Nutritional Status Assessment
Assoc. Prof. Jindřich Fiala
1
Department of Public Health
 Faculty of Medicine, Masaryk University
logo Masarykova univerzita – Lékařská fakulta

Outline, main points
2
nBackground, basics, definitions, objectives, indications
nMalnutrition
Techniques (in assessing nutritional status):
nAnthropometry
n
nPhysical (clinical) examination -  general appearance
n
nHistory
nBiochemical and immunological examinations
n
nDynamometry tests (muscle strength)
n
nValidated screening tools
n
nChildren (specifics)
n

Definitions, scope
3
nNutritional status:
- Nutritional status assessment
- Dietary assessment, (Food consumption, Dietary habits …)
nMalnutrition
- The resulting status of health and nutrition given and influenced by diet, dietary intake and
uptake,  factors influencing uptake (including  malfunctions and diseases), energy output,
heredity, environmental factors, lifestyle (physical activity, smoking, alcohol etc…)
nNutritional assessment – differentiate between:
- Nutritional status, which is characterized by a deficit or excess of energy or individual
nutrients (undernutrittion vs. overnutrition).
- This imbalance results in measurable changes in the tissues, the body's form, the functions of
the organism, and the clinical condition of the individual
v.s.

Malnutritions
4
Malnutrition by deficiency - undernutrition
Malnutritions by excess, overnutrition
nEnergy,  energy-protein deficiency malnutritions:
nSpecific deficiencies
ÞUnderweight
ÞCachexia
ÞMarasmus
ÞKwashiorkor
ÞMarasmic kwashiorkor
ÞIodine deficiency - endemic goitre (Struma)
ÞVit. A deficiency - xeroftalmia
ÞNutritional anaemia
ÞNutritional osteopenia
ÞB1 (Thiamine) deficiency - Beri beri
ÞB2 (Riboflavin) deficiency
ÞB3 (Niacin, vit. PP) - Pellagra
ÞVit C deficiency) - Scurvy
ÞSarcopenia
ÞOverweight
ÞObesity
ÞMicronutrient excess

Cachexia = kačeksia, kwashiorkor = kvošiorkór, deficiency = defišnsy

5
Clinical malnutritions according to ESPEN

ESPEN = European Society of Parenteral and Enteral Nutrition
 Frailty syndrome:  Frailty is a common clinical syndrome in older adults that carries an increased
risk for poor health outcomes including falls, incident disability, hospitalization, and mortality.
Asociated with aging =  weakness, slowing, decreased energy, lower activity, and, when severe,
unintended weight loss.

Types of Protein-Energy Malnutrition (PEM)
6
nUnderweight - adults low BMI, children low weight for age
nWasting – gradual loss of body mass (getting thinner). In children: Low weight for height.
nStunting – low height for age
nKwashiorkor – edematous PEM by protein deficiency
nMarasmus – severe wasting due to energy deficiency
nMarasmic kwashiorkor
nCachexia –associated with inflammatory or neoplastic condition
nSarcopenia - skeletal muscle wasting by ageing
nStarvation – pure caloric deficiency, conserves lean mass, increases fat metabolism

edem·​a·​tous | \ i-ˈde-mə-təs \

7
http://www.validnutrition.org/wp-content/uploads/2017/07/malnutrition-Chart.jpg


Marasmus vs Kwashiorkor
8
nMarasmus
nKwashiorkor
Marasmus is caused by a severe deficiency of nearly all nutrients, especially protein,
carbohydrates, and lipids.
Sufficient calorie intake, but with insufficient protein consumption.
C:\Users\jfiala\Desktop\Media Gallery\marasmus vs kwashiorkor.jpg

Malnutrition - causes
9
nLow intake of food
nMental health problems
nDigestive disorders and stomach conditions
nAlcoholism
nLack of breastfeeding
This may be caused by symptoms of an illness, for example, dysphagia, when it is difficult to
swallow. Badly fitting dentures may contribute.
Conditions such as depression, dementia, schizophrenia, anorexia nervosa, and bulimia can lead to
malnutrition
Some people cannot leave the house to buy food or find it physically difficult to prepare meals.
Those who live alone and are isolated are more at risk. Some people do not have enough money to
spend on food, and others have limited cooking skills.
Alcohol can lead to gastritis or damage to the pancreas. These can make it hard to digest food,
absorb certain vitamins, and produce hormones that regulate metabolism. Alcohol contains calories,
so the person may not feel hungry. They may not eat enough proper food to supply the body with
essential nutrients.
Not breastfeeding, especially in the developing world, can lead to malnutrition in infants and
children.
nSocial and mobility problems
If the body does not absorb nutrients efficiently, even a healthful diet may not prevent
malnutrition. People with Crohn's disease or ulcerative colitis may need to have part of the small
intestine removed to enable them to absorb nutrients. Celiac disease  may result in damage to the
lining of the intestines and poor food absorption. Persistent diarrhea, vomiting, or both can lead
to a loss of vital nutrients

