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Nutrition Screening and Assessment Nutrition 526: 2010. Steps to Evaluating Pediatric Nutrition Problems. Screening Assessment Data collection Evaluation and interpretation Intervention Monitor reassessment. Nutrition Screening: Purpose.
To identify individuals who appear to have or be at risk for nutrition problems
To identify individuals who require further assessment or evaluation
Process of identifying characteristics known to be associated with nutrition problems
ASPEN, Nutri in Clin Practice 1996 (5):217-228
Simplest level of nutritional care (level 1)
Baer et al, J Am Diet Assoc 1997 (10) S2:107-115
Growth measures < than 5th %ile
Growth measures > than 90th %ile
Alterations in growth patterns
Change in Z-scores
Change 1-2 SD
Medical and developmental Conditions
Improper or inappropriate food/formula choices or preparation
Laboratory ValuesExamples of Screening risk factors
Uses information gathered in screening
Adds more in depth, comprehensive data
Develops care plan
Altered nutrition related laboratory values
Decreased nutrient needs
Inadequate protein-energy intake
Excessive oral intake
Increased energy expenditure
Increased nutrient needs
Involuntary weight loss
Limited adherence to nutrition related recommendations (vs food and nutrition related knowledge)
Food and medication interactionsExamples of Nutrition Diagnosis Options
Problem/Etiology/Signs and symptoms
“Must be clear and concise. 1 problem
Jayden, Barbara, Mark, Emma, Jake
Nutrient needs influenced by:
genetics, activity, body composition, medical conditions and medications
Individuals anthropometric date influenced by:
genetics, body composition, development, history
Identification of etiology
Weighing risk vs benefit
Incorrect or inaccurate information
Not evidence based
Feeding and developmental information
Psychosocial and environmental information
Clinical information and appearance (hair, skin, nails, eyes)
Who regulates Intake?
What do measurements mean?
Growth is a dynamic process defined as an increase in the physical size of the body as a whole or any of its parts associated with increase in cell number and/or cell size
Reflects changes in absolute size, mass, body composition
A normal, healthy child grows at a genetically predetermined rate that can be compromised by imbalanced nutrient intake
Progress in physical growth is one of the criteria used to assess the nutritional status of individuals
All have limitations for CSHCN, but can be additional information for individual child
Comparison with recommendations, guidelines, evidence
Link with additional information
Dietary Reference Intakes (DRI)(including RDA, UL, and AI) are the periodically revised recommendations (or guidelines) of the National Academy of Sciences
expands and replaces RDA’s
reference values that are quantitative estimates of nutrient intakes for planning and assessing diets for healthy people
AI: Adequate Intake
UL: Tolerable Upper Intake Level
EER: Estimated Energy RequirementComparison of individual intake data to a reference or estimate of nutrient needs
Correlate individual intake with growth
Conditions that may impact growth, nutritional status, feeding
Medications that may impact nutrient needs, absorbtion, utilization, or tolerance
Illness, treatments, proceedures
Delays in feeding skills
Output (urine and stool)
Laboratory tests can be specific and may detect deficiencies or excess prior to clinical symptomotology.
Useful for assess status, response to tx, tolerance
Validity effected by handling, lab method, technician accuracy, disease state, medical therapies
Complements other components of process
Linking information collected with:
Is there a problem?
Was there a problem?
Does information make sense?
What are goals and expectations?
What is etiology of the problem?
Identify contributing factors
Support feeding relationship
Consider psychosocial factors, family choice and input
Weigh risk v.s. benefit
Monitoring and reevaluation
Identify Problem or risk
Monitor and Reevaluate
Compare to references, standards, expectations