What should be included in a nutritional assessment?

Assessing the nutritional status of individuals involves interpreting anthropometric, biochemical, clinical and dietary data. Together the information obtained from these components paints a nutritional picture reflecting health status. The goal of nutrition assessment is to identify malnutrition and nutrition risks, according to guidelines published in a January 2011 issue of the “Journal of Parenteral and Enteral Nutrition.” Diagnosis of nutritional deficiencies and toxicities occur through the assessment process.

Anthropometrics refers to body size and composition determination. In clinical settings, measurements such as height, weight and head circumference help identify abnormal growth patterns. Results are compared to standard pre-determined values. Body mass index, or BMI, uses height and weight measurements as the basis for assessing obesity and chronic disease risk. Head circumference measurements indicate potential head and brain development issues in growing infants and children. Tools estimating lean and fat body composition include skinfold thickness, underwater weighing, bioelectrical impedance and air-displacement plethysmography.

Laboratory measurements of nutrients or other chemicals in blood, stool or urine constitute the biochemical component of nutrition assessment. Hemoglobin and ferritin blood tests reflect iron status. Inflammation can be assessed with albumin and C-reactive protein blood levels. Cholesterol and lipoprotein blood test results indicate heart disease risk. Analyzing stool samples may uncover the presence of blood, indicative of abnormal gastrointestinal tract bleeding. Urine sample analysis provides information on diabetes risk, and can alert both patient and healthcare provider to early signs of deteriorating kidney function when high protein levels are present. As with anthropometric tests, comparison of laboratory results to standard values determines if an abnormality exists.

A physical exam coupled with a complete medical history aid in malnutrition determination and measurement of its degree of severity. For example, the loss of tooth enamel may indicate frequent vomiting, a sign of bulimia. Visual observation of the presence or loss of normal muscle tone can indicate protein deficiency. Medical chart review and interviews with an individual may uncover past surgical procedures, medication interactions and drug or alcohol use. All play a role in determining nutritional status and subsequent care plan development to improve health.

Analyzing the nutritional adequacy of an individual’s diet provides information relative to fat, protein, carbohydrate, water, vitamin, mineral and fiber intake. Obtained through verbal or written means, individuals review foods eaten during a specified time period, normally 24 hours or three days. A full week's food intake record may be needed for chronic nutritional concerns. Specially designed computer software programs are used for food record analysis, and results are compared to the U. S. Dietary Guidelines or Dietary Reference Intakes. Software programs vary widely, depending upon the different types of foods and nutrients contained in the program’s database. Obtaining information relative to the individual’s habits, cultural background, economic resources and living situation lend further depth to the dietary component of the assessment process.

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References

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Jennifer Carr, MSHE specializes in health and wellness, fitness, nutrition, alternative medicine and treatment for substance abuse. She has served as a health-care communicator and recovery coach, providing support and guidance for individuals going through treatment for addictions. Carr completed her Master of Science in health education at Arcadia University. She graduated from Villanova University with a Bachelor of Arts.

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The body mass index categorizes people into four weight classes. Your BMI determines whether you are underweight, normal weight, overweight or obese. Although BMI offers a starting point for determining relative body composition, don't get frustrated if you wind up in the obese category and are in tiptop shape.

You can determine your BMI using the Centers for Disease Control and Prevention's formula: your weight in pounds divided by the square of your height in inches and multiplied by 703. For example, if you stand 5 foot 3 inches tall -- 63 inches — and weigh 110 pounds, your BMI is 19.48, putting you in what the CDC considers to be a healthy range..

Of the four BMI categories, only one is normal weight. Pat yourself on the back if you fall into this category. The “normal weight” for BMI ranges from 18.5 to 24.9. Falling into another category could mean you need to change your eating and exercise habits to reach a healthier weight.

Falling into the "underweight" category does not necessarily mean you are unhealthy -- active people with low body fat can easily fall into this category. The "overweight" and "obese" categories potentially signify a greater issue, but sometimes physically fit, very muscular people land in these categories.

Overall, BMI provides a good general measure of a person's body composition, but it is not foolproof. It does not always account for healthy people who are very tall. It also doesn't take into account the higher body fat required for a normal healthy female. For example, having large breasts could put you in the obese category. Discuss your BMI with your doctor, who can give you the best sense of how well the figure does or doesn't reflect your overall fitness.

Details Last Updated: 18 May 2016

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Nutritional assessment is the systematic process of collecting and interpreting information in order to make decisions about the nature and cause of nutrition related health issues that affect an individual (British Dietetic Association (BDA), 2012).

This differs from nutritional screening (link to Screening and MUST page) which is a brief risk assessment which can be carried out by any healthcare professional and which may lead to a nutritional assessment by a dietetician.

Following a structured assessment path enables health professionals to carry out a quality nutritional assessment in order to identify those who need nutritional intervention, and to improve clinical decision making using a person centred approach. The process promotes consistent quality of practice; is user friendly; and allows effective monitoring of patients. A structured assessment pathway does not remove autonomy; it encourages professional judgement and informed decision making at every stage. The process provides a rationale for the nutritional intervention, and allows for revision of the plan as individual circumstances change over time.

By Lindsay Boyers Updated April 11, 2018

Nutrition assessments, which involve an evaluation of objective and subjective data, are used to determine an individual’s nutritional status or growth patterns. Dietitians apply the collected data from the nutrition assessment to plan a nutritional intervention, which involves helping an individual maintain or reach a desired health status. Assessing an individual’s nutritional status involves anthropometrics, biochemical data, clinical data and dietary data.

Anthropometrics are objective measurements that help determine amount of muscle and percentage of body fat. These measurements can be used to assess weight loss or gain in an individual or to compare two separate individuals. They can also be used to compare growth rates in children. Anthropometrics may include height, weight, body mass index, skin fold measurements and body frame size. During a nutrition assessment, a dietitian takes anthropometric measurements and then compares them to standard values to make an educated assessment about growth or weight.

Dietitians can assess nutritional status through laboratory testing or biochemical data. Biochemical data may be obtained through blood, urine, stool, hair and nail samples, although the Abbott Nutrition Health Institute notes that the latter two are rarely used in a nutritional setting. Hydration level, underlying medical conditions and metabolic processes, like extreme stress, can affect the outcome of biochemical data, so it is important to consider laboratory results as part of a whole.

Clinical data means obtaining an individual’s medical history, which includes any diseases or illness, prior diagnostic procedures or current treatments and medications. Some diseases or treatment procedures may increase specific nutrient needs or contribute to malabsorption, which increases the risk of developing a nutritional deficiency. It is also important to determine whether an individual is taking any vitamins, minerals or herbal supplements, which can affect nutritional status.

The dietary data component of the nutrition assessment involves documenting an individual’s dietary intake. There are several ways to obtain dietary data. The dietitian may simply ask the individual what he or she ate in the entire 24 hours prior to the nutrition assessment. Alternatively, the dietitian may request that the individual keep a food diary -- a record of every food or drink consumed -- for a specified period of time, usually three days to a week. The dietary data component may also involve a food frequency questionnaire, which is a survey used to obtain information about how often a specific food or a specific food group is consumed. During the dietary component of the nutrition assessment, the dietitian will also obtain information about any known allergies, food intolerances and food avoidances.