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Nutritional level assessment is the first step in the treatment of malnutrition of a certain society. Specific data are obtained to create a metabolic and nutritional profile of the Nutritional deficient patient. The goals are identification of Nutritional deficient patients who have, or are at risk of developing malnutrition; to quantify a patient's degree of malnutrition; and to monitor the adequacy of nutrition therapy.
The initial assessment of nutritional status requires a careful history, a physical examination, and laboratory tests. With the patient assessment in hand, one can then determine the caloric, protein, and fluid needs of the patient. Foremost in nutritional assessment is the Nutritional deficient patient interview for determining clinical history. Attention should be given to the disease state, duration of illness, intake of nutrients, and presence of such gastrointestinal symptoms as nausea, vomiting, and diarrhea.
There are3 ways to assessment of nutritional status of a society as described bellow:
1. Weight loss: Weight loss is often the first clue to an underlying cause of malnutrition. The loss of more than10% of the patient’s usual weight necessitates a thorough nutritional assessment. Recent unintentional loss of10% to20% of the patient’s usual weight indicates moderate protein-calorie malnutrition, and loss of more than20% indicates severe protein-calorie malnutrition. Valuation of the patient’s overall appearance and thorough physical examination of the skin, eyes, mouth, hair, and nails may provide a clue to the presence of malnutrition.
2. Body height and weight relation: Weight is one of the most useful elements of the physical examination for the assessment of nutritional status. Body weight is expressed as a value relative to established norms in the general population. Use of these standards may facilitate the diagnosis of significant protein-calorie malnutrition (85% of ideal body weight). The major variable that limits the usefulness of weight and height as indicators of nutritional assessment is water retention, which can occur in many disease states. Fluid retention is a major concern in patients with protein malnutrition as a result of impairments in aldosterone, antidiuretic hormone (ADH), and insulin metabolism.
3. Anthropometrics: Anthropometrics are used to estimate subcutaneous fat and skeletal muscle stores objectively. Anthropometric measurements, such as triceps skin fold thickness (TSF) and mid-arm muscle circumference (MAMC), estimate fat and lean tissue mass, respectively. Anthropometry is a useful adjunct in nutritional assessment which is simple, safe, and easily applied at the bedside. Anthropometric data are used in two ways in nutrition assessment:
a) To compare measured values with standardized controls.
b) To compare serial measurements over time in the same Nutritional deficient patient.
Three anthropometric parameters pertaining to the mid-upper arm are useful in the nutritional assessment of hospitalized adults: mid-upper arm circumference (MAC), TSF, and MAMC. They are useful in identifying the most severely malnourished patients, especially those with fluid retention as a result of disease. TSF alone is not a sensitive indicator of malnutrition because many normal adults have less than5% body fat. However, it is required to calculate MAMC:
MAMC (cm) = MAC (cm) –3.14 x TSF (mm) ÷10 -[(3.14 x TSF (mm)) ÷10]
MAMC is easily determined and provides a readily available parameter for nutritional assessment. An MAMC measurement of less than the fifth percentile according to national standards indicates severe protein-calorie malnutrition. An MAMC measurement less then the tenth percentile indicates moderate protein-calorie malnutrition
