2. Introduction to Nutritional Assessment
โข Nutritional status of a community is the sum of the
nutritional
status of the individuals who form the community
โข The objective of nutritional assessment is to obtain precise
information on the prevalence and geographic distribution of
nutritional problems of a given community and identification
of
individuals at risk of developing nutritional problems
โข The purpose of community nutritional assessments is to
develop
specific interventions to improve community`s nutritional
status
3. How to measure nutritional
status?
โข Morbidity related to nutrition
related diseases or health
problems
โข Examples:
โ Rate of low birth-weight,
โ Prevalence of anemia among
pregnant women
โ Prevalence of obesity among
children
4. Methods of nutritional
assessment
โข Direct Methods : Use individual
indices / measurements
1. Clinical Examination
2. Anthropometry
3. Biochemical evaluation
4. Functional assessment
5. Assessment of dietary intake
โข Indirect Methods: Use
community indices /
measurements
1. Vital and health statistics
2. Ecological studies
5. Clinical Examination
โข The objective is to detect relevant clinical signs which can
help in
establishing the nutritional diagnosis
โข Such as general clinical examination, with special attention
to
organs like hair, angles of the mouth, gums, nails, skin,
eyes,
tongue, muscles, bones, & thyroid gland
โข Detection of relevant signs helps in establishing the
nutritional
diagnosis. Examples: angular stomatitis, bitot`s spots,
absence of
knee jerks, enlargement of thyroid gland (endemic goiter)
6. Anthropometry
โข Anthropometric measurements include physical
measurements.
Examples: height, weight, mid arm circumference, head
circumference, waist to hip ratio and skinfold thickness
โข Reflect the patterns of growth, development and
nutritional status
over a period of time
โข It is an usually an essential component of clinical
examination of
infants, children & pregnant women
โข Limitations: The measured values reflect current
nutritional status &
donโt differentiate between acute & chronic changes or
7. Laboratory and biochemical assessment
โข Laboratory and biochemical investigations are
used to estimate
serum levels of specific nutrients or to detect
biochemical
indicators specific to certain nutritional
deficiencies
โข Examples: estimation of haemoglobin levels
and estimation of
serum vitamin D level
โข Offer more precise assessment of nutritional
status and identify
malnutrition in pre-clinical stage
โข Limitations: expensive and time consuming
8. Functional indicators
โข Specific physiological functions can be used as static
indices of
nutritional status
โข Play an important role in nutritional assessment as
they are wellestablished and familiar to practitioners
and public health workers
โข Examples: Erythrocyte fragility, Prothrombin time
and nerve
conduction
โข Limitation: Non-specific indicators, expensive and
time
consuming
9. Assessment of dietary intake
โข Assessment of food consumption provides
opportunity to
understand dietary patterns, food
consumption, nutritional intake
โข Direct assessment of food intake may
involve: Household inquiries
or individual food consumption surveys
โข Helps in identify possible dietary deficiencies
or risk factors for
particular diseases related to specific dietary
pattern
โข Limitations: time consuming, require specific
10. Vital statistics
โข An Analysis of vital and health statistics โ mortality and
morbidity
data can be used to identify population groups at high risk of
nutritional deficiencies and related health issues
โข Data can be obtained from hospital records and community
morbidity or mortality surveys
โข Examples: rate of low birth-weight babies, anemia and
proteinenergy malnutrition
โข Limitations: May required well established HMIS, community
surveys may be very expensive and require specific skills/
expertise
โ Mortality indicators are not appropriate to assess nutritional
status of the population
11. Assessment of Ecological Factors
โข Use ecological data or information related to
socio-cultural
environment to make conclusions regarding
nutritional status of
the community
โข Social environment includes: healthcare
system, educational status
feeding patterns , occupation, immunization
practices and endemic
disease patterns etc
โข Limitations: require multilevel data, time
consuming and may
require specific skills
12. Challenges in nutritional
assessment
โข Non-specificity of signs
โข Overlapping of nutritional
deficiencies
โข Bias of the observer
โข Bias of observed
โข Changing nutritional standards
or dietary guidelines
