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.

Camina-Martín MA, de Mateo-Silleras B, Malafarina V, Lopez-Mongil R, Niño-Martín V, López-Trigo JA, et al. Nutritional status assessment in geriatrics: Consensus declaration by the Spanish Society of Geriatrics and Gerontology Nutrition Work Group. Maturitas. 2015 Jul. 81 (3):414-9. [Medline].

Elmadfa I, Meyer AL. Developing suitable methods of nutritional status assessment: a continuous challenge. Adv Nutr. 2014 Sep. 5 (5):590S-598S. [Medline].

Feldman M, Friedman L, Brandt L. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease – Pathophysiology, Diagnosis, Management. 9. Elsevier; 2009.

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

Cornier MA, Després JP, Davis N, et al. Assessing adiposity: a scientific statement from the American Heart Association. Circulation. November/2011. 124:1996-2019. [Medline].

Durnin JV, Womersley J. Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged from 16 to 72 years. Br J Nutr. July/1974. 32:77-97. [Medline].

Jackson AS, Pollock ML. Generalized equations for predicting body density of men. Br J Nutr. November/1978. 40:497-504. [Medline].

Siri WE. Body composition from fluid spaces and density: analysis of methods. Nutrition. October/1993. 9:480-91. [Medline].

Brozek J, Grande F, Anderson JT, Keys A. Densitometric analysis of body composition: Revision of some quantitative assumptions. Ann N Y Acad Sci. September/1963. 110:113-40. [Medline].

Heyward V. ASEP Methods Recommendation: Body Composition Assessment. JEPonline. 2001. 4:1-12.

Leahy S, O’Neill C, Sohun R, et al. Generalised equations for the prediction of percentage body fat by anthropometry in adult men and women aged 18-81 years. Br J Nutr. May/2012. 29:1-8. [Medline].

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].

Makhija S, Baker J. The Subjective Global Assessment: a review of its use in clinical practice. Nutr Clin Pract. August-September/2008. 23:405-9. [Medline].

Vellas B, Villars H, Abellan G, et al. Overview of the MNA–Its history and challenges. J Nutr Health Aging. November-December/2006. 10:456-63. [Medline].

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].

Baracos V, Caserotti P, Earthman CP, et al. Advances in the science and application of body composition measurement. J Parenter Enteral Nutr. January/2012. 36:96-107. [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].

Heyward V. Advanced Fitness Assessment and Exercise Prescription. 6. Human Kinetics; 2006. 179-82.

Brodie D, Moscrip V, Hutcheon R. . Body composition measurement: a review of hydrodensitometry, anthropometry, and impedance methods. Nutrition. March/1998. 14:296-310. [Medline].

Roberts HC, Denison HJ, Martin HJ, et al. A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach. Age Ageing. July/2011. 40:423-9. [Medline].

Jacobs DG, Jacobs DO, Kudsk KA et al. Practice Management Guidelines for Nutritional Support of the Trauma Patient. J Trauma. September/2004. 57:660-79.

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


Symptom or Sign


General appearance





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


Premature whitening of hair


Spooning (upcurling) of nails



Impaired night vision

Vitamin A

Corneal keratomalacia (corneal drying and clouding)

Vitamin A


Cheilosis and glossitis

Riboflavin, niacin, pyridoxine, iron

Bleeding gums

Vitamin C, riboflavin





Paresthesias or numbness in a stocking-glove distribution

Thiamin (beriberi)


Ca, Mg

Cognitive and sensory deficits

Thiamin, niacin, pyridoxine, vitamin B12


Thiamin, niacin, vitamin B12


Wasting of muscle


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

Vitamin D, Ca

Bone tenderness

Vitamin D

Joint pain or swelling

Vitamin C



Protein, niacin, folate, vitamin B12

Diarrhea and dysgeusia


Dysphagia or odynophagia (due to Plummer-Vinson syndrome)





Percentage of Standard (%)

Men (cm2)

Women (cm2)

Muscle Mass

100 ± 20*

54 ± 11

30 ± 7














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


Half-life, days





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



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)


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)


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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