nutrition assessment

• related: GI

Overview

• Key elements of nutrition assessment

Social History

• access to food
  • financial access: can afford?
  • mobility: can obtain?
• preparing food
  • who cooks
  • can patient cook, how often?

Diet History

• specific diet?
  • gluten free, low carb, keto, paleo, vegan
• food intolerance, allergies
  • lactase def, fructose intol, red meat (a-gal)
• dining out, how often
• 24 hour diet recall, calorie count inpatient, food diaries
  • what you ate for breakfast, lunch, dinner yesterday
• vitamins and supplements

PMHx

• GI illnesses preventing absorption
  • oropharynx: dysphagia, tooth extractions (do you still have molars)
  • stomach: PUD, chronic nausea, gastroparesis
  • intestine: diarrhea, celiac dis, crohn's
• chronic illnesses

SHx

• stomach: ulcer operations, resection, bypass
• intestine anastomoses
• cholecystectomy

Symptoms

• appetite increased or decreased
• edema as sx of depleted albumin storage
• pica: urge to chew ice

Weight Hx

• current weight, BMI
• ideal body weight
  • estimate using weight after finishing high school (where when they finished road to adult)
  • Hamwi method
  • NHANES survey
• % ideal body weight: body weight should be +- 10% IBW
• maximum lifetime weight
• desired weight
• recent change in weight

BMI

• weight/height kg/m2
• surrogate for adiposity (fat mass/total mass)

Adiposity

• bioelectric impedance: signal sent from one part to another. Fat is insulator
• DEXA: in research setting
• underwater weighing: uses buoyancy of fat

fat distribution

• uses waist/hip ratio as surrogate for central obesity
• waist circumference

Longitudinal weight history

• most dangerous: emergency if loses more than in box

Daily energy requirements

• Harris-Benedict Equation: gender, weight, height, age
• indirect calorimetry: measures O2 consumption, CO2 consumption
• rule of thumb:

Protein requirements

• lean body mass (estimates for somatic protein store)
• plasma protein as surrogate to measure visceral protein
  • albumin: half life 3 weeks. Negative acute phase reactants
  • prealbumin: half life 2-3 days, also -APR
• nitrogen balance: calorie count (cumbersome)
• rule of thumb:

Vitamin and mineral

• water soluble: B12, thiamine, folic acid
• fat: ADEK, INR
• iron storage
• macro minerals: electrolytes
• trace minerals: Cu, Co, etc.