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SOURCE

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Source: Chessman KH, Kumpf VJ. Assessment of nutrition status and nutrition requirements. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861&sectionid=146076535. Accessed March 23, 2017.

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CLASSIFICATION OF NUTRITION DISEASE

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  • Causes of undernutrition.

    • Inadequate nutrition intake.

      • Protein, calories, or one nutrient (eg, vitamins or trace elements)

        • Marasmus: deficiency in total intake or nutrient utilization.

        • Kwashiorkor: relative protein deficiency.

        • Mixed marasmus-kwashiorkor.

    • Impaired absorption of nutrients.

    • Altered metabolism.

  • Overnutrition (obesity)

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NUTRITION SCREENING

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  • Systematic way to identify individuals at risk for undernutrition.

  • Rapid and simple process done in any care environment.

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RISK FACTORS FOR UNDERNUTRITION

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  • Any disease state, complicating condition, treatment, or socioeconomic condition that results in decreased nutrient intake, altered metabolism, and/or malabsorption.

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ASSESSMENT OF NUTRITION STATUS

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  • Goals.

    • Identify presence (or risk) of developing malnutrition.

    • Determine risk of malnutrition complications.

    • Estimate nutrition needs.

    • Establish baseline parameters for assessing outcome of therapy.

  • Clinical evaluation.

    • Medical and dietary history should include:

      • Weight changes within 6 months.

      • Dietary intake changes.

      • Gastrointestinal (GI) symptoms.

      • Functional capacity.

      • Disease states.

  • Physical examination.

    • Assessment of lean body mass (LBM)

    • Anthropometric measurements.

      • Weight.

        • Interpretation of actual body weight should consider ideal weight for height, usual body weight, fluid status, and age.

        • Unintentional weight loss >10% in <6 months correlates with poor clinical outcome in adults.

        • Ideal body weight provides a population reference standard against which actual body weight can be compared to detect both under- and overnutrition (Tables 1 and 2).

        • Appropriate rate of growth best indicator of adequate nutrition in children (Table 3)

        • Body mass index (BMI): index of weight-for-height highly correlated with body fat. Interpretation includes consideration of gender, frame size, and age.

      • Stature.

      • Head circumference for children <3 years of age.

      • Waist circumference to estimate abdominal fat.

      • Measurements of limb size.

        • Skinfold thickness to estimate subcutaneous fat.

        • Midarm muscle circumference to estimate skeletal muscle mass.

        • Wrist circumference.

      • Bioelectrical impedance analysis (BIA)

        • Simple, noninvasive, and relatively inexpensive way to measure LBM

  • Laboratory tests.

    • Measurement of serum visceral proteins (Table 4)

      • Interpret relative to overall clinical status due to impact of factors other than nutrition.

    • Immune function tests.

      • Total lymphocyte count values <1500 cells/mm3 (1.5 × 109 cells/L) have been associated with nutrition depletion.

      • Delayed cutaneous hypersensitivity (DCH) commonly assessed using antigens to which patient has been previously sensitized.

        • Recall antigens used most frequently: mumps, Candida albicans, and Trichophyton.

        • Anergy associated with severe malnutrition. Immune response may be restored with nutrition repletion.

    • Trace elements.

      • Clinical syndromes associated with deficiencies of:

        • Zinc.

        • Copper.

        • Manganese.

        • Selenium.

        • Chromium.

        • Iodine.

        • Fluoride.

        • Molybdenum.

        • Iron.

    • Vitamins.

      • Single vitamin deficiencies uncommon.

      • Multiple vitamin deficiencies more commonly occur with undernutrition.

    • Essential fatty acids.

      • Deficiency is rare but can occur with prolonged lipid-free parenteral nutrition, very-low-fat enteral formulas or diets, severe fat malabsorption, or severe malnutrition.

      • All fatty ...

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