How Nutritional Assessments Help Treatment
Comprehensive Diagnostic Evaluations at J. Flowers Health Institute
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What is a Nutritional Assessment?
A nutritional assessment is a practice provided typically by nutritionists or trained healthcare providers that looks at an individual's overall dietary health. J. Flowers Health Institute uses nutritional assessments as part of its comprehensive diagnostic evaluations, leading to better treatment outcomes.
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?
A nutritional assessment will first and foremost identify if an individual is malnourished. Malnutrition is defined as "disturbance of form or function arising from the deficiency or one or more nutrients."2 Because everyone's body composition is so different, malnutrition can be hard to diagnose, but typically a diagnosis looks at the body mass index (BMI) and if 5-10 percent of total body weight has been intentionally lost in the last 3-6 months.2 Symptoms of malnutrition may include low mood, fatigue, muscle weakness, and being prone to infection or illness.2
Where and How is a Nutritional Assessment Performed?
A nutritional assessment is typically conducted by a nutritionist or a health professional who is trained in nutrition.1 While nutritional assessment might be conducted on patients who have been identified to be malnourished or at risk for malnourishment, anyone can visit a nutritionist to get an idea of their health status and how they might make better nutritional choices. When they understand the relationship between what they eat and how that impacts their health, both positively and negatively, they might be more likely to eat foods that are more nutritious and better for their health.
Nutritional assessments can occur in a health care facility, in home-based care, or during support group meetings.1 A nutritional assessment will include taking anthropomorphic measurements, which include measuring height, weight, head circumference, mid-upper-arm-circumference (MUAC) and skinfold thickness, and a biochemical, clinical and dietary assessment, sometimes followed by an environmental assessment.1
What is Tested?
An anthropomorphic assessment is the measurement of the size, weight, and proportions of the body.1
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 old, most babies are expected to have doubled their birth weight.1 For babies 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 kidneys and liver.3 Some examples of biochemical measurements include:3
Hemoglobin, which looks at iron levels and indicates anemia.
Albumin, which at low levels can indicate inflammation or infection.
C-Reactive Protein, which indicates potential infection and inflammation.
White cell count, which is an indicator of an active immune system. If white cell count is high, then infection is present.
Glycated Hemoglobin indicates an average blood sugar level over a period of months.
Sodium levels indicate hydration status and kidney function. High sodium levels might indicate dehydration.
Urea levels indicate kidney function and may indicate possible dehydration.
Calcium and phosphate levels are used to assess the risk of refeeding syndrome, which is a result of malnourishment.
Magnesium levels that are low indicate gastrointestinal losses.
Micronutrients will be impacted if inflammation or infection is present.
Chronic obstructive pulmonary disease
Gastrointestinal disorders (Crohn's disease, liver disease, coeliac disease)
Neurological conditions (stroke, motor neuron disease, Parkinson's disease, multiple sclerosis, dementia)
Burns, surgery, or trauma
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, having nutritional deficiencies can also impact the effectiveness of and medications.
A clinical assessment also checks for signs of nutritional deficiencies such as bilateral pitting edema, emaciation, hair loss, and changes in hair color.1
A bilateral pitting edema (also called a 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.
If edema exists in both feet or both legs, then it is a clear sign of severe nutrition, but only if present in both feet or both legs.1 If an individual has bilateral pitting edema but still has an appetite and no other medical complications, they are still suffering from malnutrition and should seek treatment.1
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 where they didn't eat enough during or after an illness.1 A dietary assessment can be conducted via several methods that include:
A 24-hour recall is when a patient recalls all of the food and drink that they consumed in the previous 24 hours. These can be conducted numerous times on different days to account for the differences in eating habits from day to day. Patients will recall what time they ate, and the size of their portions.1
Food Frequency Questionnaire
A food frequency questionnaire asks patients about the quality of their food, how frequently they eat, and the size of their portions. While questionnaires are easy and inexpensive to administer, patients often under-report or do not accurately report what they eat, whether that is due to memory issues or wanting to withhold certain information.1
Food Group Questionnaire
A food group questionnaire is different than the first two methods in that a healthcare professional will show the patient visuals of different types of food and food groups and ask them to identify if they ate any of that the day before. This way, rather than someone having to recall everything they ate on their own, their memory might be stimulated by showing them various food groups and options of what they might have eaten.1
Food Security Assessment
Food security is defined as having physical and economic access to enough food to meet the dietary requirements for a healthy life. This means that food must be made available to people and must exist in large enough quantities to feed the population. Food must also be made ready for consumption and utilization. If someone is struggling with food security, there are many support systems in place to help people have access to plentiful healthy food.1
An environment assessment looks at an individual's ability to shop, cook, and feed themselves. It looks at 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 regards 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 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
To identify the risk of malnutrition and intervene before becoming malnourished
To identify malnourished patients and refer them to treatment
To track the growth of a child
To identify medical issues that affect the body's ability to digest food and process nutrients
To identify habits, behaviors, or practices that might increase the risk of malnutrition or infection
To inform nutritional education
To help collect data for diagnostic purposes
To monitor any changes in nutritional status
To help create a nutritional plan and provide nutritional guidance
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.
