Nutritional status
the degree of balance between nutrient intake and nutrient requirements
factors that may affect nutritional balance
including physiologic, psychosocial, developmental, cultural, and economic.
Optimal nutritional status
achieved when sufficient nutrients are consumed to support day-to-day body needs and any increased metabolic demands due to growth, pregnancy, or illness (Persons having optimal nutritional status are more active, have fewer physical illnesses, and live l
Undernutrition
nutritional reserves are depleted and/or when nutrient intake is inadequate to meet day-to-day needs or added metabolic demands
groups vulnerable for undernutrition
infants, children, pregnant women, recent immigrants, persons with low incomes, hospitalized people, and aging adults
risks associated with undernutrition
impaired growth and development, lowered resistance to infection and disease, delayed wound healing, longer hospital stays, and higher health care costs
Overnutrition
caused by the consumption of nutrients�especially calories, sodium, and fat�in excess of body needs
risks associated with overnutrition
can lead to obesity and is a risk factor for heart disease, type 2 diabetes, hypertension, stroke, gallbladder disease, sleep apnea, certain cancers, and osteoarthritis
Developmental Competence: Infants and Children
-time from birth to 4 months of age is the most rapid period of growth in the life cycle
-infants double their birth weight by 4 months and triple it by 1 year of age
-number of pounds gained during the second year approximates the birth weight
-Infants i
Brain Growth and Development: Infants and Children
-size also increases very rapidly during infancy and childhood
-by age 2 years, the brain has reached 50% of its adult size
-by age 4, 75%
-by age 8, 100%
-infants and children younger than 2 years should not drink skim or low-fat milk or be placed on low
advantages of breastfeeding
1) ideally formulated to promote normal infant growth and development and natural immunity
2) fewer food allergies and intolerances
3) reduced likelihood of overfeeding
4) less cost than commercial infant formulas
5) increased mother-infant interaction ti
Developmental Competence: Adolescence
-adolescence is characterized by a rapid physical growth and endocrine and hormonal changes
-caloric, protein, calcium and iron requirements increase
-increased requirements cannot be met by three meals per day; therefore nutritious snacks play an importa
factors to consider when working with adolescents on nutrition
skipped meals, excessive fast food and sweetened beverage consumption, limited fruit and vegetable intake, peer pressure, alternative dietary patterns, eating disorders, hectic schedules, and possible experimentation with drugs and alcohol
Gender Considerations: Adolescence
-in general, boys grow taller and have less body fat than girls
-the percent of body fat increases in females to about 25% and decreases in males (replaced by muscle mass) to about 12%
-typically, girls double their body weight between the ages of 8 and 1
Developmental Competence: Pregnancy and Lactation
-to support the synthesis of maternal and fetal tissues, sufficient calories, protein, vitamins, and minerals must be consumed
-iron, folate, and zinc are essential for fetal growth
-vitamin and mineral supplements are often required
Recommended Pregnancy Weight Gain
-25 to 35 lb for women of normal weight
-28 to 40 lb for underweight women
-15 to 25 lb for overweight women
-11 to 20 lb for obese women
Developmental Competence: Adulthood
-growth and nutrient needs stabilize
-most adults are in relatively good health
-important time for education, to preserve health and to prevent or delay the onset of chronic disease
lifestyle factors to consider regarding adult health
cigarette smoking, stress, lack of exercise, excessive alcohol intake, and diets high in saturated fat, cholesterol, salt, and sugar and low in fiber can be factors in the development of hypertension, obesity, atherosclerosis, cancer, osteoporosis, and di
Developmental Competence: Aging Adult
-increased risk for undernutrition or overnutrition
-decrease in energy requirements due to loss of lean body mass (the most metabolically active tissue) and an increase in fat mass
-protein and vitamin and mineral needs remain the same or increase nutrie
major risk factors for malnutrition in older adults
poor physical or mental health, social isolation, alcoholism, limited functional ability, poverty, and polypharmacy
NORMAL physiologic changes in aging adults that directly affect nutritional status
poor dentition, decreased visual acuity, decreased saliva production, slowed gastrointestinal motility, decreased gastrointestinal absorption, and diminished olfactory and taste sensitivity
factors that may contribute to immigrant nutritional problems
� They are in a new country with a completely new language, culture, and society
� They are faced with unfamiliar foods, food storage, food preparation, and food-buying habits
� Many familiar foods are difficult or impossible to obtain
� Low income may al
cultural heritage factors that may affect nutrition
