The Importance of a Nutritional Assessment

Nutrition assessment is normally defined as “a comprehensive approach to determining nutritional status”. Today, a nutrition assessment includes computerized food intake analysis, clinical nutrition, body composition assessment, laboratory blood test results, anthropometrics, review of medications, lifestyle andfitness indicators. It also includes food-drug interactions, cultural, religious and ethnic food preferences, age related nutrition issues and the need for diet counseling. Basically, nutrition assessment is a structured way to establish nutritional status and energy-requirements of a person, and to provide appropriate nutrition education and intervention. 

Nutrition education is an essential component in improving dietary habits and food choices, in order to improve the nutritional diagnosis. The nutrition diagnosis needs to be accurate in order to provide effective intervention. Poor dietary habits and lack of physical activity can be a vital reason for poor nutritional status among people. The positive impact of nutrition education on the nutritional status of people has been confirmed by many studies

 

Components of Nutrition Assessment:

1. Medical and social history

  • Gathered from an in-depth patient-client interview 
  • Medical history: diagnosis, current and past medical issues, medications and/or supplement use, alcohol and drug use, bowel habits, family history „ 
  • Psychosocial data: economic status, occupation, physical activity level, education level, living and cooking arrangements, mental status 
  • Behavioral data: body image, level of readiness„ 
  • Other: age, sex, daily living activities 

2. Diet history and intake

  • Appetite and intake: taste changes, dental issues, dysphagia, feeding independence, vitamin/mineral, supplement intake
  • Eating patterns: daily and weekend, diet restrictions, ethnicity, eating away from home, fad diets 
  • Estimation of typical calorie and nutrient intake: Obtain diet intake from 24-hour recall, food frequency hour recall, food frequency questionnaire, food diary, observation of food intake questionnaire

Diet Assessment

  • Evaluate what and how much a person is eating, as well as habits, beliefs and social conditions that may put the client at risk 

Usual intake:

  • „ 24-hour recall: retrospective, easy 
  • „ Food logs: prospective, requires motivation 
  • „ Food frequency questionnaire: general idea of how often foods are consumed, generally over or under estimate
  •   Compare to estimation of needs

Nutritional questions for consideration

General

  • „ Usual adult weight 
  • „ Current weight 
  • „ Maximum, minimum weights 
  • „ Weight change 1 and 5 years prior 
  • „ Recent changes in weight and time period 
  • „ Recent changes in appetite or food tolerance 
  • „ Presence of weakness and/or fatigue 
  • „ Recent changes in sleep habits, daytime sleepiness 

Nutritional

  • „ Abdominal pain, bloating, distress, nausea, vomiting 
  • „ Changes in bowel movement 
  • „ Diarrhea (consistency, frequency, volume, color, presence of cramps, food particles, fat drops) 
  • „ Difficulty swallowing (solids vs. liquids, intermittent vs. continuous) 
  • „ Indigestion or heartburn 
  • „ Food intolerance or preferences 
  •   Favorite and worst food preferences
  •   Number of meals consumed outside of the house and/or take away
  •   Sugar/salt intake
  •   Meals and snacks per day
  •   Caffeinated drinks, alcoholic beverages consumption 

3. Clinical examination

Clinical data provides information about the individual's medical history, including acute and chronic illness and diagnostic procedures, therapies, or treatments that may increase nutrient needs. Current medications need to be documented, and both prescription drugs and over-the-counter drugs, such as laxatives or analgesics, must be included. Vitamins, minerals , and herbal preparations also need to be reviewed. 

4. Anthropometrics

  • „ Inexpensive, noninvasive, easy to obtain, valuable with other parameters 
  • „ Height, weight and weight changes
  •   Ideal and adjusted body weight
  •   Body mass index explanation 
  • „ Segmental lengths, fat folds and various body circumferences and areas
  •   Personal target 
  • „ Repeated periodically to note changes
  • „ Individuals serve as own standard 
  • „ Changes sometimes are not obvious for 3-4 weeks

Biochemical data

  •   Used to assess body stores 
  • „ Altered by lack of nutrients, medications, metabolic changes during illness or stress 
  • „ Interpret results carefully 
  • „ Fluid status distorts results 
  • „ Use reference values established by individual lab

To summarize, nutrition assessment is an evidence-based, cost effective way to improve health outcomes and foster healthy eating habits for a lifetime. Unfortunately, nutrition assessment is often over-looked or taken for granted. Via the assessment procedure, the clinical dietitian can provide the client-patient with adequate information, skills and motivation to procure and to consume appropriate foods. No single component of the nutrition assessment procedure is more important than the other. All components combine together in order to reinforce specific nutrition-related practices or behaviors to change habits that contribute to poor health; this is done by creating a motivation for change among people, to establish desirable food and nutrition practices for promotion and protection of good health. People are given help to learn new information about nutrition and to develop the attitudes, skills and confidence that they need to improve their nutrition practices.

Stefanos Machucas
BSc Food & Nutrition
MSc Exercise & Nutrition Science
MSc Clinical Dietetics
stefanos.machucas3@gmail.com

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