Worldwide most frequent micronutrient deficiencies
10
nIron deficiency
nIodine
nVitamin A deficiency
ØThe world's most widespread micronutrient deficit (2 billion people)
ØAnaemia, reduced mental and physical performance, susceptibility to infections
ØIn adult individual pool for 2  years
ØIn developing countries, babies are born with small supplies and do not receive vitamin A by
breastfeeding either
ØFirst, reversible night blindness
ØLater, irreversible blindness (annually 1.5 million children)
ØDecrease in immune functions, pneumonias, infectious diarrhea, death
Ø
Ø
ØThe second most common deficit, very serious manifestations for the population
ØThe world’s most prevalent, yet easily preventable, cause of brain damage
Ø"Iodine Deficiency Disorders" (IDD) - goiter, hypothyroidism, retardation of psychomotor
development, cretinism
ØThe best prevention: iodised salt
ØNatural content in food outside marine products depends on the geological basement - mountain
deficiency
ØThe urinary excretion shows the saturation (<100 ug / l = deficiency)

The spectrum of iodine deficiency disorders, IDD
11
Fetus
Miscarriage
Stillbirths
Congenital anomalies
Increased perinatal morbidity and mortality
Endemic cretinism
Neonate
Neonatal goiter
Neonatal hypothyroidism
Endemic neurocognitive impairment
Increased susceptibility of the thyroid gland to nuclear radiation
Child and adolescent
Goiter
(Subclinical) hypothyroidism
Impaired mental function
Retarded physical development
Increased susceptibility of the thyroid gland to nuclear radiation
Adult
Goiter with its complications
Hypothyroidism
Impaired mental function
Spontaneous hyperthyroidism in the elderly
Iodine-induced hyperthyroidism
Increased susceptibility of the thyroid gland to nuclear radiation

12
METHODS


Methods, techniques
13
nAnthropometry
nPhysical, (clinical) examination – general appearance
nLaboratory – biochemical and immunological examinations
nDynamometry tests (muscle strength)
nHistory
nValidated screening tests
nChildren

History
14
nChronic and current diseases of the examined person
nDietary habits, possible alternative diets, social status..
nLifestyle – physical activity, alcohol…
n
To a large extent, it overlaps with the „Dietary assessment" , or "Nutritional history". Directly
within the Nutritional Status assessment,we focus especially on the factors that can influence the
nutritional status:
ÞFocus on gastrointestinal problems
ÞUsing drugs that can interact with the digestion and uptake of nutrients

Methods, techniques
15
Physical, (clinical) examination – general appearance

Symptoms and signs of undernutrition and micronutrient deficiency
16
C:\Users\jfiala\Pictures\Beze jména.jpg

Výsledek obrázku pro koilonychie
https://classconnection.s3.amazonaws.com/639/flashcards/1040639/png/screen_shot_2012-09-29_at_73928
_pm1348962057890.png
Close-up view of 4 fingers. White horizontal bands
https://img.medscapestatic.com/pi/meds/ckb/41/28841tn.jpg
Nails
nFe deficiency - koilonychia, spooning of nails
nProtein deficiency – white tranverse strips

Eyes
https://upload.wikimedia.org/wikipedia/commons/thumb/3/34/Blepharitis.JPG/220px-Blepharitis.JPG
Výsledek obrázku pro xerosis conjunctival
https://webeye.ophth.uiowa.edu/eyeforum/atlas/photos-earlier/xerosis-conjunctivae.jpg
Výsledek obrázku pro corneal xerosis
https://image.slidesharecdn.com/problemsolvingexercise-vita-copy-160505054605/95/vitamin-a-and-its-
deficiency-19-638.jpg?cb=1462427304
Související obrázek
https://openi.nlm.nih.gov/imgs/512/100/2873666/PMC2873666_jceh_23_72_004_f18.png?keywords=vitamin+a
+deficiencies,bitot%27s+spots
http://3.bp.blogspot.com/-xl6WLqTk1uI/TriLOUllM6I/AAAAAAAAAJw/rU2PltJiqsc/s1600/corneal_neovascular
ization.jpg
nVit. A deficiency
nXerotic cornea
nBitot’s spot
nKeratomolacia
nCorneal scars
nImpaired night vision
Související obrázek