example: studies have shown that Black women have lower hemoglobin levels than white women independent of iron intake and that their risk for osteoporosis is significantly less despite lower overall calcium intake
cultural values factors that may affect nutrition
example: many cultures worldwide consider obesity an indication of beauty, affluence, and well-being
religious beliefs that may affect nutrition
Buddhism (restrict meat); Hinduism (restrict beef, pork, and some fowl, alcohol, Garlic and onions by some, Red-colored foods by some); Islam; Mormon; Orthodox Judaism; Seventh-Day Adventist
cultural stereotyping
the tendency to view individuals of common cultural backgrounds similarly and according to a preconceived notion of how they "ought" to behave
Purposes and Components of Nutritional Assessment
1) identify individuals who are malnourished or are at risk for developing malnutrition
2) provide data for designing a nutrition plan of care that will prevent or minimize the development of malnutrition
3) establish baseline data for evaluating the effi
Nutrition Screening
-first step in assessing nutritional status
-equired for all patients in all health care settings within 24 hours of admission
-based on easily obtained data, nutrition screening is a quick and easy way to identify individuals at nutrition risk, such as t
parameters used for nutrition screening
ypically include weight and weight history, conditions associated with increased nutritional risk, diet information, and routine laboratory data
comprehensive nutritional assessment
-used for individuals identified at nutritional risk during screening
-includes dietary history and clinical information, physical examination for clinical signs, anthropometric measures, and laboratory tests
methods for collecting current dietary intake information
-24/hour recall
-food frequency questionnaire
-food diary
*During hospitalization, documentation of nutritional intake is achieved through calorie counts of nutrients consumed and/or infused
24-hour recall
-easiest and most popular method
-individual or family member completes a questionnaire or is interviewed and asked to recall everything eaten within the last 24 hours
-advantage of the 24-hour recall is that it can elicit specific information about dieta
sources of error/disadvantages of 24/hr recall
1) the individual or family member may not be able to recall the type or amount of food eaten
2) intake within the last 24 hours may be atypical of usual intake
3) the individual or family member may alter the truth for a variety of reasons
4) snack items
food frequency questionnaire
information is collected on how many times per day, week, or month the individual eats particular foods, providing an estimate of usual intake
disadvantages of food frequency questionnaire
1) it does not always quantify amount of intake
2) like the 24-hour recall, it relies on the individual's or family member's memory for how often a food was eaten
food diaries
ask the individual or family member to write down everything consumed for a certain period of time
-3 days (two weekdays and one weekend day) are customarily used
-food diary is most complete and accurate if you teach the individual to record information
disadvantages of food diaries
1) noncompliance
2) inaccurate recording
3) atypical intake on the recording days
4) conscious alteration of diet during the recording period.
Direct observation
direct observation of the feeding and eating process can detect problems not readily identified through standard nutrition interviews
Subjective Data for Nutritional Assessment
1 Eating patterns
2 Usual weight
3 Changes in appetite, taste, smell, chewing, swallowing
4 Recent surgery, trauma, burns, infection
5 Chronic illnesses
6 Vomiting, diarrhea, constipation
7 Food allergies or intolerances
8 Medications and/or nutritional s
Objective Data for Nutritional Assessment
-examine the patient for clinical signs of nutritional deficiencies. These signs are most readily detected in the skin, hair, mouth, lips, and eyes, but may also appear in the nails and musculoskeletal and neurologic systems
-Use anthropometric measures t
anthropometric measures
height, weight, triceps skinfold thickness, mid-upper arm circumference, and possibly arm span and frame size
laboratory tests to detect preclinical nutritional deficiencies
include hematocrit and hemoglobin, cholesterol, triglyceride, and serum protein levels
cardinal features of a successful long-term weight loss plan
1) getting regular (i.e., 4-5 times/week for 30 minutes) physical exercise
2) eating a low-calorie (?1400-1500 kcal/day), low-fat (20%-25% of total calories) diet
3) monitoring daily food intake (e.g., food diary, portion size) and weight
Abnormal Findings (in regards to nutrition)
-obesity
-Marasmus (protein-calorie malnutrition)
-Kwashiorkor (protein malnutrition)
-Marasmus/kwashiorkor mix
-Pellagra
-Kwashiorkor
-Follicular Hyperkeratosis
-Scorbutic Gums
-Bitot's Spots
-Rickets
-Magenta Tongue
-Metabolic Syndrome (MetS)
Potential Nutritional Consequences of Bariatric Surgery and Related Dietary Changes
-Malabsorption of protein and calories due to decreased absorptive surface and availability of digestive enzymes
>Eating small, nutrient-dense meals
Malabsorption of vitamins and minerals due to achlorhydria or loss of site of absorption
>Taking vitamin a