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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.

  • 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
        • Molybdenunum
        • 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 acids synthesized by body except for linoleic and linolenic acid.
    • Carnitine
      • Synthesis decreased in premature infants.
      • Low carnitine levels can occur in premature infants receiving parenteral nutrition or carnitine-free diets.

Table 1. Evaluation of Body Weight

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