress, intra uterine anoxia Extra uterine/postnatal: nutrition, infection, anoxia, economiy, culture
*Anthropometric Measurements = picture of human growth at different age level (from fetoes to adulthood):
age, height/length, weight upper arm circumference (UAC/LILA) head circumference BMI (body Mass Index) skinfold thickness
a. REFERENCE or STANDARD:
*Based on measurements of : 1. statistically adequate samples in number 2. healthy, well-fed population 3. age known precisely 4. sex 5. representative for all socio-economicethnic groups
* Ideally every country has its own standard, However to do such study is very, very expensive.
At present there are national standards of UK, USA (CDC/NCHS standards), International standards WHO 2000
* Indonesia modifies the NCHS for its KMS (Kartu Menuju Sehat = child growth chart FOR RESEARCH USE WHO 2000
b.PRESENTATION OF MEASUREMENTS Wt/A, Ht/A, Wt/Ht, WT/HT2 In percent , median, percentile or z-score of the standards. in many studies, z-score is mostly used in Indonesia KMS : median NCHS value/ curve becomes 90 percents curve.
Nutritional screening
1. identification of signs and symptoms of nutr. Problem 2. identification patients at risk of becoming malnourished during hospitalization by: collecting and assessing clinical condition, food intake, antrophometry data and lab results
1. to reduce complication, failure in therapy, and cost of hospital cost (for hospital as we4ll as for patients) Screening: decrease/increase of BW more than 5- 10% within few weeks/month, inadequate intake Nutr.Assessment: D/ nutr status, to decide nutr.therapy, and monitoring respons to therapy
Screening instruments
SGA=subjective global assessment simple, non invasive MNA=mini nutr. Assessment: low score is associated with increased mortalityand length of hospital stay (PLEASE LOOK FOR SGA AND MNA MANUAL)!!!!
SGA
CONSISTS of: change in BW,(last 2-6 months), food intake, gastrointestinal complaints, functional capasity, and physical examination (muscle wasting, no dat under the skin, oedema, ankle oedema, teeth and gums, stomatitis == A=good NS, B=mild malnutrition, C=severe malnourished
Nutritional status
Parameters: anthropometry, lab assessment, clinical, physical, intake Look for the changes in body composation such as gross weight, body fats, muscle mass, extrcel fluids BMI =BW in kg/ Height in sq meter 18.5-23= normal BMI , <18.5 malnourshed,>23-27=overweight, >27= obese
Height
If height can not be measured, use arm span or knee height Male: 64.19+[KH in cm x 2.03].[0.04 x age in years] Female: 84.88 +[KH in cm x 1.83].[0.24x age in years]
Mid arm circumference (LILA) Skinfold thickness (triceps, biceps,subscapular, waist) Frame=Height(cm)/wrist circumference(cm) Male: large fr >10.4, medium 10.4-9.6, and small =<9.6 cm
Biochemical assessments
Please think, and write down parameters of biochemical values that have something to do with nutritiona;l status or food intake.
chrn maln acute maln Weight decr. Mid arm decr <-> Albumin > decr Lymphc count > decr Immune func >/decr decr
Disease impacts on NS
Increase nutritional needs ( fever, trauma, tissue damage, sepsis, cancer) Increase nutients loss (nause, diarhea, wounds, bleeding) Disturbance in absorption and digestion DIAGNOSIS IN NUTRITION WILL SUPPORT THE PHARMACEUTICAL AND NURSING CARE TO REACH OPTIMAL RESULT OF HOSPITAL TRATMENT
HOME ASSIGNMENTS
TULIS KEUNGGULAN DAN KELEMAHAN ANTROPOMETRI--- SERAHKAN SAYA MINGGU MENDATANG (PALING TIDAK 5 JENIS KELEMAHAN DAN KEUNGGULAN DISERTAI PENJELASANNYA) Sebutkan AKB, AKI, AK BALITA DI INDONESIA SAAT INI (DATA TERBARU) - termasuk tinggi/sedang/rendah dibanding negara lain di Asia dan Eropa???
DIETARY RECALL/SURVEY
DIETARY RECALL 2 X 24 HOURS RECALL IN INDIVIDUALS DEITARY SURVEY: DIETARY RECALL + FOOD FREQUENCY QUESTIONNAIRE FOR COMMUNITY ASSESSMENT
VITAL STATISTICS
Maternal Mortality Rate (AKI), Infant Mortality Tare (AKB), Under Five years old mortality rate (AK Balita) - they are alwys related to nutritional status, nutrition care an d food consumption - they are used as paramater of healt and nutritional condition of a country The lower, the better
BIOPHYSICAL METHODS
C0NSISTS OF: radiographic examination, physical function test, and cytological test 1. to see the signs of ricetts, osteoporosis, osteomalacia 2. measure change of functions realted to deficiency ( rabun senja in vit A deficiency): difficult to do, not objective) 3 to see epithelial changes by epithelial smear.> very seldom used
REFERENCES
PENILAIAN STATUS GIZI: I Dewa Nyoman Supariasa, Bachyar Bakri, Ibnu Fajar. WHO Anthro 2000. BMI STANDAR YANG BERLAKU UTK Indonesia Ilmu gizi dan aplikasinya utk keluarga dan masyarakat:Soekirman.