1	NUTRITION ASSESSMENT Amy C. Brown, PhD, RD Department of Human Nutrition, Food & Animal Sciences University of Hawaii at Manoa
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3	ROLE OF NUTRITION In HEALTH Maximize Potential Pregnancy/Infancy/Childhood/Adolescent Maintain Health Immune system/Surgery/Illness/Recovery Medical Nutrition Therapy (MNT) Nutrition interventions to treat an illness, injury or condition
4	ROLE OF NUTRITION in DISEASE Cause unknown? A number of risk factors Nutrition is only one factor Diseases/Conditions: Heart Disease Cancer Diabetes Hypertension Osteoporosis Obesity/Underweight Eating Disorders Inborn Errors of Metabolism Food Allergies Gastrointestinal Disorders Pancreatic/Gall Bladder Liver Disease Renal Disease
5	NUTRITION ASSESSMENT A = Anthropometric B = Biochemical C = Clinical D = Dietary
6	NUTRITION ASSESSMENT Anthropometric A = Anthropometric Measurements that reflect growth, development, and death Growth Charts (Ross Laboratories) Head Circumference Ht-Wt Tables Body Mass Index (BMI) = 20-25 normal
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8	NUTRITION ASSESSMENT Anthropometric Hospital Charting Terms IBW - Ideal (desired) Body Weight Ht/Wt Tables Hamwai formula 5 ft = add 100 lb female or 106 lb male Every 1” above 5 ft = add 5 lb female or 6 lb male ABW (Adjusted Body Weight) Used for obese PTs Only 25% adipose tissue is metabolically active = [(Actual Body Wt – Ideal Body Wt) x 0.25] + IBW
9	NUTRITION ASSESSMENT Anthropometric Hospital Charting Terms % of UBW (actual wt / usual wt ) x 100 % of Wt Loss (Loss of wt / original wt) x 100
10	Cachexia in a patient with chronic obstructive lung disease
11	NUTRITION ASSESSMENT Anthropometric - Muscle Mass MAC – midarm circumference MAMC – midarm muscle circumference % Body Fat Skinfold measurements Underwater weighing Electrical Impedence
12	Measurement of the triceps skinfold with Lange Skinfold calipers Measurement of the midarm circumference
13	NUTRITION ASSESSMENT B = Biochemical Laboratory Tests Blood Urinalysis
14	NUTRITION ASSESSMENT C = Clinical Medical Exam by Physician Medical Hx Existence of chronic diseases/conditions Prescribed diets (MNT) Meds Signs that may reflect nutritional status
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16	Xanthelsma of the eyelids in type II hyperlipidemia
17	Eruptive xanthomas in diabetic patient with hyperlipidemia
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19	Clinical Findings in Kwashiorkor Easy, painless hair pluckability (Top Left) Pitting Edema (Top Right), Skin Breakdown (Bottom Left) and delayed wound healing (Bottom Right)
20	Xerophthalmia
21	BERIBERI NEUROLOGICAL
22	Clinical findings of Niacin deficiency before (top) and after (bottom) therapy
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25	IRON DEFICIENCY NAILS - Spooned
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27	NUTRITION ASSESSMENT D= Dietary Dietary Assessment 24 Hour Recall Food Frequency 3-Day Dietary Record Food Processor Nutritionist Pro WWW.nat.uiuc.edu (NAT Version 2.0) – analyze diet
28	DIET EVALUATION SHEET Evaluate Nutrient Intake Against Ideal Kcals Protein, Fat, Carbohydrate Fiber, Cholesterol Vitamins & Minerals
29	HOSPITAL DIETS General – Routine/Regular/House Modified Consistency Prescribed (MNT) by MD Heart Disease Diabetic Renal Sodium Restricted Low Fat, High Fiber, High Calorie Tonsillectomy Wired Jaw Diet Enteral and Parenteral Feeding Diseases – Cancer, ESLD, cystic fibrosis, intestinal disorders, etc.
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31	MODIFIED CONSISTENCY Clear Liquid Full Liquid Blenderized Liquid Mechanically Altered
32	Clear vs. Full Liquid Diet Clear Liquid Diet WHAT: Provides foods with little residue in the GI tract WHO: For patients with limited tolerance to food Full Liquid Diet WHAT: Provides foods that require minimal chewing and digesting Includes foods that have liquid consistency at room temperature WHO: For patients with difficulty chewing
33	Clear Liquid Sample Menu
34	Full Liquid Sample Menu
35	Adequate or Not? Clear Liquid Diet Inadequate in all nutrients Full Liquid Diet Inadequate in all nutrients May be adequate in Vitamin C if certain juices are given
36	Nutrient Assessment
37	The Soft Diet is a Type of Modified Consistency Diet A.k.a. bland, low-residue, low-fiber Smooth texture, little seasoning Low spiced, fried, strong-flavored or gas-forming vegetables: cruciferous, broccoli, cabbage, cauliflower, etc Foods that require minimal chewing Foods are moist for ease of chewing Excludes hard fruits and veggies, seeds and nuts
38	The soft diet is a transitional diet INDICATIONS: For PTs transitioning from a liquid to general diet Often prescribed for post-op PTs to prevent nausea, vomiting, gas, and distension from anesthesia and gastric immobility For PTs with mild GI problems Weak PTs or the convalescent PTs with dental problems
39	Soft diet and mechanically soft diet not to be confused Soft Diet Foods with naturally soft texture or those made soft by cooking For post-op PTs transitioning to general diet or for convalescent PTs Mechanically Soft Diet Foods altered mechanically (ground, cut, diced, etc.) for easier ingestion For PTs with chewing or swallowing (dysphagia) difficulties
40	Importance of a High Fiber Diet A High Fiber Diet provides foods that increase the content of residue in the GI tract. Contains at least 25-35 g dietary fiber per day. Purposes: ↑ fecal bulk, promote regularity, normalize serum lipid levels, and modulate blood glucose levels.