Mouth, tongue, teeth, gums
•Gums
oBleeding gums – vit C
•Tongue
oGlosssitis, loss od papillae
•Teeth
oCaries
•Ca, F
oSpotty enamel
•Fluorine excess
•
o
Výsledek obrázku pro gingivitis
https://images.onhealth.com/images/slideshow/dental-problems-s6-gingivitis.jpg
Související obrázek
https://upload.wikimedia.org/wikipedia/commons/thumb/4/4e/Dental_fluorosis_%28mild%29.png/300px-Den
tal_fluorosis_%28mild%29.png
Výsledek obrázku pro cheilitis
•Rty
oAngulární stomatitis – nedostatek riboflavinu, pyridoxinu, železa
oAngulární jizvy – nedostatek riboflavinu, pyridoxinu
oCheilitis – nedostatek riboflavinu

Skin
•
oPallor (anemia from iron, folate)
oBruising, petechiae, hematomas (vit C, vit K)
oHypo or hyperpigmentation (Zinc, niacin)
oPerifollicular hyperkeratosis (vit A
Výsledek obrázku pro follicular hyperkeratosis
https://jamanetwork.com/data/Journals/DERM/4687/dsk50017f2.png
https://noskinproblems.com/wp-content/uploads/2015/06/seborrheic-dermatitis-face.jpg
Výsledek obrázku pro follicular petechiae
http://slideplayer.com/1718407/7/images/10/Case+One%3A+Skin+Exam+Perifollicular+petechiae.jpg
Výsledek obrázku pro petechial hemorrhaging
http://www.uaz.edu.mx/histo/pathology/ed/ch_7/c7_rmsf_hand.jpg

Skin
•Kůže
oZměny pigmentace
•Špinavě hnědé skvrny – chronická podvýživa
•Depigmentace – kwashiorkor
•Erytém, svědění, pálení – puchýřky – hrubnutí kůže – pelagra
•Bledá kůže - chudokrevnost
Výsledek obrázku pro kwashiorkor skin
https://www.med.uottawa.ca/sim/data/Images/Kwashiorkor.jpg
Výsledek obrázku pro pellagra skin
https://niacinreviews.com/wp-content/uploads/2016/10/Pellagra-300x209.jpg

•Vit. D deficiency
oBone derformities:
oCraniotabes
oProminet costovertebral junctions
oWidering of metaphyses (wrist and ankle)
oFrontal bossing
oWide anteri
Výsledek obrázku pro craniotabes
https://usercontent2.hubstatic.com/8761643_f520.jpg
Související obrázek
http://slideplayer.com/10592260/36/images/20/caput+quadratum.jpg
Výsledek obrázku pro rachitic rosary
https://image.slidesharecdn.com/bonedemineralizationpblariff-150108110339-conversion-gate02/95/bone
-demineralization-10-638.jpg?cb=1420720388
Výsledek obrázku pro pectus carinatum Související obrázek
https://lh3.googleusercontent.com/-j4DAMWNSi1E/VyuFmVjt3BI/AAAAAAAABis/ww3CnqYmfno/s640/blogger-ima
ge-2107067516.jpg
Bones, skeleton

Thyroid
•Iodine defeficiency
oGoitrea (thyromegaly)
o
Výsledek obrázku pro struma
https://i.iinfo.cz/images/414/struma-vole-zvetsena-stitna-zlaza-2-thumb.jpg
Výsledek obrázku pro parotitis
https://www.wikidoc.org/images/a/aa/Parotitis01.jpg

24
ANTHROPOMETRY


Anthropometric (somatometric) measurements used in nutritional status assessment
25
nDirectly measured simple parameters:
n
ÞHeight
ÞWeight
ÞWaist
ÞHip
ÞArm (MUAC)
ÞSkinfolds
nAnthropometric indexes:
n
nBody composition analysis:
n
ÞBMI
ÞWHR
ÞBIA
ÞHydrodensitometry (hydrostatic weighing)
ÞDEXA
ÞMRI
ÞPlethysmography (BodPod) (whole body air displacement plethysmography)
Þ3D-scanning

