PRINSIP TERAPI DIET

Nutritional Assessment

?1

Screening and Assessment of the Nutritional Status

2SCREENING

3

Nutritional AssessmentBody compositionBiochemical dataClinical Assessment Subjective Global Assessment (SGA)4Patients who are at nutritional risk require a more detailed assessment. The nutritional assessment is the process of collecting, assessing, and interpreting three classes of data: Body composition from anthropometric measurements Biochemical data Clinical assessmentBoth biochemical data and body composition measurements are subject to interference from a number of factors and therefore should not be used alone. Ideally, all three components should be evaluated before malnutrition is diagnosed. The technique known as Subjective Global Assessment (SGA) allows physicians to utilize available clinical data to assess a patients nutritional status. This technique will be described later and you will actually practice SGA in Workshop 1A.

5

6

7

8

9

10Nutritional Screening Involuntary increase or decrease in weight > 10% of usual weight over 6 months or > 5% of usual weight over 1 monthInadequate oral intake

11The first step in the process is to screen patients according to their nutritional risk. Screening tools can be quite simple and quick to administer. This slide gives an example of nutritional information that the patient can provide, such as body weight changes within a given time frame and amount of oral intake.

Barrocas et al. J Am Diet Assoc 1995;95:647-648.

Nutritional Assessment: Body Composition Parameter Weight and heightBMI = weight / height2Triceps or subscapular thickness of skin fold Mid-arm muscle circumference and mid-arm muscle area

12Body composition parameters in nutritional assessment are often measured by anthropometric techniques. Among the most common are:Weight and height, which can generally be expressed as Body Mass Index (BMI).Triceps or subscapular skin fold thickness, which is used to measure fat mass.Mid-arm muscle circumference (MAMC) and mid-arm muscle area (MAMA), used to measure muscle mass.Some institutions have the technical resources and trained staff to take other measurements, such as bioelectric impedance, underwater weighing, tomography, total-body potassium, and ultrasound.

Nutritional Assessment:Biochemical Parameters At Risk LevelSerum albumin< 3.5 g/dLTotal lymphocyte count< 1500 cell/mm3Serum transferrin