How Can a Nutritional Assessment Help with the Treatment of Substance Use Disorder?
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 their 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.
While nutritional guidance is often overlooked in the treatment of substance use disorder, research shows that treatment and recovery outcomes are improved with nutrition therapy and a well-balanced diet.2 What we put into our body to nourish it really affects our health.
What is Nutritional Guidance?
The U.S. Department of Health and Human Services and U.S. Department of Agriculture have created the 2015–2020 Dietary Guidelines for Americans, 8th Edition.4 These guidelines outline healthy eating practices, recommendations, and guidelines for living a healthy life. The guidelines provided are: 4
Follow a healthy eating pattern across the lifespan. All food and beverage choices matter. Choose a healthy eating pattern at an appropriate calorie level to help achieve and maintain a healthy body weight, support nutrient adequacy, and reduce the risk of chronic disease.
Focus on variety, nutrient density, and amount. To meet nutrient needs within calorie limits, choose a variety of nutrient-dense foods across and within all food groups in recommended amounts.
Limit calories from added sugars and saturated fats and reduce sodium intake. Consume an eating pattern low in added sugars, saturated fats, and sodium. Cut back on foods and beverages higher in these components to amounts that fit within healthy eating patterns.
Shift to healthier food and beverage choices. Choose nutrient-dense foods and beverages across and within all food groups in place of less healthy choices. Consider cultural and personal preferences to make these shifts easier to accomplish and maintain.
Support healthy eating patterns for all. Everyone has a role in helping to create and support healthy eating patterns in multiple settings nationwide, from home to school to work to communities.
What a Healthy Eating Pattern Includes
When it comes to recommendations on healthy eating patterns, the guidelines state a healthy eating pattern includes:4
Vegetables from all subgroups (dark green, red, orange, legumes (beans and peas), starchy, etc.)
Grains (at least half being whole grains)
Fat-free or low-fat dairy (milk, yogurt, cheese)
Protein (seafood, lean meat, and poultry, eggs, legumes, nuts, seeds, soy)
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).4 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 daily activity and decrease 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 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 a 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 are:4
- 80% for vegetables
- 80% for dairy
- 75% for fruit
- 70% for healthy oil
- 40% for healthy grains
- 40% for health protein
The same people exceed the recommended daily intake of the following food groups:4
- 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 of foods that are unhealthy and dangerous in excess.
Recommendations involving food groups and calories include:4
Consume less than 10 percent of calories per day from added sugars
Consume less than 10 percent of calories per day from saturated fats
Consume less than 2,300mg of sodium per day
Guidelines for Physical Activity
In terms of physical activity guidelines
- Children aged 6 to 17 should go 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?
The percentage of people in each age group who follow the physical activity guidelines is: 4
- 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, American's are not getting enough physical exercise. That, compiled with the fact that American's are also not following dietary guidelines, has lead to remarkably high rates of obesity, with more than half the country being overweight or obese.4The 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.
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 understanding 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.
Sooner or later, however, a lack of proper nutrients will catch up to us, and it is essential to be informed and knowledgeable about health guidelines. Nutritional guidance can be incorporated as a part of a treatment plan, particularly for those who are severely malnourished as a result of a substance use disorder. Choose an addiction treatment program that incorporates nutritional guidance to maximize your chances of recovery.