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MENDOZA, MSPH
Planning Officer
Food and Nutrition Research Institute
Department of science and Technology
Disordered nutrition of any kind, can be categorized in
a number of ways (McLaren)
(Secondary)
Impaired food absorption,
utilization, or transport
Increased requirements,
destruction or excretion
Biochemical
Nutrient levels in blood,
urine tissues
DECREASED TISSUE LEVELS Anthropometry
Weight for height, fat folds,
circumferences
ALTERED PHYSIOLOGICAL/ Blood, urine and tissue levels
BIOCHEMICAL FUNCTIONS of enzymes, coenzymes and
metabolites
Anthropometric measurement
Biochemical examination
Biophysical technique
Clinical examination
Methods that provide indirect information
Measurements of nutrients
of their metabolites
Performed usually on blood or urine
Index/Indices
- Combination(s) of measurements;
e.g. weight-for-age, weight-for-height and
height-for-age
Indicator
- Relates to the use or application of indices;
e.g. infant mortality rate (ratio of deaths to births)
Reference data
- Population characteristic or distribution properly
derived from a large representative sample of the
population which is reasonably healthy and well
nourished, against which indices are compared
Cut-off Points
- Based on the relationship between nutritional
assessment indices and functional impairment
and/or clinical signs of deficiency; used to classify
malnourished individuals and determine prevalence
of malnutrition
Factors in choosing a method
Objective/ goal of =P
==
the study
Resources
a. funds
b. time
c. manpower
Desired reliability
concerns with measurements
of the variations of the
physical dimensions and
gross composition of the
human body at different age
levels and degrees of
nutrition
Growth Measurements
Body Composition
Measurements
most widely used anthropometric
measurements in the assessment
of growth are those of stature
(length or height) & body weight;
in addition, circumferences and
diameters (breadth) of some parts
of the body, e.g., head, elbow, etc.
can be subdivided into measurements of
body fat and fat-free mass
- the fat-free mass consists of the skeletal
muscle, non-skeletal muscle and soft lean
tissues, and the skeleton
- body fat, on the other hand, is deposited in
two types of storage sites: one for essential
lipids and the other general fat storage.
Anthropometric techniques can indirectly
assess these two body compartments
Weight
measure of total body mass
Weight-for-age
growth or degree of
skeletal
development,
measures the
amount of linear
growth
Length - refers to the
measurement in a recumbent
position, and is measured in
laying position for children under
2 years of age
indicator of current
nutritional status or
acute undernutrition
(wasting)
Wasting
deficit in tissue and fat mass
Fractured
vertebrae
Rib
cage
Pelvis
Mitchell, 1997
Blade on anterior surface of thigh,
proximal to the patella
Subject
supine
Gibson, 1990
Stature
For Women Gibson, 1990
Knee Stature (cm)
height For Men
190
(cm) (cm)
70 203
180
65 193
60 183
Age 170
(years)
90 55 173
50 163 160
80
70 45 153
150
60 40 143
140
35 133 Formulae - Developed by
Chumlea et al.
130
Male stature (cm) = (2.02 x knee height [cm]) - (0.04 x age [yr]) + 64.19
Female stature (cm) = (1.83 x knee height [cm]) - (0.24 x age [yr]) + 84.88
Armspan - distance
between outstretched
fingers of right and left
hands, with arms
extended laterally and
maximally to the level
of the shoulders
Halfspan - distance
between middle finger
of stretched hand and
arm to the mid u bone
at the base o f the
neck
Ismail & Manandhar, 1999
Weight-for-height ratios
Relative weight
Power-type indices
ht
Ponderal index = 3/wt
wt
Benn’s index = (ht) p
Body Mass Index
also known as Quetelet’s index
BMI: Chart
1
W W
E E
I I
G G
H H
T T
k k
g g
s s
BMI: Chart
2
W W
E E
I I
G G
H H
T T
k k
g g
s s
Overweight 25 Increased
Pre-obese 25 - 29.9 Moderate
Obese class I 30.0 - 34.9 Severe
Obese class II 35.0 - 39.9 Very Severe
Obese class III 40.0
1.8
1.6
Mortality
1.4
1.2
1.0
0.8
0.6
15 20 25 30* 35
Body mass index (kg/m2)
HC is be measured by positioning
the measuring by positioning the
measuring tape around the hips
at the level of the great
trochanters
Acromion
process
on shoulder
blade
Mid-upper arm
circumference is Forearm, mid-point
palm down Olecranon
measured at the midpoint across process of
of the upper arm and body the ulna
Muscle
Double
fold of
skin
and fat
Mitchell, 199
Measurement
of Triceps Skinfold
Location of the
Subscapular and
Suprailiac Skinfold Sites
Mid-Axillary
Line
Left shoulder
blade
Suprailiac
skinfold
site
Local
Bulatao-Jayme, et. al.