Height
26
C:\Users\jfiala\Desktop\Media Gallery\výška - měření.jpg C:\Users\jfiala\Desktop\Media
Gallery\seca.jpg C:\Users\jfiala\Desktop\Media Gallery\seca staiometer.jpg
C:\Users\jfiala\Desktop\VÝUKA\20 - Výuka jaro 2018\OPZ II\Beze jména.jpg
C:\Users\jfiala\Desktop\VÝUKA\20 - Výuka jaro 2018\OPZ II\Beze jména.jpg

Weight
27
C:\Users\jfiala\Desktop\Media Gallery\váha.jpg C:\Users\jfiala\Desktop\Media Gallery\Beze jména.jpg
nAlternatives to weighing patients:
C:\Users\jfiala\Pictures\personal-floor-scale.jpg C:\Users\jfiala\Desktop\VÝUKA\20 - Výuka jaro
2018\OPZ II\Beze jména.jpg C:\Users\jfiala\Desktop\VÝUKA\20 - Výuka jaro 2018\OPZ II\Beze jména.jpg

BMI
28
Classification:
Underweight
Normal range
Overweight
Obesity
BMI
< 18.5
18.5 – 24.9
25.0 -29.9
≥ 30.0
nBMI = weight (kg) / height2 (m2)
n

BMI – Diagnostic criteria (cut-offs)
29


Circumferences
30
nWaist
n
nHip
n
nArm
n
C:\Users\jfiala\Desktop\Media Gallery\Beze jména.jpg
nCalf
n
Possible circumferences in nutritional status assessment:

Circumferences – measuring sites:
31
nWaist – taken in level of the umbilicus (navel)
n
nArm – mid upper arm, relaxed
n
C:\Users\jfiala\Desktop\Media Gallery\měření obvidu gluteálníhp.jpg C:\Users\jfiala\Desktop\Media
Gallery\měření obvodu paže.jpg
nHip  - measurement is taken at the widest lateral extension of the hips
n
C:\Users\jfiala\Desktop\Media Gallery\Beze jména.jpg C:\Users\jfiala\Desktop\Media Gallery\Beze
jména.jpg Cover

Waist circumference – diagnostic criteria
32

OK
Risk increased
Substantially increased
Men
< 94
94.1 - 102
> 102
Women
< 80
80.1 - 88
> 88
nWHO – risk of metabolic complications:
n

33
C:\Users\jfiala\Desktop\VÝUKA\20 - Výuka jaro 2018\00 - příprava OPZ II\hodnocení výživového
stavu\Media Gallery\zzz.jpg

Waist circumference – correlation with abdominal fat
34
Després J P, Lemieux I, Prud'homme D: Treatment of obesity: need to focus on high risk abdominally
obese patients. BMJ. 2001 Mar 24;322(7288):716-20.
C:\Users\jfiala\Desktop\VÝUKA\13 - výuka podzim 2014\13 - obezitologie\obr.2.jpg

Metabolic syndrome
35
nMetabolic syndrome, sometimes known by other names, is a clustering of at least three of the five
following medical conditions: abdominal obesity, high blood pressure, high blood sugar, high serum
triglycerides and low high-density lipoprotein (HDL) levels.
n
nMetabolic syndrome is associated with the risk of developing cardiovascular disease and type 2
diabetes.
n
nInsulin resistance, metabolic syndrome, and prediabetes are closely related to one another and
have overlapping aspects.
n
nThe syndrome is thought to be caused by an underlying disorder of energy utilization and storage.

