Nutritional history and exam

A: Anthropometric

• BMI often used
• BMI relatively cheap and easy to measure and reproducible
• Other parameters include: skin fold thickness around the arm and waistline measurement B: Biochemical
• Albumin used - can be complicated by a variety of factors incl. sepsis but is frequently measured to assess progress
• Should be considered only in the context of other nutritional markers
  • Other key biochemical indices include urea, haemoglobin and phosphate C: Clinical
• Overt signs of deficiencies are uncommon and usually late signs of significant diseases such as disseminated malignancy.
• However, should be part of initial assessment in pts requiring major surgery
• Clinical factors that may influence, or be influenced by nutritional status, i.e. high output stoma, dysphagia, impaired wound healing, should be considered D: Dietary Intake
• Full dietary assessment time consuming - Reserved for complex pts and specific disease states, e.g. Crohn’s, or prior to major surgery, e.g. oesophagectomy

Examination:

GENERAL INSPECTION:

1. well / under nourished
2. cachetic
3. poor wound healing
4. ulcers
5. NGT/TPN feeding a. What are they eating?

SPECIAL TEST for FAT loss:

1. FINGER-THUMB test
2. Rub triceps between finger and thumb
3. +ve if can feel dermis on dermis
4. suggests at least 10% fat loss

FACE:

1. Eyes a. Anaemia b. Jaundice
2. TEMPORALIS muscle wasting a. Protein loss

HANDS + NAILS:

1. Hand shake- strong?
2. Squeeze fingers
3. Hand muscle wasting (interosei)
4. Nails a. Beus lines – non pigmented transvers lines, suggest systemic illness b. Koilonychia – Fe def

SPECIAL TESTS for PROTEIN loss:

1. TENDON test: can you feel the biceps tendon
2. BONE test: has the skeleton emerged a. Eg: scapula spine

SPECIAL TESTS:

1. Calipers of measuring skin fold thickness
2. GRIP strength meter
3. PEFR- lumg function
4. Indirect CALORIMETRY
5. Peripheram oedema
6. Ascites