Nutritional Assessment

Excerpt

Food and nutrition are basic, indispensable needs of humans. Nutrition plays a critical role in maintaining the health and well-being of individuals and is also an essential component of the healthcare delivery system. The nutritional status of individuals affects the clinical outcomes. Essential nutrients are classified into 6 groups, namely carbohydrates, proteins, lipids, minerals, vitamins, and water.

Nutritional requirements of healthy individuals depend on various factors, such as age, sex, and activity. Hence, recommended values for dietary intake vary by group. In the United States, the Food and Nutrition Board of the Institute of Medicine (IOM), under the National Academy of Sciences, issues nutrition recommendations for populations across the life span, called Dietary Reference Intakes (DRIs).

An imbalance in nutritional intake leads to malnutrition. The word ‘malnutrition’ is defined in multiple ways, and there is still no consensus. Traditionally, the term malnutrition has been used in the context of inadequate energy intake or nutrient deficiencies, under which 2 main conditions, namely marasmus and kwashiorkor, are discussed. Marasmus primarily refers to energy or calorie deficiency, whereas kwashiorkor refers to protein deficiency, characterized by peripheral edema.

However, the term malnutrition now encompasses conditions resulting from both insufficient and excessive intake of macronutrients and micronutrients. As per WHO guidelines, malnutrition encompasses 3 categories, namely,

1. Undernutrition (low weight-for-height, low height-for-age, and low weight-for-age),

2. Micronutrient (vitamins and minerals) deficiency or excess, and

3. Overnutrition (overweight, obesity, and other diet-related health conditions such as type 2 diabetes mellitus and cardiovascular disorders).

The presentation of malnutrition can be acute, sub-acute, or chronic and may or may not be associated with underlying inflammation. Furthermore, the double burden of malnutrition has also been emphasized in various studies. This involves the coexistence of overnutrition and undernutrition, making the diagnosis of malnutrition challenging. Hence, a comprehensive, multifaceted evaluation of a patient's nutritional status is warranted. A comprehensive nutritional assessment, however, should be differentiated from nutritional screening. Nutritional screening is done to quickly identify individuals at risk of developing malnutrition.

For example, the mini nutritional assessment (MNA) is used in the geriatric patient population to screen for individuals at risk of malnutrition. This screening tool consists of a questionnaire and a scoring system to help identify at-risk individuals. On the other hand, a comprehensive nutritional assessment is performed to evaluate the nutritional status of patients already identified at nutritional risk. Nutritional assessment enables healthcare providers to systematically evaluate patients' overall nutritional status, diagnose malnutrition, identify underlying pathologies that contribute to it, and plan appropriate interventions.