Good Nutrition Essential for Health
Nutritional Screening and Assessment
Nutrition Care Process
Opportunities in Nutritional Assessment
Nutritional assessment is the first of the four steps in the Nutrition Care Process. Anthropometric
•The measurement of the physical dimensions and gross composition of the body (Chapters 6 and 7).
•Include measuring a nutrient or its metabolite in blood, feces, or urine or measuring a variety of other components in blood and other tissues that have a relationship to nutritional status (Chapters 7 to 9).
•The patient’s personal and family history, medical and health history, and physical examination are clinical methods used to detect signs and symptoms of malnutrition (Chapter 10).
•Measuring the quantity of the individual foods and beverages consumed during the course of one to several days or assessing the pattern of food use during the previous several months (Chapters 2 to 4).
The “central core” of the NCP is the relationship between the client and the dietetics professional.
There are four steps in the NCP: “ADIME” If you want to learn more check out What is one of the reasons we have governments of any kind is due to the fact that people have a hard time working together?
•STEP 1: Nutrition assessment
•STEP 2: Nutrition diagnosis
•STEP 3: Nutrition intervention
•STEP 4: Nutrition monitoring and evaluation
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The NCP is influenced by:
•The strengths and abilities that the practitioner brings to the process (knowledge, skills and competencies, critical-thinking skills, collaboration, communication, evidence-based practice, and a code of ethics).
•Environmental factors (practice settings, health-care systems, social systems, and economics).
•Support systems (screening and referral system and an outcomes management system).
Nutritional assessment is organized into four domains:
•Biochemical data (with medical tests and procedures)
Nutrition diagnosis is organized into three domains: We also discuss several other topics like What is the main idea of rawls' theory of justice?
Nutrition intervention has two basic components: planning and implementation:
•Planning: Summarize nutrition intake recommendations, the patient’s health condition, and the nutrition diagnosis in a statement known as the nutrition prescription. We also discuss several other topics like What major events happened while andrew johnson was president?
•Implementation: Establish specific strategies and goals of the intervention, communicate to all relevant parties, and execute the plan.
Monitoring and Evaluation
Purpose: to determine whether and to what extent the goals and objectives of the intervention are being met.
Estimated Average Requirement (EAR): The daily dietary intake level that is estimated to meet the nutrient requirement of 50% of healthy individuals in a particular life stage and gender group.
Recommended Dietary Allowance (RDA): The average daily dietary intake level that is sufficient to meet the nutrient requirement of nearly all (97% to 98%) healthy individuals in a particular life stage gender group.
Adequate Intake (AI): The recommended daily dietary intake level that is assumed to be adequate and that is based on experimentally determined approximations of nutrient intake by a group (or groups) of healthy people. The AI is an observational standard that is used when insufficient data is available to determine an RDA.
Tolerable Upper Intake Level (UL): The highest level of daily nutrient intake that is likely to pose no risk of adverse health effects to almost all apparently healthy individuals in the general population. As intake increases above the UL, the risk of adverse (toxic) effects increases. If you want to learn more check out Define elasticity.
Estimated Energy Requirement (EER): The average dietary energy intake that is predicted to maintain energy balance in a healthy adult of a defined age, gender, weight, height, and level of physical activity, consistent with good health. In children and in pregnant and lactating women, the EER includes the needs associated with the deposition of tissues or the secretion of milk consistent with good health.
The Diet Quality Index (DQI): an instrument to assess the overall diet quality of groups and to evaluate disease risk.
Dietary guidelines or goals: statements from authoritative scientific bodies translating nutritional recommendations into practical advice to consumers about their eating habits. We also discuss several other topics like Who is the godfather of entrepreneurship?
Goal for the Dietary Guidelines of America: to “improve the health of our Nation’s current and future generations by facilitating and promoting healthy eating and physical activity choices so that these behaviors become the norm among all individuals.”
● The “Choose Your Foods” system is a method of planning meals that simplifies controlling energy consumption (particularly from carbohydrates), helps ensure adequate nutrient intake, and allows considerable variety in food selection.
● The food exchange system originally was developed in 1950 by the Academy of Nutrition and Dietetics (formerly known as the American Dietetic Association) and the American ● Diabetes Association in cooperation with the U.S. Public Health Service for use in planning the diets of persons who have diabetes.
● The system categorizes foods and beverages according to their carbohydrate, protein, fat, alcohol, and energy content and lists them in four categories—carbohydrates, meat and meat substitutes, fat, and alcoholic beverages—as shown in Table 2.19.
● 24-Hour Recall
•Requires less than 20 minutes to administer
•Easy to administer
•Can provide detailed information on types of food consumed
•Low respondent burden
•Probability sampling possible
•Can be used to estimate nutrient intake of groups
•Multiple recalls can be used to estimate nutrient intake of individuals
•More objective than dietary history
•Does not alter usual diet
Useful in clinical settings
•One recall is seldom representative of a person’s usual intake
•Underreporting/over reporting occurs
•Relies on memory
•Omissions of dressings, sauces, and beverages can lead to low estimates of energy intake
•May be a tendency to overreport intake at low levels and underreport intake at high levels of consumption
•Data entry can be very labor intensive
USDA Automated Multiple-Pass Method (AMPM)
NCI ASA 24
● Food Record or Diary
•Does not depend on memory
•Can provide detailed intake data
•Can provide data about eating habits
•Multiple-day data more representative
of usual intake
•Reasonably valid up to five days
•Requires high degree of cooperation
•Response burden can result in low response rates when used in large national surveys •Subject must be literate
•Takes more time to obtain data
•Act of recording may alter diet
•Analysis is labor intensive and expensive
Estimated food record versus weighed food record (Box 3.3)
● Food Frequency Questionnaires
•Can be self-administered
•Modest demand on respondents
•Relatively inexpensive for large sample sizes
•May be more representative of usual intake than a few days of diet records •Design can be based on large population data
•Considered by some as the method of choice for research on diet-disease relationships Limitations:
•May not represent usual foods or portion sizes chosen by respondents •Intake data can be compromised when multiple foods are grouped within single listings •Depends on ability of subject to describe diet
Simple or nonquantitative food frequency questionnaire
Semiquantitative food frequency questionnaire (Figure 3.3B)
Quantitative food frequency questionnaire (Figure 3.3C)
Targeted food frequency questionnaires (screeners) (Figure 3.4)
Willett questionnaire, Block questionnaires, diet history questionnaire (DHQ), NHANES Food Frequency Questionnaire
● Diet History Method
•Assesses usual nutrient intake
•Can detect seasonal changes
•Data on all nutrients can be obtained
•Can correlate well with biochemical measures
•Lengthy interview process
•Requires highly trained interviewers
•Difficult and expensive to code
•May tend to overestimate nutrient intake
•Requires cooperative respondent with ability to recall usual diet
● Duplicate Food Collection Method
•Can provide more accurate measurements of actual nutrient intake than calculations based on food composition tables
•Expense and effort of preparing more food
•Effort and time to collect duplicate samples
•May underestimate usual intake
● Food Account Method
•Suitable for use with large sample sizes
•Can be used over relatively long periods
•Gives data on dietary patterns and habits of families and other groups •Less likely to lead to alterations in diet than some other methods •Relatively economical
•Does not account for food losses
•Respondent literacy and cooperation necessary
•Not appropriate for measuring individual food consumption