36
C:\Users\jfiala\Desktop\VÝUKA\20 - Výuka jaro 2018\00 - příprava OPZ II\hodnocení výživového
stavu\Matabolic synsrom\mrtabolic syndrom criteria.jpg
Metabolic syndrome

37
C:\Users\jfiala\Desktop\VÝUKA\20 - Výuka jaro 2018\00 - příprava OPZ II\hodnocení výživového
stavu\Matabolic synsrom\waist circumference.jpg

38
Výsledek obrázku pro WHR Výsledek obrázku pro WHR Výsledek obrázku pro WHR - apple pear Výsledek
obrázku pro WHR - apple pear
WHR – Waist to Hip Ratio

WHR – diagnostic criteria
39

Low risk
Moderate risk
High risk
Men
< 0.95
0.95 - 1.00
> 1.00
Women
< 0.80
0.81 - 0.85
> 0.85
C:\Users\jfiala\Desktop\VÝUKA\13 - výuka podzim 2014\13 - obezitologie\obr 5.jpg
Ideal value (health and fertility):   Men 0.9,   Women 0.7

WHR interpretation pitfalls
40
Després J P, Lemieux I, Prud'homme D: Treatment of obesity: need to focus on high risk abdominally
obese patients.
BMJ. 2001 Mar 24;322(7288):716-20.
C:\Users\jfiala\Desktop\VÝUKA\13 - výuka podzim 2014\13 - obezitologie\obr 1.jpg

WHR
41
C:\Users\jfiala\Desktop\VÝUKA\13 - výuka podzim 2014\13 - obezitologie\Beze jména.jpg Výsledek
obrázku pro WHR Výsledek obrázku pro WHR - waist to hip, masculine - feminine Související obrázek
The most desirable between 0.6 – 0.75

Diagnostická kritéria - WHR
42
C:\Users\jfiala\Desktop\VÝUKA\13 - výuka podzim 2014\13 - obezitologie\Beze jména.jpg

MUAC (Mid Upper Arm Circumference), MAC, AC
43
n♂ >26 cm
nLow MAC adult =< 24
n21 – 23 = yelow zone
n< 21 cm – red
n
n
n
n♀ >25 cm
Adults:
UNICEF – Adults:
Children tape:

Calf circumference cut-offs
44
Mid-arm and calf circumferences (MAC and CC) are better than body mass index (BMI) in predicting
health status and mortality risk in institutionalized elderly Taiwanese.
Arch Gerontol Geriatr. 2012 May-Jun;54(3):443-7.
Mid-arm and calf circumferences are stronger mortality predictors than body mass index for patients
with chronic obstructive pulmonary diseaseInt J Chron Obstruct Pulmon Dis. 2016; 11: 2075–2080.
Calf (CC):
Ø< 31 cm – manutrition
Ø> 31 - OK

45
 BODY FAT AND BODY COMPOSITION MAEASUREMENT


Skinfolds measurement
46
nSeveral types od calipers
C:\Users\jfiala\Desktop\VÝUKA\20 - Výuka jaro 2018\00 - příprava OPZ II\hodnocení výživového
stavu\Media Gallery\26883.jpg C:\Users\jfiala\Desktop\VÝUKA\20 - Výuka jaro 2018\00 - příprava OPZ
II\hodnocení výživového stavu\Media Gallery\06.jpg C:\Users\jfiala\Desktop\VÝUKA\20 - Výuka jaro
2018\00 - příprava OPZ II\hodnocení výživového stavu\Media Gallery\07.jpg
C:\Users\jfiala\Desktop\VÝUKA\20 - Výuka jaro 2018\00 - příprava OPZ II\hodnocení výživového
stavu\Media Gallery\kaliper best.jpg
Best:
Harpenden:

Skinfolds measurement
47
C:\Users\jfiala\Desktop\VÝUKA\20 - Výuka jaro 2018\00 - příprava OPZ II\hodnocení výživového
stavu\Media Gallery\řasy - měření - best.jpg
nMeasuring with Best caliper:
C:\Users\jfiala\Desktop\VÝUKA\20 - Výuka jaro 2018\00 - příprava OPZ II\hodnocení výživového
stavu\Media Gallery\zzz.jpg C:\Users\jfiala\Desktop\VÝUKA\20 - Výuka jaro 2018\00 - příprava OPZ
II\hodnocení výživového stavu\Media Gallery\zz.jpg C:\Users\jfiala\Desktop\VÝUKA\20 - Výuka jaro
2018\00 - příprava OPZ II\hodnocení výživového stavu\Media Gallery\zzz.jpg
nTriceps
nSupraspinal
nSubscapular

