Concept about Nutritional status – This book covers the entire syllabus of “Nutrition and Dietetics” prescribed by BNMC-for all Diploma in Nursing Science and Midwifery students. We tried to accommodate latest information and topics. This book is examination friendly setup according to the teachers’ lectures and examination’s questions. At the end of the book previous university questions are given. We hope in touch with the book students’ knowledge will be upgraded and flourished. The unique way of presentation may make your reading of the book a pleasurable experience.

Table of Contents

Concept about Nutritional status

Definition Of Nutritional Status:

Nutritional status is the condition of health of the individual as influenced by the utilization of the nutrients. It can be determined only by the correlation of information obtained through a careful medical and dietary history, a thorough physical examination and appropriate laboratory investigations.

[OTHER DEFINITION – NICE TO KNOW]

Nutritional status is the condition of the health of the individual as influenced by the utilization of the nutrients. It is determined by taking medical history, physical examination and laboratory investigation.

Nutritional Status Indicators:

Nutritional status is a positive health indicator. Three nutritional status indicators are considered important as indicators of health status. They are-

1. Anthropometric measurements of preschool children, e.g, weight and height, mid-arm circumference.
2. Height (and sometimes weights) of children at school entry.
3. Prevalence of low birth weight (less than 2.5kg).

Assessment Methods of Nutritional Status:

Direct Methods of Nutritional Assessment

These are summarized as ABCD

Anthropometric methods
Biochemical, laboratory methods
Clinical examination methods
Dietary evaluation methods

Indirect Methods of Nutritional Assessment

These include three categories:

Ecological variables / factors.
Economic factors e.g. per capita income, population density & social habits
Vital health statistics particularly infant & under 5 mortality & fertility index

Direct Methods of Nutritional Assessment

A. Anthropometric methods/ Nutritional Anthropometry:

a) Height & weight

Gomez’ classification (height for age)
Well come classification (weight for age)
Waterlow’s classification (weight for Height)

b) Arm circumference
c) Skin fold thickness.

B. Biochemical evaluation:

a) Laboratory tests: Hemoglobin (Hb) estimation, stool examination, Urine examination,
b) Biochemical tests: Serum iron, Serum retinol, Urinary iodine, Serum folate.

C. Clinical examination: A WHO Export Committee classified signs used in nutritional surveys into 3 categories as those:

a) Not related to nutrition: e.g. alopecia, pyorrhoea, pterygium
b) That needs further investigation: e.g. malar pigmentation, corneal vascularization, geographic tongue.
c) Known to be of value: e.g. angular stomatitis, Bitot’s spots & enlargement of thyroid gland etc.

D. Dietary survey/ Assessment of dietary intake: A diet survey may be carried out by one of the following methods:

a) Weighment of raw foods
b) Weighment of cooked foods.
c) Oral questionnaire method

Indirect Methods of Nutritional Assessment

A. Vital & Health statistics:
a) Infant mortality rate
b) Neonatal mortality rate
c) Still birth rate, etc.

B. Ecological studies:
a) Food balance sheet e.g. per capita supply
b) Socio-economic factors e.g. family size
c) Health and educational services e.g. PHC service
d) Conditioning influences e.g. viral infection

Others

Functional Assessment:
a) Structural integrity,
b) Host defense,
c) Hemostasis,
d) Reproduction,
e) Nerve function,
f) Work capacity.

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Signs of Nutritional Imbalance:

SL	Area of concern	Possible deficiency	Possible excess
1	Hair : Dull, dry, brittle Hair loss Flag sign (loss of hair Pigment in strips around the head).	Protein. Protein, Zn, Biotin Protein, copper	Vitamin A
2	Head and neck : Headache. Epistaxis (nasal bleeding) Thyroid enlargement	Vitamin K Iodine	Vitamin A, D
3	Eyes : Conjunctival and corneal xerosis (dryness).	Vitamin
4	Skin: Dry, scaly Eczematous lesions, Poor wound healing.	Vitamin A, Zn, Essential fatty, acids Zn Protein, Zn, Vit. C	Vitamin A
5	Nails : Koilonychia (spoon-shaped, nails) Brittle, fragile.	Iron Protein
6	Mouth : Cheilosis or angular stomatitis (lesions at corners of mouth). Glossitis (red, sore tongue). Gingivitis (inflamed gums)’ Hypogeusia, dysgeusia (Poor sense of taste, bad taste) Dental caries.	Vitamin B2 Niacin, folate, Vit.B12 Vitamin C Zn Fluoride
7	Abdomen: Hepatomegaly Ascites.	Protein Protein	Vitamin A
8	Heart: Enlargement, tachycardia, failure. Sudden failure, death. Arrythmia Hypertension	Vitamin B Selenium (Se) Mg, K, Se Calcium, K.	Vitamin A
9	Neurologic: Weakness. Tremor. Decreased tendon reflexes. Disorientation. Drowsiness, lethargy Depression.	Vit. C, B1. B6, B12. Magnesium (mg) Vitamin B1, biotin	Vitamin A, D
10	Musculoskeletal, extremities: Edema. Bone and joint tenderness. Knock knee, bowed legs, fragile bones.	Protein, vitamin B1 Vitamin C or D, Ca,P Vitamin D, Ca, P, Cu.	Vitamin A

Poor Clinical Signs of Nutritional Status:

1. General appearance: Restless, apathetic, cachexic.

2. Hair: Stringy, dull brittle, de-pigmented

3. Neck glands: Thyroid enlarged.

4. Skin, face, neck: Greasy, discolored, scaly.

5. Eyes: Dryness, signs of infection, increased vascularity, glassiness, thickened 11 Conjunctivae

6. Lips: Dry, scaly, swollen, angular lesions (stomatitis)

7. Tongue: Papillary atrophy, smooth appearance, swollen, red, beefy (glossitis)

8. Gums: Marginal redness or swelling, receding, spongy.

9. Teeth: Unfilled cavities, absent teeth, worn surface, mottled, mal-positioned,

10. Skin, general: Rough, dry, scaly, pale, pigmented, irritated.

11. Abdomen: Swollen.

12. Legs, feet: Edema, tender caft, tingling, weakness.

13. Skeleton: Bowlegs, knock-knee, chest deformity at diaphragm, beaded ribs, prominent scapula’s.

14. Weight: Overweight or underweight.

15. Muscles: Flaccid, poor tone, undeveloped, tender.

16. Nervous control: Inattentive, irritable.

17. Gastrointestinal function: Anorexia, indigestion, constipation or airhead.

18. General vitality: Easily fatigued, no energy, falls asleep in school, looks tired, apathetic,

Signs of Good Nutritional Status:

1. General appearance: Alert, responsive.

2. Hair: Shiny, lustrous, healthy scalp,

3. Neck glands: No enlargement.

4. Skin, face, neck: Smooth, slightly moist, good color, reddish pink mucous membranes,

5. Eyes: Bright, clear, no fatigue circles.

6. Lips: Good color, moist

7. Tongue: Good pink color, surface papillae present, no lesions.

8. Gums: Good pink color, no swelling or bleeding firm.sinad flow

9. Teeth: Straight, no crowding, well-shaped jaw, clean, no discoloration, and

10. Skin, general: Smooth, slightly moist, good color.

11. Abdomen: Flat.

12. Legs, feet: No tenderness, weakness, swelling, good color.

13. Skeleton: No malformation.

14. Weight: Normal for height, age, body builds

15. Muscles: Well-developed, firm.

16. Nervous control: Good attention span for age, does not cry easily, not irritable or restless.

17. Gastrointestinal function: Good appetite and digestion, normal, regular elimination.

18. General vitality: Endurance, energetic, sleeps well at night, vigorous.

Measurement of Nutritional Anthropometry:

A. Measuring Weight and Height: Formula for approximate average weight and height of normal infants and children

Weight:

At birth = Average-2.5 kg.
3 to 12 month= {Age (month) +9}/2
1-6 years = {Age (yr) x 2} +8
7-12 years= {(Age x 2)+8} /2

Height:

At birth: 50 cm
At 1 Year : 75 cm
2-12 years: Age (yr) x 6} +77 cm

B. Measuring Occupito -Frontal Circumference (OFC): It is generally measured in infants and children less than 3 years of age by a flexible, non-stretchable measuring tape.

Procedure of measurement:

Average OFC of a child:

At birth	At 3 months (cm)	At 6 months (cm)	At 1 year (cm)	At 1 year (cm)
35	41	44	47	49

C. Measuring the MUAC of children
A special tape is used for measuring the MUAC of a child (see Figure 2.3). The tape has three colours, with the red indicating severe acute malnutrition, the yellow indicating moderate acute malnutrition and the green indicating normal nutritional status. Figure 2.4 shows you how to use the tape to measure a child’s MUAC.

Figure 2.3 MUAC measuring tape

Figure 2.4 Measuring MUAC.

Procedures for measuring MUAC

Ask the mother to remove any clothing that may cover the child’s left arm. If possible, the child should stand erect and sideways to the measurer.
Estimate the midpoint of the left upper arm (arrow 6).
Straighten the child’s arm and wrap the tape around the arm at the midpoint. Make sure the numbers are right side up. Make sure the tape is flat around the skin (arrow 7).
Inspect the tension of the tape on the child’s arm. Make sure the tape has the proper tension (arrow 7) and is not too tight or too loose (arrows 8 and 9). Repeat any step as necessary.
When the tape is in the correct position on the arm with correct tension, read the measurement to the nearest 0.1 cm (arrow 10).
Immediately record the measurement.

Level of nutrition	MUAC
Normal	>13.5 cm (green)
Borderline PEM.	12.5-13.5 cm (yellow)
Malnourished.	<12.5 cm (red)

D. BMI (Body Mass Index):
The body mass index (BMI) or Quetelet index is a value derived from the mass (weight) and height of an individual. The BMI is defined as the body mass divided by the square of the body height, and is universally expressed in units of kg/m², resulting from mass in kilograms and height in meters.

Formula:

Metric BMI Formula

BMI = weight (kg) + height² (m²)

Imperial BMI Formula

BMI = weight (lb) + height² (in²) x 703

Example Using Formula
For an adult with height of 180 cm and weight of 75 kg. Our first step needs to be to convert the height into meters (British spelling: metres). As there are 100cm in a meter, we divide our figure by 100. This gives us 1.8m.

Let’s plug those figures into our formula:
BMI = 75+ (1.8 × 1.8)
BMI=753.24
This gives us a BMI figure of 23.15.

Read more:

Concept about Food | CHAPTER 1 | Nutrition and Dietetics

Concept about Nutritional status | Chapter 5 | Nutrition and Dietetics