41	Indications for Use Constipation (↑ stool bulk, holds H₂O ) Diverticulosis (prevents exacerbation & ↓ pain) Avoid in diverticulitis Diabetes Mellitus (can slow glucose absorption) Colon Cancer (may decrease risk) Hypercholesterolemia (decreases cholesterol by interfering with absorption of bile acids) Obesity (↓ caloric density & ↑ satiety effect) Irritable Bowel Syndrome (↓ constipation, but the OTC Equalactin provides better benefit)
42	PRESCRIBED Heart Disease (hypercholesterolemia) Diabetic Renal Sodium Restricted Low Fat, High Fiber, High Calorie Tonsillectomy Wired Jaw Diet Enteral and Parenteral Feeding Diseases – Cancer, ESLD, cystic fibrosis, intestinal disorders, etc.
43	Renal Diet Dietary Modifications Control consumption of: Protein & Phosphorous: meats, fish, poultry, dried beans, nuts, dairy products, tofu Sodium: salt, shoyu, canned vegetables Potassium: Banana, orange, potato, taro, dark green vegetables Fluids (when restricted): water, soup, juice, soda Obtain adequate Calories to met nutritional demands an decrease protein deterioration
44	Dietary Recommendations for Adults Highly Individualized Energy 30-45 kcals/kg Protein 0.6-1 g/kg Adjust as dialysis function and stress levels change Phosphorous 8-15 mg/kg/day Sodium 2-3 g/day (may need further restriction) Potassium 2-3 g/day Calcium individualized Fluid 24 hr urine output plus 500mL (700-1500mL)
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46	TONSILLECTOMY Common Name Cold Semi-liquid Diet Definition Foods non-irritating (thermal, mechanical, & chemically) Avoid red & acid foods, & chocolate all interferes with detection of hemoptysis-blood in sputum Notes Diet 1^st day Popsicles, ice chips Diet 2^nd day Bland fruit juices, milk, ice cream, pudding, custard, broth (cold or warm), gelatin, sherbert, drinks (cold or warm)
47	WIRED JAW Common Name Wired Jaw Diet Definition Higher nutrient content (longer term) Purpose Broken &/or wired jaw Oral sugery Chewing problems
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49	Why Feed by Tube? Malnutrition with inadequate p.o. intake Dysphagia (stroke, neuro, etc) Upper GI obstruction (tumor, radiation, paralysis, etc) Pancreatitis Other causes…
50	ENTERAL NUTRITION - WHEN Needed after: Inability to eat for 7-10 days Malnutrition Chronic disease Injury
51	ENTERAL NUTRITION - HOW 3 Locations to feed Nasogastric tube Esophagus Stomach Small intestine
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53	ENTERAL NUTRITION PLACING The TUBE Surgical Enterostomies Lower tubes Guided by radiographic veiwing Less danger of aspiration/vomiting esp if on ventilators, or in a coma Pumps – regulate rate of formula flow
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55	FORMULA SOURCES Actual Food Liquid / blenderized foods that are administered via tube when: 1) oral feedings not tolerated 2) ↑ nutrient needs Commercial Formulas Standardized Modular Formulas Individualized (diabetic, renal, fiber)
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57	TYPES OF PARENTERAL ROUTES Peripheral Parenteral Nutrition (PPN) Smaller peripheral vein Central Parenteral Nutrition (CPN) Central vein Golden rule Aseptic (Soln preparation, tube placement, feeding, cleaning)
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60	WHY PARENTERAL FEEDING? Quantitative No food for 5-7 days Lost 7% Usual Body Weight/2 months %UBW = ABW/UBW x 100 % wt change = UBW – (ABW/UBW) x 100 Losing 15 g urinary nitrogen/24 hours
61	WHY PARENTERAL FEEDING? Chronic illness Inflammatory bowel disease Short bowel syndrome Injury/burns Obstruction/cancer of GI tract Chronic malnutrition Unable to eat Coma, anorexia, mental problems ETC
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