Anda di halaman 1dari 36

NUTRITIONAL ASSESSMENT (ASSESSING NUTRITIONAL STATUS)

By Siti Fatimah Muis

Nutritional Assessment:
Interpretation of information from dietary, laboratory, anthropometrics and clinical Studies

(status gizi=keadaan gizi)

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 )

dapat dilakukan baik untuk individu maupun masyarakat/sekelompok orang

Nutritional Assessment Methods:


1.

2.
3. 4. 5. 6. 7.

dietary methods laboratory examination anthropometric measurements Biophysical measurement clinical examinations assessment of ecological factors Vital statistics

No 2,3,4, 5= direct assessment 1,6,7 = indirect assessment

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

raw measurements do not mean anything, if not compared to REFERENCE or STANDARDS.

*Human growth is influenced by


1. Biological determinants : sex, intra uterine environment, birth order, birth weight, parental size, genetic constitution

2. Environmental : Climate, living condition,socio-economic condition,diseases, psychological factor

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.

CLINICAL SCREENING AND ASSESSMENT


BACKGROUND 1.In US,UK, Canada in 1994-1996: 2/3 of hopatilized patients lost weight, 12% was badly malnourished 2. 1997 in a hospital Jakarta, 75 % decreased nutr. Status The underlying reason: there was no nutr. Assessment of patient on day of admission, and no recording of body weight and food intake

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

Objective of screening and nutritional assessment

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]

Body Fat and Body frame

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.

Nutritional parameters changes

chrn maln acute maln Weight decr. Mid arm decr <-> Albumin > decr Lymphc count > decr Immune func >/decr decr

mixed decr decr decr 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

-- ANALYZED AS QUALITATIVE OR QUATITATIVE DATA

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.

Anda mungkin juga menyukai