NUTRI LAB NOTES FINALS 8. The child’s shoulders should be levelled (arrow 10).

PHYSICAL ASSESMENT 9. The head piece should be placed firmly on the child’s head (arrow
ANTHROPOMETRIC MEASUREMENTS 15).
- are noninvasive quan�ta�ve measurements of the body 10. The measurement should be recorded on the ques�onnaire
- According to the Centers for Disease Control and Preven�on (arrow 1).
(CDC), anthropometry provides a valuable assessment of
nutri�onal status in children and adults.
- includes weight, height, body mass index (BMI), body
circumference (arm, waist, hip and calf), waist to hip ra�o
(WHR), elbow amplitude and knee-heel length.
Body circumference
- Mid-brachial, calf, waist and hip circumferences were
measured using a flexible non-elas�c measuring tape.
Procedure:
1. Individuals stood with feet together and arms res�ng by
their sides.
2. The hip circumference was measured from the maximum
perimeter of the butocks.
3. The waist circumference was taken as the plane between
the umbilical scar and the inferior rib border.
*The waist circumference was used to identify individuals with
possible health risks based upon threshold values of ≥ 88 cm for
women and ≥ 102 cm for men
Height
- This is measured with the child or adult in a standing
posi�on (usually children who are two years old or more). Weight
- The head should be in the Frankfurt posi�on - A weighing sling (spring balance), also called the ‘Salter
 a posi�on where the line passing from the Scale’ is used for measuring the weight of children under
external ear hole to the lower eye lid is parallel to two years old, to the nearest 0.1 kg.
the floor - In adults and children over two years a beam balance is used
- during measurement, and the shoulders, butocks and the and the measurement is also to the nearest 0.1 kg.
heels should touch the ver�cal stand. - In both cases a digital electronic scale can be used if you
- Either a stadiometer or a portable anthropometer can be have one available.
used for measuring. - Do not forget to re-adjust the scale to zero before each
- Measurements are recorded to the nearest millimeter. weighing.
Stadiometer Anthropometer - You also need to check whether your scale is measuring
correctly by weighing an object of known weight.
Procedure:
1. Adjust the pointer of the scale to zero level.
2. Take off the child’s heavy clothes and shoes.
3. Hold the child’s legs through the leg holes.
4. Hold the child’s feet.
5. Hang the child on the Salter Scale.
6. Read the scale at eye level to the nearest 0.1 kg.
7. Remove the child slowly and safely.

Procedure:
1. Both the assistant and measurer should be on their knees
(arrows 2 and 3).
2. The right hand of the assistant should be on the shins of the child
against the base of the board (arrow 4).
3. The le� hand of the assistant should be on the knees of the child
to keep them close to the board (arrow 5).
4. The heel, the calf, butocks, shoulder and occipital
prominence (prominent area on the back of the head) should be
flat against the board (arrows 6, 7, 14, 13 and 12).
5. The child should be looking straight ahead (arrow 8).
6. The hands of the child should be by their side (arrow 11).
7. The measurer’s le� hand should be on the child’s chin (arrow 9).
Weight Birth weight
- Most reliable criteria of assessment of nutri�on - is weight of the child at birth and is classified as follows:
- Periodic recording will help to detect malnutri�on in under more than 2500 grams = normal birth weight
5 at early age. 1500–2499 grams = low birth weight
• Beam type weighing balance less than 1500 grams = very low birth weight
• Electronic scales for infants and children Body composi�on
• Bathroom type (very unreliable) - Is the propor�on of fat and non-fat mass in your body.
• Salter spring machine (in field condi�ons) - A healthy body composi�on is one that includes a lower
Body mass index percentage of body fat and a higher percentage of non-fat
- Or quetelet index is a good es�mate of the degree of obesity mass, which includes muscle, bones, and organs.
or amount of total body fat. Two types of mass
- Body mass index (BMI) is a measure of body fat based on 1. Body fat:
height and weight that applies to adult men and women. - can be found in muscle �ssue, under the skin (subcutaneous
- It is a value derived from the mass (weight) and height of an fat), or around organs (visceral fat).
individual - Some fat is necessary for overall health.
BMI is calculated using the following formulas: - "Essen�al fat" helps protect internal organs, stores fuel for
Units Formula and calcula�on energy and regulates important body hormones.
Kilograms and Formula: weight (kg) / [height (m)]2 - But you may also have excess storage of fat and non-
meters With the metric system, the formula for BMI essen�al body fat.
is weight in kilograms divided by height in 2. Non-fat mass:
meters squared. Since height is commonly - includes bone, water, muscle, organs, and �ssues.
measured in cen�meters, divide height in - It may also be called lean �ssue.
cen�meters by 100 to obtain height in - Non-fat mass �ssues are metabolically ac�ve, meaning they
meters. burn calories for energy, while body fat does not.
Example: Weight = 68 kg, Height = 165 cm Factors Affec�ng Body Composi�on
(1.65 m) 1. Age
Calcula�on: 68 ÷ (1.65 x 1.65) = 24.98 2. Genes
Pounds Formula: weight (lb) / [height (in)]2 x 703 3. Hormones
and inches Calculate BMI by dividing weight in pounds 4. Sex
(lbs) by height in inches (in) squared and
mul�plying by a conversion factor of 703.
Example: Weight = 150 lbs, Height = 5’5”
(65ʺ)
Calcula�on: 150 ÷ (65 x 65) x 703 = 24.96
Interpreta�on

