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1. CRITICAL DIET ASSESMENT
METHODS
DR.SYED ZIYAD FURQAN
MBBS.BSMS.MSPH

2. Introduction to Nutritional Assessment
• Nutritional status of a community is the sum of the
nutritional
status of the individuals who form the community
• The objective of nutritional assessment is to obtain precise
information on the prevalence and geographic distribution of
nutritional problems of a given community and identification
of
individuals at risk of developing nutritional problems
• The purpose of community nutritional assessments is to
develop
specific interventions to improve community`s nutritional
status

3. How to measure nutritional
status?
• Morbidity related to nutrition
related diseases or health
problems
• Examples:
– Rate of low birth-weight,
– Prevalence of anemia among
pregnant women
– Prevalence of obesity among
children

4. Methods of nutritional
assessment
• Direct Methods : Use individual
indices / measurements
1. Clinical Examination
2. Anthropometry
3. Biochemical evaluation
4. Functional assessment
5. Assessment of dietary intake
• Indirect Methods: Use
community indices /
measurements
1. Vital and health statistics
2. Ecological studies

5. Clinical Examination
• The objective is to detect relevant clinical signs which can
help in
establishing the nutritional diagnosis
• Such as general clinical examination, with special attention
to
organs like hair, angles of the mouth, gums, nails, skin,
eyes,
tongue, muscles, bones, & thyroid gland
• Detection of relevant signs helps in establishing the
nutritional
diagnosis. Examples: angular stomatitis, bitot`s spots,
absence of
knee jerks, enlargement of thyroid gland (endemic goiter)

6. Anthropometry
• Anthropometric measurements include physical
measurements.
Examples: height, weight, mid arm circumference, head
circumference, waist to hip ratio and skinfold thickness
• Reflect the patterns of growth, development and
nutritional status
over a period of time
• It is an usually an essential component of clinical
examination of
infants, children & pregnant women
• Limitations: The measured values reflect current
nutritional status &
don’t differentiate between acute & chronic changes or

7. Laboratory and biochemical assessment
• Laboratory and biochemical investigations are
used to estimate
serum levels of specific nutrients or to detect
biochemical
indicators specific to certain nutritional
deficiencies
• Examples: estimation of haemoglobin levels
and estimation of
serum vitamin D level
• Offer more precise assessment of nutritional
status and identify
malnutrition in pre-clinical stage
• Limitations: expensive and time consuming

8. Functional indicators
• Specific physiological functions can be used as static
indices of
nutritional status
• Play an important role in nutritional assessment as
they are wellestablished and familiar to practitioners
and public health workers
• Examples: Erythrocyte fragility, Prothrombin time
and nerve
conduction
• Limitation: Non-specific indicators, expensive and
time
consuming

9. Assessment of dietary intake
• Assessment of food consumption provides
opportunity to
understand dietary patterns, food
consumption, nutritional intake
• Direct assessment of food intake may
involve: Household inquiries
or individual food consumption surveys
• Helps in identify possible dietary deficiencies
or risk factors for
particular diseases related to specific dietary
pattern
• Limitations: time consuming, require specific

10. Vital statistics
• An Analysis of vital and health statistics – mortality and
morbidity
data can be used to identify population groups at high risk of
nutritional deficiencies and related health issues
• Data can be obtained from hospital records and community
morbidity or mortality surveys
• Examples: rate of low birth-weight babies, anemia and
proteinenergy malnutrition
• Limitations: May required well established HMIS, community
surveys may be very expensive and require specific skills/
expertise
– Mortality indicators are not appropriate to assess nutritional
status of the population

11. Assessment of Ecological Factors
• Use ecological data or information related to
socio-cultural
environment to make conclusions regarding
nutritional status of
the community
• Social environment includes: healthcare
system, educational status
feeding patterns , occupation, immunization
practices and endemic
disease patterns etc
• Limitations: require multilevel data, time
consuming and may
require specific skills

12. Challenges in nutritional
assessment
• Non-specificity of signs
• Overlapping of nutritional
deficiencies
• Bias of the observer
• Bias of observed
• Changing nutritional standards
or dietary guidelines

14. Angular stomatitis

15. Mid upper arm circumference

16. Skin fold

17. THANKS!
GOOD LUCK