BIA – Bioelectrical impedance analysis
48
nBIA actually determines the electrical impedance, or opposition to the flow of an electric current
through body tissues which can then be used to estimate total body water (TBW), which can be used
to estimate fat-free body mass and, by difference with body weight, body fat.
n
n
Výsledek obrázku pro Bioelectrical impedance analysis C:\Users\jfiala\Desktop\VÝUKA\20 - Výuka jaro
2018\00 - příprava OPZ II\hodnocení výživového stavu\Media Gallery\zzz.jpg
C:\Users\jfiala\Desktop\VÝUKA\20 - Výuka jaro 2018\00 - příprava OPZ II\hodnocení výživového
stavu\Media Gallery\zzz.jpg C:\Users\jfiala\Desktop\VÝUKA\20 - Výuka jaro 2018\00 - příprava OPZ
II\hodnocení výživového stavu\Media Gallery\zzz.jpg C:\Users\jfiala\Desktop\VÝUKA\20 - Výuka jaro
2018\00 - příprava OPZ II\hodnocení výživového stavu\Media Gallery\zzz.jpg
C:\Users\jfiala\Desktop\VÝUKA\20 - Výuka jaro 2018\00 - příprava OPZ II\hodnocení výživového
stavu\Media Gallery\zzz.jpg Výsledek obrázku pro BIA measurement bodystat

Inbody S10
49
C:\Users\jfiala\Desktop\VÝUKA\20 - Výuka jaro 2018\00 - příprava OPZ II\hodnocení výživového
stavu\obrázky\inbodys10_posture2.jpg

50
C:\Users\jfiala\Desktop\VÝUKA\20 - Výuka jaro 2018\00 - příprava OPZ II\hodnocení výživového
stavu\obrázky\Inbody - Body composition analysis.jpg C:\Users\jfiala\Desktop\VÝUKA\20 - Výuka jaro
2018\00 - příprava OPZ II\hodnocení výživového stavu\obrázky\Inbody - Muscle fat analysis.jpg
C:\Users\jfiala\Desktop\VÝUKA\20 - Výuka jaro 2018\00 - příprava OPZ II\hodnocení výživového
stavu\obrázky\Inbody Segmental lean analysis.jpg
Inbody S10

51
 OTHER TECHNIQUES


Underwater weighing - hydrodensitometry
52
C:\Users\jfiala\Desktop\Media Gallery\08.jpg

DEXA – Dual  Energy X-ray Absorptiometry
53
C:\Users\jfiala\Desktop\Media Gallery\DEXA principle.jpg Související obrázek

BodPod –Air displacement plethysmography
54
C:\Users\jfiala\Desktop\Media Gallery\09.jpg C:\Users\jfiala\Desktop\Media Gallery\bod-pod.png

Body fat  - diagnostic criteria
55

Men ♂
Women ♀
PBF Corressponding to BMI
< 20
< 32
Oliveros
< 20
< 30
Tanita
< 20–25
< 33–36
Biospace
< 20
< 28
Bodystat
< 18
< 26
Category
OK
Overweight
Obesity
BMI
< 25
25 – 30
> 30
PBF males
< 20 %
20 – 25 %
>  25 %
PBF females
< 32 %
32 – 38 %
>  38 %
Measured PBF corresponding to BMI cut-offs: (Galagher et al.)
Cut-offs for „too high BFP“ according to different sources:

Body fat  - diagnostic criteria
56
Oliveros E, Somers V, Sochor O, Goel K, Lopez-Jimenez F: The concept of normal weight obesity.
Progress in cardiovascular diseases, 2014, 56, 426-433

Men
Women
Normal
< 20
< 30
Overfat
20 - 25
30 - 35
Obesity
> 25
> 35
Biospace:  Standard body fat percent is 15 % (range 10 - 20)  for men  and 23 % (range 18 - 28)
for women
C:\Users\jfiala\Desktop\VÝUKA\13 - výuka podzim 2014\13 - obezitologie\obr 3.jpg
Category
OK
Overweight
Obesity
BMI
< 25
25 – 30
> 30
PBF males
< 20 %
20 – 25 %
>  25 %
PBF females
< 32 %
32 – 38 %
>  38 %
Measured PBF corresponding to BMI cut-offs: (Galagher et al.)
C:\Users\jfiala\Desktop\VÝUKA\20 - Výuka jaro 2018\00 - příprava OPZ II\hodnocení výživového
stavu\Media Gallery\zzz.jpg C:\Users\jfiala\Desktop\VÝUKA\20 - Výuka jaro 2018\00 - příprava OPZ
II\hodnocení výživového stavu\Media Gallery\zzz.jpg

