Nutritional Status Assessment in Adults

Nutritional Status Assessment in Adults

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An assessment of nutritional status in adults may include a comprehensive evaluation consisting of a tailored history and physical examination, laboratory assessment, anthropometrics, body composition, and functional data. [1, 2]

No single variable accurately and reliably relays nutritional status of a subject in every situation. Validated screening tools are available for use in certain populations.

Poor nutritional status has been known to have unfavorable effects. Individuals with less than 80% expected total body protein levels have demonstrated increased morbidity, and 10% or greater unintentional weight loss has been associated with adverse outcomes and prolonged hospitalizations. In lean healthy subjects, weight loss over 35%, protein loss over 30%, and fat loss over 70% from baseline has been associated with death. [3]

Measurement of nutritional status in adults has no absolute indications. The importance of nutritional assessment becomes apparent during acute illness, in which malnutrition has been associated with increased morbidity and mortality. Identification of malnourishment and appropriate intervention may improve outcomes.

Assessment of nutritional status in adults has no specific contraindications. However, owing to the cooperation required, hydrodensitometry may not be suitable for subjects who are physically challenged, children, or elderly persons. Additionally, bioelectrical impedance analysis (BIA) should not be performed in subjects with pacemakers.

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Jensen GL, Hsiao PY, Wheeler D. Adult nutrition assessment tutorial. JParenter Enteral Nutr. May/2012. 36:267-74. [Medline].

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American College of Sports Medicine. ACSM’s guidelines for exercise testing and prescription. 8. Philadelphia: Lippincott Williams & Wilkins; 2010.

Practical assessment of body composition. Jackson A, Pollock M. Physician and Sports Medicine. 1985. 13:76-90.

Frisancho AR. New norms of upper limb fat and muscle areas for assessment of nutritional status. Am J Clin Nutr. November/1981. 34:2540-5. [Medline].

Miller MD, Crotty M, Giles LC, et al. Corrected arm muscle area: an independent predictor of long-term mortality in community-dwelling older adults?. J Am Geriatr Soc. July/2002. 50:1272-7. [Medline].

Wijnhoven HA, van Bokhorst-de van der Schueren MA, Heymans MW, et al. Low mid-upper arm circumference, calf circumference, and body mass index and mortality in older persons. J Gerontol A Biol Sci Med Sci. June/2010. 65:1107-14. [Medline].

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Massy-Westropp NM, Gill TK, Taylor AW, et al. Hand Grip Strength: age and gender stratified normative data in a population-based study. BMC Res Notes. April/2011. 14:127. [Medline].

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Biaggi RR, Vollman MW, Nies MA, et al. Comparison of air-displacement plethysmography with hydrostatic weighing and bioelectrical impedance analysis for the assessment of body composition in healthy adults. Am J Clin Nutr. May/1999. 69:898-903. [Medline].

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Banh L. Serum Proteins as Markers of Nutrition: What Are We Treating?. Practical Gastroenterology. October/2006. 29:46-64.

Area/System

Symptom or Sign

Deficiency

General appearance

Wasting

Energy

Skin

Rash

Many vitamins, zinc, essential fatty acids

Rash in sun-exposed areas

Niacin (pellagra)

Easy bruising

Vitamin C or K

Hair and nails

Thinning or loss of hair

Protein

Premature whitening of hair

Selenium

Spooning (upcurling) of nails

Iron

Eyes

Impaired night vision

Vitamin A

Corneal keratomalacia (corneal drying and clouding)

Vitamin A

Mouth

Cheilosis and glossitis

Riboflavin, niacin, pyridoxine, iron

Bleeding gums

Vitamin C, riboflavin

Extremities

Edema

Protein

Neurologic

Paresthesias or numbness in a stocking-glove distribution

Thiamin (beriberi)

Tetany

Ca, Mg

Cognitive and sensory deficits

Thiamin, niacin, pyridoxine, vitamin B12

Dementia

Thiamin, niacin, vitamin B12

Musculoskeletal

Wasting of muscle

Protein

Bone deformities (e.g., bowlegs, knocked knees, curved spine)

Vitamin D, Ca

Bone tenderness

Vitamin D

Joint pain or swelling

Vitamin C

GI

Diarrhea

Protein, niacin, folate, vitamin B12

Diarrhea and dysgeusia

Zinc

Dysphagia or odynophagia (due to Plummer-Vinson syndrome)

Iron

Endocrine

Thyromegaly

Iodine

Percentage of Standard (%)

Men (cm2)

Women (cm2)

Muscle Mass

100 ± 20*

54 ± 11

30 ± 7

Adequate

75

40

22

Marginal

60

32

18

Depleted

50

27

15

Wasted

*Mean mid upper arm muscle mass ± 1 standard deviation. From the National Health and Nutrition Examination Surveys I and II.

Protein

Half-life, days

Function

Comment

Albumin

14-20

Maintenance of plasma oncotic pressure; carrier protein

levels increase with dehydration, blood and albumin transfusion, and anabolic steroids

levels decrease in liver failure, inflammation, volume overload states (cirrhosis, congestive heart failure, renal failure), zinc deficiency, protein-losing states (nephrotic syndrome, enteropathy), corticosteroid use, and bedrest

Transferrin

8-9

Iron transport

levels increase during dehydration, iron deficiency, pregnancy, estrogen therapy, and acute hepatitis

levels decrease in liver and renal failure, inflammation, anemia due to chronic disease and vitamin B12 and folate deficiency, corticosteroids, zinc deficiency, and protein-losing states (nephrotic syndrome, enteropathy)

Often measured indirectly as total iron-binding capacity (TIBC)

Prealbumin (transthyretin)

2-3

Binds thyroxine; carrier for retinol-binding protein

levels increase in renal failure (degraded by the kidney) and corticosteroid and oral contraceptive use

levels decrease in liver failure, inflammation, and hyperthyroidism

Retinol-binding protein (RBP)

12-24

Vitamin A transport; binds to prealbumin

levels increase in renal failure (degraded by the kidney)

levels decrease in cirrhosis, inflammation, vitamin A and zinc deficiency, and hyperthyroidism

W Aaron Hood, DO Fellow, Department of Gastroenterology, Largo Medical Center, Nova Southeastern University College of Osteopathic Medicine

W Aaron Hood, DO is a member of the following medical societies: American College of Gastroenterology, American College of Osteopathic Internists, American College of Physicians, American Osteopathic Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Jeremy R Stapleton, DO Charleston Gastroenterology Associates

Jeremy R Stapleton, DO is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Vikram Kate, MBBS, MS, PhD, FACS, FACG, FRCS, FRCS(Edin), FRCS(Glasg), FIMSA, MAMS, MASCRS Professor of General and Gastrointestinal Surgery and Senior Consultant Surgeon, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), India

Vikram Kate, MBBS, MS, PhD, FACS, FACG, FRCS, FRCS(Edin), FRCS(Glasg), FIMSA, MAMS, MASCRS is a member of the following medical societies: American College of Gastroenterology, American College of Surgeons, American Society of Colon and Rectal Surgeons, Royal College of Physicians and Surgeons of Glasgow, Royal College of Surgeons of Edinburgh, Royal College of Surgeons of England

Disclosure: Nothing to disclose.

Nutritional Status Assessment in Adults

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