Our nutrition assessment is an in-depth evaluation of both objective and subjective data related to an individual’s food and nutrient intake, lifestyle, and medical history.
Once the data on an individual is collected and organized, we can assess and evaluate the nutritional status of that person. The assessment leads to a plan of care, or intervention, designed to help the individual either maintain the assessed status or attain a healthier status.
In 1959, research indicated that the lowest mortality rates were associated with below-average weight, and the phrase “desirable weight” replaced “ideal weight” in the title of the height and weight table.
To further characterize an individual’s height and weight, tables also include body-frame size, which can be estimated in many ways. An easy way is to wrap the thumb and forefinger of the nondominant hand around the wrist of the dominant hand. If the thumb and forefinger meet, the frame is medium; if the fingers do not meet, the frame is large; and if they overlap, the frame is small.
Determining frame size is an attempt at attributing weight to specific body compartments. Frame size identifies an individual relative to the bone size, but does not differentiate muscle mass from body fat. Because it is the muscle mass that is metabolically active and the body fat that is associated with disease states, Body Mass Index (BMI) is used to estimate the body-fat mass. BMI is derived from an equation using weight and height.
Clinical data provides information about the individual’s medical history, including acute and chronic illness and diagnostic procedures, therapies, or treatments that may increase nutrient needs or induce malabsorption . Current medications need to be documented, and both prescription drugs and over-the-counter drugs, such as laxatives or analgesics, must be included in the analysis. Vitamins , minerals , and herbal preparations also need to be reviewed. Physical signs of malnutrition can be documented during the nutrition interview and are an important part of the assessment process.
There are many ways to document dietary intake. The accuracy of the data is frequently challenged, however, since both questioning and observing can impact the actual intake. During a nutrition interview the practitioner may ask what the individual ate during the previous twenty-four hours, beginning with the last item eaten prior to the interview. Practitioners can train individuals on completing a food diary, and they can request that the record be kept for either three days or one week. Documentation should include portion sizes and how the food was prepared. Brand names or the restaurant where the food was eaten can assist in assessing the details of the intake. Estimating portion sizes is difficult, and requesting that every food be measured or weighed is time-consuming and can be impractical. Food models and photographs of foods are therefore used to assist in recalling the portion size of the food.
In a metabolic study, where accuracy in the quantity of what was eaten is imperative, the researcher may ask the individual to prepare double portions of everything that is eaten—one portion to be eaten, one portion to be saved (under refrigeration, if needed) so the researcher can weigh or measure the quantity and document the method of preparation.
Food frequency questionnaires are used to gather information on how often a specific food, or category of food is eaten. The Food Guide Pyramid suggests portion sizes and the number of servings from each food group to be consumed on a daily basis, and can also be used as a reference to evaluate dietary intake.
During the nutrition interview, data collection will include questions about the individual’s lifestyle—including the number of meals eaten daily, where they are eaten, and who prepared the meals. Information about allergies , food intolerances, and food avoidances, as well as caffeine and alcohol use, should be collected. Exercise frequency and occupation help to identify the need for increased calories. Asking about the economics of the individual or family, and about the use and type of kitchen equipment, can assist in the development of a plan of care. Dental and oral health also impact the nutritional assessment, as well as information about gastrointestinal health, such as problems with constipation , gas or diarrhea, vomiting, or frequent heartburn.
-Carole S. Mackey