How Nutritional Assessments Help Treatment
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What is a Nutritional Assessment?
Table of Contents
A nutrient is a substance that provides the body with the nourishment required to be healthy. A nutritional assessment looks at whether the body is receiving the necessary nutrients. A nutritional assessment involves taking anthropomorphic measurements and looking at medical history, clinical and biochemical characteristics, diet, and other environmental factors such as food security.1
What is Malnutrition?
Where and How is a Nutritional Assessment Performed?
What is Tested?
The first step in an anthropomorphic assessment is usually to measure an individual's weight, which is strongly related to their health status. Losing weight unintentionally can be an indicator of poor health and an inability of the body to fight off infection. Weight gain can be indicative of poor nutritional practices or a side effect of a medication they might be taking. Having a low pre-pregnancy weight and inadequate weight gain during pregnancies are indicators of growth problems and potential low birth weight for babies.1
Weight is measured using a scale. Newborns are weighed using balance beam scales or digital scales and are thought to have a low birth weight if they are less than 2,500g.1 A low birth weight puts babies at higher risk of physical and cognitive problems and nutrition-related chronic diseases.1 While all babies lose weight immediately after birth, if they have not regained the weight within their first week of life, they are at risk of further complications.1
By five months most babies are expected to have doubled their birth weight. Forbabies under the age of six months, the anthropomorphic measures include weight-for-length, weight-for-age, and head circumference.1 The reason that babies are weighed so frequently after birth is that weight is an excellent indicator of nutritional health in infants.
Adults and infants alike are measured with measuring tapes. An individual's height is not particularly indicative of their health on its own, however, combined with their weight can tell a lot about their particular health in terms of how much they weigh compared to how tall they are. In other words, taller people will typically weigh more than shorter people, so the proportions of the measurements have to be taken into consideration.
Weight-for-height (WHZ) is an index that is used the measure the nutritional health of infants up until the age of five.1 A WHZ index compares a child's weight to the weight of other children that are the same height and sex and have been identified in the WHO Child Growth Standards.1
Mid Upper Arm Circumference (MUAC)
MUAC is the measurement of the circumference of the mid-upper arm at the mid-point between the tip of the shoulder and the tip of the elbow.1 A MUAC measuring tape is used, which shows millimeter measurements. MUAC assessments measure the nutrient reserves in muscle and fat.1 The MUAC assessment is measured independently to consider an individual's height or whether or not they are pregnant. MUAC assessments can also be used as an alternative to WHZ measurements, BMI for age measurements, or for those whose height and weight cannot be measured.1 MUAC should not be used for infants under six months and should not be used as a tool for people who have edema.1
A biochemical assessment looks at the levels of nutrients and chemicals present in the blood, urine, or stools.1
This testing is sent to a lab after which the results can be used by healthcare professionals to find information about the individual’s health, any medical problems they have, or any medical problems they might be at risk of. Tests also measure the function of vital organs such as the kidneys and liver.3
Some examples of biochemical measurements include:3
Having diarrhea, constipation, reflux, bloating, nausea, vomiting, lethargy, feeling prematurely full, having trouble swallowing, or experiencing lethargy are all symptoms of a disease that may decrease nutrient intake or increase nutritional losses.3
Certain medications might interfere with the absorption of nutrients, digestion, and metabolism. On the flip side, nutritional deficiencies can also impact the effectiveness of medications.
Bilateral pitting edema (also called nutritional edema) is when there is swelling in both the feet or legs caused by the build-up of fluid underneath the skin.1
This occurs when too much fluid moves from the blood vessels into the tissues or when not enough fluid moves from the tissues back into the blood vessels.1
A bilateral pitting edema can be easily identified by pushing a thumb into the swollen feet or legs and seeing if the indentation remains even after releasing the thumb.
An essential part of understanding nutritional health is knowing what food and fluids one is ingesting daily. A dietary assessment will provide information on how much food an individual eats, the quality of their food, any changes in appetite they have experienced, food allergies or intolerances, and times when they didn’t eat enough during or after an illness.1
A dietary assessment can be conducted via several methods that include:
Food Frequency Questionnaire
Food Group Questionnaire
Food Security Assessment
An environment assessment looks at an individual’s ability to shop, cook, and feed themselves. It looks at the budget, mobility, meal times, and family support, particularly if nutrition is a concern.3
It will also look at appetite, dexterity, how cutlery is used, and the general practices surrounding food.3
What Does the Assessment Identify?
A nutritional assessment provides patients and healthcare providers with an overall picture of their health and nutrition. The overall health of the body with regard to nutrition, dietary habits, and weight is an important factor in identifying any possible health risks or health problems and preventing and treating diseases.
Weight loss or weight gain can be indicative of bigger health problems. Losing 10% of one’s weight or more can lead to prolonged hospitalizations and losing 35% of one’s weight (if they are at a healthy weight to begin with) can lead to death.1
Nutritional status also affects the immune system and the way that the body responds to medical interventions.1
Some of the specific reasons that healthcare providers conduct nutritional assessments are to:1
What Type of Plan is Created by the Assessment?
The results of a nutritional assessment help healthcare providers to create a plan for patients that may involve counseling, treatment, or referrals to food security or other social supports. For example, someone struggling with their eating habits might be referred to counseling, or someone struggling to have access to might be referred to a social worker or a food bank or other support service to prevent malnutrition.