MID-UPPER ARM CIRCUMFERENCE (MUAC)

- Used to evaluate fat stores. It provides an es�mate of the
arm so� �ssue or was�ng.
- Measures the size of the arm and all of its components –
muscle mass, subcutaneous fat, and bone.
FOR KIDS Technique in Measurement
- Use non-stretchable tape, or Shakir tape (3-colored)
- Have the subject sit with the le� arm hanging freely at the
side
- Mark the midpoint between the acromion and olecranon
- Place the tape gently but firmly around the mid-upper arm
- Readings are taken to the nearest cen�meters
- Average the results of 3 measurements
Fat-fold or skin-fold thickness Waist to hip ra�o
- is a simple means of es�ma�ng body composi�on which is - valuable indicator of body fat distribu�on and adiposity;
widely used in children, but there is litle informa�on on its - also called abdominal/gluteal ra�o or abdominal girth
validity. measurement
- There has been a prolifera�on of equa�ons for es�ma�on
of body composi�on from skinfolds, but some doubt as to
their general applicability.
Placement Calcula�ng Your Waist-to-Hip Ra�o
- This helps ensure that the calipers are placed in Measure waist circumference.
the correct posi�on each �me the skinfold is measured. - Wrap the tape measure around the widest part of your
- All skinfold measurements should be taken on the right stomach, across your belly buton. The tape measure should
side of the body unless otherwise specified. rest gently on your skin. Once the tape measure is
7 Site Skinfold Measurements posi�oned correctly, breathe in gently, and then take the
1. Triceps. measurement on the exhale.
2. Chest/Pectoral. Take a hip measurement.
3. Midaxillary. - Stand with your feet directly beneath your hips and wrap
4. Subscapular. the tape around the widest part of your hips and butocks.
5. Supra iliac. Note the measurement in inches.
6. Abdominal. Calculate your WHR. Divide your waist size by your hip size to get
7. Thigh your WHR.
• To measure your WHR correctly, you should remove any bulky
clothing that can add padding around your abdomen.
• According to the World Health Organiza�on, a WHR greater than
1.0 is indica�ve of a higher-than-normal risk of developing heart
disease. A healthy WHR for women is under 0.85 and a healthy
WHR for men is 0.90 or less.

Waist circumference (WC)

- serves as a marker of abdominal fatness.
- WC is an indicator of health risk associated with excess fat
around the waist.
- A waist circumference of 102 cen�meters (40 inches) or
more in men, or 88 cen�meters (35 inches) or more in
women, is associated with health problems such as type 2
diabetes, heart disease and high blood pressure.