The health impact of obesity, NWO
57
nCondition „fit fat“ is better (healthier) than „unfit unfat“
n
nThe most important is the ratio between fat and muscle tissue
n
nNWO  (Normal Weight Obesity) – increased fat in normal BMI, it poses metabolic and health risk.
Diagnosis is often missed!
n

58
 LABORATORY


Biochemical parameters in nutritional status
59
C:\Users\jfiala\Desktop\Media Gallery\Beze jména.jpg

Normal
[g/l]
Heavy deficiency
[g/l]
Halftime
Albumin
> 32
< 21
20 days
Transferin
> 2
< 1
8-10 days
Prealbumin
> 0.2
< 0.1
2 days

60
C:\Users\jfiala\Desktop\Media Gallery\Beze jména.jpg


Dynamometry  - hand grip  (muscle strength)
61
n♂ >30 kp
n
n♀ >20 kp
The values above refers to age category 65-70, where they correspond to 85% of the table norm
according to age.
n

62
 CHILDREN


Nutritional status assessment in children – BMI percentiles
63
C:\Users\jfiala\Desktop\VÝUKA\20 - Výuka jaro 2018\00 - příprava OPZ II\hodnocení výživového
stavu\obrázky\děti - BMI 0-18r - chlapci.jpg C:\Users\jfiala\Desktop\VÝUKA\20 - Výuka jaro 2018\00
- příprava OPZ II\hodnocení výživového stavu\obrázky\děti BMI 0-18 r - dívky.jpg

Hodnocení výživového stav dětí
64
C:\Users\jfiala\Desktop\VÝUKA\20 - Výuka jaro 2018\00 - příprava OPZ II\hodnocení výživového
stavu\obrázky\děti - BMI - percentilové grafy - hodnocení.jpg

Definitions of nutrition indicators in children
65


Z  -  score
66
nThe difference between the measured value and  the 50. percentile, expressed in units of SD.
n

MUAC (Mid Upper Arm Circumference), MAC, AC
67
Children tape:

68
 Screening tests


Validated screening test
69
nMNA – Mini Nutritional Assessment (+ MNA-SF – short form)
nSGA – Subjective Global Assessment
nNRS (or NRS 2002) – Nutritional Risk Screening
nMUST – Malnutrition Universal Screening Tool
C:\Users\jfiala\Desktop\Media Gallery\Beze jména.jpg

70
MNA (SF)


71
MNA - continuing


72
C:\Users\jfiala\Desktop\Media Gallery\Beze jména.jpg


SGA – Subjective Global Assessment
73
It covers 3 areas:
nMedical History
ØWeight change
ØDietary intake change
ØGastrointestinal symptoms
ØFunctional capacity
n
nPhysical examination
ØLoss of subcutaneous fat
ØLoss of muscle mass
ØPresence of oedema, ascites
nSubjective global assessment
ØA – Well nourished
ØB -  Mildly/Moderately Malnourished
ØC - Severely Malnourished
Ø
The individual items are not point scored as the assessment is subjective. The results of the
medical history and physical examination are summarized in the „Subjective Global Assessment“
Ø

74
C:\Users\jfiala\Desktop\Media Gallery\Beze jména.jpg


SGA – Subjective Global Assessment Guidance for Body Composition
75
Subcutaneous fat
Muscle wasting
C:\Users\jfiala\Pictures\Beze jména.jpg

SGA – Subjective Global Assessment
76
A - Well-nourished
B - Mildly/moderately malnourished
C- Severely malnourished
nNo decrease in food/nutrient intake;
n< 5% weight loss;
nNo/minimal symptoms affecting food intake;
nNo deficit in function;
nNo deficit in fat or muscle mass
nDefinite decrease in food/nutrient intake;

n5% - 10% weight loss without stabilization or gain;

nMild/some symptoms affecting food intake;
nModerate functional deficit or recent deterioration;

nMild/moderate loss of fat and/or muscle mass
nSevere deficit in food/nutrient intake;
n> 10% weight loss which is ongoing;
nSignificant symptoms affecting food/ nutrient intake;
nSevere functional deficit
nOR *recent significant deterioration obvious signs of fat and/or muscle loss
Fluid retention
Subjective Global Assessment

NRS 2002  - Nutritional Risk Screening
77


78
C:\Users\jfiala\Desktop\Media Gallery\Beze jména.jpg