What Does the Assessment Identify?
A nutritional assessment can help with the treatment of substance use disorders to understand how addiction affects nutrition and eating habits and how those effects might need to be addressed in a treatment plan. Substance use disorders can often lead to malnutrition, metabolic disorders, and altered body composition.2 Using substances can change an individual’s dietary habits, appetite, the portions of food that they eat, and the way that they view their body.2
All of these changes can negatively impact nutritional health, and thus, it is important when treating substance use disorders to also focus on nutritional health.
Alcohol Use Disorders and Malnutrition
People who struggle with alcohol use disorder, in particular, are generally malnourished because alcohol inhibits the absorption of nutrients.1 Excessive alcohol can negatively impact the health of the gastrointestinal tract and can have some of the following effects: mucosal damage in the mouth, esophagus, and stomach, delayed gastric emptying, increased intestinal permeability, and membrane damage, bacterial overgrowth, and cancer.2
Research has shown that patients with alcohol use disorders have inadequate levels of most nutrients including:2
Uncovering Unhealthy Eating Patterns
Conducting a nutritional assessment with someone who suffers from substance use disorder will be useful in uncovering unhealthy eating patterns, potential health problems, and potential health risks. An individual’s body and health are integrated fully, so when being treated for one problem, it is important to look at the body as a whole and how that one problem might have affected other parts. Identifying which nutrients are needed will allow healthcare providers to come up with a plan to help with the maintenance of healthy nutrient levels, whether that includes changes to eating patterns, supplements, and vitamins.
What is Nutritional Guidance?
The U.S. Department of Health and Human Services and the U.S. Department of Agriculture have created the 2015–2020 Dietary Guidelines for Americans, 8th Edition. These guidelines outline healthy eating practices, recommendations, and guidelines for living a healthy life. The guidelines provided are:4
What a Healthy Eating Pattern Includes
How Many Calories Should be Consumed in a Day?
There is no exact answer to how many calories one should consume every day. This number will depend on height, weight, and daily activity level. Generally, adult women should eat between 1,600 to 2,400 calories a day, and adult men should eat between 2,000 and 3,000 calories per day (lower end for sedentary individuals and higher end for very active individuals). If an individual needs to gain weight to maintain a healthy weight, they should increase their calorie intake. If they need to lose weight to maintain a healthy weight, they need to increase their daily activity levels and decrease their daily calorie intake. One should not engage in large amounts of weight loss or weight gain without speaking to a doctor or nutritionist first.
How Can Nutritional Guidance Help with the Treatment of Substance Use Disorder?
Those who suffer from alcohol and substance use disorders are often malnourished. Substance abuse can affect nutritional status and body composition by resulting in inadequate nutrient intake, absorption, and changes to metabolism. Once the body is no longer receiving and absorbing nutrients correctly, a slew of health problems may appear.
Therefore, nutritional guidance is critical in helping people with substance use disorder understand nutrition, eating habits, and how what they eat affects their health. Because human beings can easily eat unhealthy foods for long periods without noticing severe health issues, it is easy to ignore nutrition and just eat what we want from day to day.
How Effective is Nutritional Guidance?
While we have all heard someone talk about nutrition at some point in our lives, whether that was a parent, teacher, or healthcare professional. With the amount of processed food on the shelves, it is no surprise that it is challenging to stick to the guidelines.
The percentage of people who do not meet the recommended daily intake for the different food groups is:4
- 80% for vegetables
- 80% for dairy
- 75% for fruit
- 70% for healthy oil
- 40% for healthy grains
- 40% for healthy protein
- 90% for sodium
- 60% for saturated fats
- 60% for refined sugar
The Need to Follow Nutritional Guidance
To put it simply, people are not eating enough of the healthy foods they should eat and are overeating foods that are unhealthy and dangerous in excess.
Guidelines for Physical Activity
- Children aged 6 to 17 should do at least one hour of physical activity a day, which should include aerobic exercises (high intensity three times a week), muscle-strengthening (three times a week), and bone-strengthening exercises (three times a week).4
- Adults aged 17 to 64 should get at least 150 minutes of moderate-intensity exercise a week or 75 minutes of high-intensity exercise a week.4
- Adults should strength-train at least two times a week, and 300 minutes of exercise would be recommended for the best health results.4
- Adults over the age of 65 should be as physical as possible while trying to maintain 150 minutes of activity a week.1
Do People Follow Physical Activity Guidelines?
- 30% for ages 18-24
- 20% for ages 25-44
- 20% for ages 45 to 54
- 10-15% for ages 65 to 74
- 10% for ages 75 to 84
- 5% for ages 85 and older
To make a long story short, Americans are not getting enough physical exercise. That, compiled with the fact that Americans are also not following dietary guidelines, has led to remarkably high rates of obesity, with more than half the country being overweight or obese.4
The statistics are startling; in 2009-2012, 65% of adult females and 73% of adult males were overweight or obese, and nearly one in three youth ages 2 to 19 years were overweight or obese.4
This can lead to further health problems and health complications and can shorten the lifespan, which is why it is vital to follow nutritional guidelines and physical activity guidelines as much as possible to live a healthy and nutritious lifestyle.