OTHER SOURCES OF DATA

NUTRITIONAL STATUS
- refers to the degree of balance between nutrient intake and
nutrient requirement.
- this balance is affected by many factors, including
physiologic, physical, developmental, cultural, and
economic
 REMEMBER THIS!!!! B. Moderately malnourished or at risk of malnutri�on: Some
OPTIMAL NUTRITION evidence of weight loss, changes in dietary intake, or mild
- sufficient nutrients are consumed to support day to physical signs of malnutri�on.
day body needs and any increased metabolic demands. C. Severely malnourished: Significant weight loss, marked
(growth, illness, pregnancy). changes in dietary intake, and evident physical signs of
UNDERNUTRITION malnutri�on.
- Nutrient intake is inadequate to meet day to day need or 3. MNA (Mini Nutri�onal Assessment)
add metabolic demand - It is a screening tool to help iden�fy elderly pa�ents who are
OVERNUTRITION malnourished or at risk of malnutri�on.
- consump�on of nutrient in excess of body need - It iden�fies the risk of malnutri�on before severe changes
NUTRITIONAL ASSESSTMENT in weight or serum protein levels occur.
- a comprehensive analysis of a person's nutri�on status that THE ASSESSMENT IS TYPICALLY DIVIDED INTO TWO PARTS:
uses historical informa�on, food intake data, 1. Screening (Short Form):
anthropometric measurements, physical examina�on & - This ini�al part consists of six ques�ons and helps quickly
biochemical data. iden�fy individuals at risk of malnutri�on. Ques�ons cover
1. Iden�fy individuals who are malnourished or are at risk for aspects such as weight loss, dietary intake, mobility,
developing malnutri�on. psychological stress or acute disease, neuropsychological
2. Provide data for designing a nutri�on plan of care to prevent or problems, and body mass index (BMI).
minimize development malnutri�on. 2. Assessment (Full MNA):
3. Establish baseline data for evalua�ng the efficacy of nutri�onal - If the screening suggests a risk of malnutri�on, the second
care. part of the assessment is conducted.This more detailed
DEFINITION OF TERMS sec�on includes addi�onal ques�ons related to food intake,
1. MUST (Malnutri�on Universal Screening Tool) mobility, psychological stress, recent illness or surgery, and
- Iden�fy adults, who are malnourished, at risk of anthropometric measurements such as calf circumference.
malnutri�on (undernutri�on), or obese (overnutri�on). It also includes a global assessment of the individual's
- It also includes management guidelines which can be used health and nutri�onal status.
to develop a care plan. It is for use in hospitals, community Based on the scores obtained from both the screening and
and other care se�ngs and can be used by all care workers. assessment, individuals are categorized into one of the following three
2. SGA (Subjec�ve Global Assessment) groups:
- Evaluates whether an individual is appropriately nourished A. Normal Nutri�onal Status: No apparent risk of
- It is a clinical method used by healthcare professionals to malnutri�on.
assess an individual's nutri�onal status based on both B. At Risk of Malnutri�on: This category indicates that the
subjec�ve and objec�ve informa�on. individual may be at risk of malnutri�on and requires
- It is o�en employed in healthcare se�ngs, par�cularly by further inves�ga�on or interven�on.
die��ans and clinicians, to iden�fy individuals at risk of C. Malnourished: This category suggests that the individual is
malnutri�on. already malnourished and needs immediate aten�on and
- SGA involves gathering informa�on through a combina�on nutri�onal support.
of clinical judgment, medical history, and physical 4. GNRI (Geriatric Nutri�onal Risk Index)
examina�on. - Is a widely used, simple, and well-established tool to assess
THE ASSESSMENT IS TYPICALLY CONDUCTED IN TWO PARTS: nutri�onal risk.This was to assess the associa�on between
Subjec�ve Assessment: GNRI and all-cause mortality in diabe�c foot ulcers pa�ents
- This involves obtaining informa�on from the individual undergoing minor or major amputa�ons.
or, in some cases, from their caregivers. FORMULA:
- The healthcare professional may inquire about changes GNRI= [1.489 x albumin (g/L)] + [41.7 x (body weight/ideal body
in weight, dietary intake, gastrointes�nal symptoms, and weight)].
func�onal capacity.
Objec�ve Assessment:
- This part involves a physical examina�on to gather objec�ve
data.
- The healthcare professional evaluates anthropometric
measurements (such as weight, height, and body mass The GNRI is interpreted as follows:
index), body composi�on, and signs of muscle and fat • GNRI ≥ 98: No or low risk of nutri�onal complica�ons.
was�ng. Clinical observa�ons, including the presence of • 92 ≤ GNRI < 98: Mild to moderate risk of nutri�onal
edema or other physical signs, are also considered. complica�ons.
Based on the gathered information, the healthcare professional • GNRI < 92: Severe risk of nutri�onal complica�ons.
assigns a global rating, classifying the individual into one of three Here's a brief breakdown of the components used in the GNRI formula:
categories: Serum Albumin Level:
A. Well-nourished: No evidence of malnutri�on. - Serum albumin is a protein found in the blood and is o�en
used as an indicator of nutri�onal status.
  Low levels of serum albumin may suggest protein
malnutri�on or other underlying health issues.
Actual Weight and Ideal Weight:
- The ra�o of actual weight to ideal weight is a measure of
body weight in rela�on to what is considered op�mal
for an individual's height.
 Devia�ons from the ideal weight may indicate
malnutri�on or excess weight.
Example:
Compute for the GNRI
Mariano: H-161,W-61, Serum albumin: 24g/dl 161-100=61
161-150=11/4 = 2.75
61-2.75 = 58.25 (ideal body wt.)
(1.489x24=35.74)+41.7(61/58.25=1.05)= 43.78
35.74+43.78= 79.52
(Severe risk of nutri�onal complica�ons)