Source: Chessman KH and Kumpf VJ. Assessment of Nutrition Status and Nutrition Requirements. In: DiPiro,
JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy:
A Pathophysiologic Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=8011919.
Accessed July 28, 2012.
- Causes of undernutrition
- Inadequate nutrition intake
- Protein, calories, or one
nutrient (e.g., 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)
- Systematic way to identify individuals at risk for undernutrition
- Rapid and simple process done in any care environment
- Any disease state, complicating condition, treatment,
or socioeconomic condition that results in decreased nutrient intake,
altered metabolism, and/or malabsorption.
- Identify presence (or risk) of developing
- Determine risk of malnutrition complications.
- Estimate nutrition needs.
- Establish baseline parameters for assessing outcome of therapy.
- Clinical evaluation
- Medical and dietary history
- Weight changes within 6 months
- Dietary intake changes
- Gastrointestinal (GI) symptoms
- Functional capacity
- Disease states
- Physical examination
- Assessment of lean body
- Anthropometric measurements
- 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.
- 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)
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:
- 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 acids synthesized by body except for linoleic and
- Synthesis decreased in premature
- Low carnitine levels can occur in premature infants receiving
parenteral nutrition or carnitine-free diets.
Table 1. Evaluation of Body Weight