FNRI-PPS Standards
a means to check child’s size
measures deviations from the normal
or average pattern of growth
serves as reference to measure change
in health and nutritional status
evaluates results of intervention
programs
defines extent and severity of under or
over-nutrition
provides basis for program planning
Percentile System
F
r
e
q
u
e
n
c
y
3 10 25 50 75 90 97
-3 SD -2 SD -1 SD Median +1 SD +2 SD +3 SD
(Note that the values below & above the median are different. This is explained by the fact that the
distribution of weight in the reference are not symmetrical and that separate standard deviations were
calculated for the upper and lower halves of the distributions.)
ratio of a measured value in
the individual for instance
weight, to the median value of
the reference data for the
same age or height,
expressed as a percentage
Comparison of Percentage Below Median (reference)
Corresponding Approximately to 3rd Centile (-2 SD) & to 97th
Centile (+2 SD) in Young Children up to 60 Months of Age.
115 100 85
Arm
* Severecircumference/
underweight for age: 60 per cent often used - simple to remember; long clinical use.
age
^ Severe underweight for height: 70 per cent (-3 SD)
The Gomez Classification
% Expected Category of
Weight Classification Nutritional
for Age Status
> 90% Normal Normal
Mild 1st degree
76-90% malnutrition
malnutrition
Sequential measurements
- serial measurements to calculate
growth velocity
Growth monitoring of individuals
- consecutive measurements to
determine faltering or flattening of
growth curve
Predictor of mortality risk
BIOCHEMICAL
ASSESSMENT
METHODS TO ASSESS
NUTRITIONAL STATUS
a. Physical examination of subjects for
presence or absence of signs and
symptoms of nutrient deficiency
b. Inquiry into dietary history
c. Biochemical test on easily available
fluids:
e.g., blood and urine
RATIONALE
Biochemical tests provide specific nutrition
information as well as identify borderline nutritional
conditions prior to the development of perceptible
or clinical symptoms of malnutrition. Biochemical
survey data, when considered with the dietary
intake and clinical findings, can be of considerable
value in assessing the nutritional status of
population groups.
Advantages of Biochemical Test
b. Urine
Random sample - convenient but
undependable
First voided morning sample
24 - hr specimen - desirable but difficult
to collect
TYPES OF BIOCHEMICAL TESTS
2. Measurements of one or more functions
of the nutrient
Example:
Glucose load test for thiamine where
blood levels of pyruvate and lactate are
determined
CLINICAL
ASSESSMENT
Clinical Assessment
Information collected:
Patient’s description, including current
illness
Personal, social, and medical history
including use of medications
Review of body’s physiological systems
Family medical history
Dietary history including use of dietary
supplements
Medical/Clinical History
Age of menarche
History of pregnancy
Overnutrition
Undernutrition
Iron deficiency anemia
Iodine deficiency anemia
Zinc deficiency
Physical Signs Indicative/Suggestive
of Malnutrition
Chronic Energy Deficiency – deficiency of energy intake for a
prolonged period of time.
Protein Energy Malnutrition – deficiency of protein and energy caused
by severe recent or long term restriction or deprivation
acute – characterized by thinness for height (wasting)
chronic – characterized by short height for age
(stunting)
Overnutrition
Children Elderly
DIMENSION IN DIETARY
SURVEY METHODS
TIME FRAME
Usual
Current
Nutrient databases
Direct chemical analyses
DIETARY ASSESSMENT IN
SPECIFIC SITUATIONS
Cross-sectional surveys
Case control (retrospective) studies
Cohort (prospective) studies
Intervention studies
Dietary screening in clinical settings
Dietary surveillance
FOOD CONSUMPTION:
NATIONAL LEVEL
2. Market Databases
Food account
Food inventory
Food record/weighing
Food recall
FOOD CONSUMPTION:
INDIVIDUAL LEVEL
Food record
weighed
estimated
24-hour food recall
Dietary history
Food frequency questionnaire
CONCERNS IN THE ESTIMATION
OF DIETARY INTAKE
Fortified foods
Dietary supplements
Functional
food/bioactive
components
Alcohol
DIETARY ASSESSMENT
METHODS
Twenty-four hour recall
Food frequency questionnaire
Dietary history
VALIDITY
Use of biochemical markers: 24-
hr urinary N excretion as a
measure of protein intake
DIETARY ASSESSMENT
MEASUREMENT CONCERNS
Age associated decline in short-term memory/memory
lapse
Incorrect estimation
Respondent biases
Flat slope syndrome
Supplement usage
Others: Use of alcohol, tobacco and drugs, dietary
restriction/food avoidance
CONVERSION INTO NUTRIENTS
1. USE OF FCT
data banks
INFOODS
2. DIRECT CHEMICAL ANALYSIS