How can nutritional status be assessed in current practice

Nutritional assessment should include assessment of body composition, the presence and duration of inadequate nutrient intake, and the degree and duration of metabolic stress. The main markers of nutritional assessment in healthy adults are shown in Table!. All the current criteria for objective evidence of malnutrition are non-specifically affected by many diseases and are subject to wide errors; also, disease and inactivity alone can result in the same effects as malnutrition. Sophisticated methods of measuring body composition have been developed, such as multiple isotope dilution methods, dual-photon absorption, and g-neutron activation. Because of technical complexity, scientific limitations, and high cost, none of these methods is of clinical utility in routine critical care. In current practice, a comprehensive assessment of nutritional status relies on a step-by-step clinically based approach and cautious interpretation of measurements and results.

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Table 1 Indices of nutritional assessment

Clinical assessment

Recording the patient's history and physical examination, including weight measurement, must remain the first steps of standard nutritional assessment. History

The history includes dietary habits, nutrient intake, and interference between nutrition and the disease process itself. The latter may be responsible for either inadequate intake (because of anorexia, nausea, or dysphagia for example) or excessive losses (because of vomiting, diarrhea, or malabsorption for example).

Physical examination

Signs of nutritional deficiency, such as muscle wasting, loss of subcutaneous fat, skin rashes, hair thinning, edema, ascites, fingernail abnormalities such as koilonychia, glossitis, and other mucosal lesions, are sought. Apathy and lethargy can also be attributed to malnutrition. Particular signs of specific nutrient deficiencies must also be noticed.

Estimation of weight loss

A loss of 10 per cent of the usual body weight over a 6-month period or 5 per cent over a 1-month period are indicative of a compromised nutritional status. However, the sensitivity of correctly predicting actual weight loss and the predictive power are both less than 75 per cent. Weight and weight variations do not reflect nutritional status or nutritional support efficacy when edema or dehydration, whatever the cause, are or were present.

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